MON-247 Growth Trajectories from Childhood to Adolescence in a Cohort of Children Born to Women with Obesity Alone Differ from Children Born to Women with Obesity and Gestational Diabetes

Abstract Disclosure: M.M. Barr: None. P. Li: None. P.C. Chandler-Laney: None. Background: Children born to women with obesity or gestational diabetes mellitus (GDM) are at risk for obesity and cardiometabolic disease, but because most women with GDM also have obesity, it is difficult to disentangle the effects of each. The primary objective of this study is to describe the growth trend of children born to women with normal weight (NW) without GDM, overweight/obesity (OW/OB) without GDM, or OW/OB with GDM, during the 5 years following a baseline assessment in the Health After Pregnancy (HAPi) study (2017-2019, child age 4-10 years). Methods: A retrospective chart review of electronic health records (EHR) was conducted of child participants from the HAPi study. Body weight, height, and BMI Z-scores were retrieved from clinic or emergency room visits that occurred in the Children’s of Alabama or University of Alabama at Birmingham EHR between 1/1/2020 and 10/31/2024. Data was stratified by age range (4-6, 6-9, 9-11, 11-13, and 13-17 years). Using SAS software, a curvilinear mixed effects regression model was used to evaluate group differences in children’s BMI Z-scores over time, accounting for non-linear trend of BMI Z-scores over time. Results: Of the original 219 children enrolled in the HAPi Study, 132 had clinical visits in the EHR with weights at least 28 days apart during the 5 years following the HAPi study (child age 4.5 to 17 years). There was no significant difference in the proportion of participants from each group with EHR data: NW without GDM (Group 1, N=48), OW/OB without GDM (Group 2, N=45), and OW/OB with GDM (Group 3, N=39). Each child had between one and eighteen weight measurements. Children Groups 2 and 3 had significantly higher BMI Z-scores compared to group 1 (control group) from ages 9 to 13 years. Of interest, Group 2 children mean BMI Z-scores decreased as they aged and were not significantly different from Group 1 by ages 13 to 17 years. This was distinctly different from steady upward BMI Z-scores with increasing age in Group 3. These trends held when controlled for maternal BMI (both during pregnancy and at time of HAPi study), child BMI Z-score during the HAPi study, household income, household number of children, maternal education attainment, childhood insulin resistance (measured during the HAPi Study), and length of breastfeeding during infancy. Conclusion: Greater adiposity in the 9 to 13-year-old children born to women with OW/OB or GDM (Groups 2 and 3), compared to those born to women with NW (Group 1), is consistent with data from the parent study. Although not statistically significant until older ages, the trend showing divergence of the growth trajectory for children in Group 2 versus Group 3 suggests that pediatric obesity is less likely to persist through adolescence for those born to glucose tolerant women with OW/OB, and more likely to persist for those born to women with GDM. Presentation: Monday, July 14, 2025