Optimizing Feeding Practices Improves Outcomes During Early Childhood in Former Small for Gestational Age (SGA) Infants

Background: Infants born small for gestational age (SGA) are at increased risk of altered postnatal growth and early metabolic vulnerability. Early feeding practices may modulate these outcomes, but evidence from Eastern Europe remains limited. Objective: To evaluate the influence of birth weight and early nutrition on anthropometric outcomes at 2–3 years of age in former SGA infants in Romania, and to examine associations with allergies, respiratory infections, and food intolerances. Methods: We conducted a retrospective comparative study including two cohorts of term SGA infants born in a Romanian tertiary hospital in 2010–2011 (n = 600) and 2020–2021 (n = 508). Perinatal data were extracted from medical records; anthropometrics and feeding practices at 2–3 years were obtained via parental telephone interviews. BMI z-scores were calculated using WHO standards. Logistic regression models were used to identify predictors of overweight/obesity and selected health outcomes. Results: Breastfeeding increased markedly over one decade (59.1% vs. 35.5%, p < 0.001), as did appropriate complementary feeding (74.2% vs. 66.3%, p = 0.005). Obesity prevalence decreased from 29.5% to 22.4% at 2 years and from 32.7% to 20.7% at 3 years (both p < 0.001), while overweight prevalence increased slightly. In the historical cohort, mixed feeding (vs. formula) predicted overweight/obesity at 2 years (aOR 2.55, 95% CI 1.52–4.43, p < 0.001); the association was directionally similar but not significant in the contemporary cohort (aOR 1.62, 95% CI 0.75–3.47, p = 0.215). Breastfeeding was protective in both cohorts. Appropriate complementary feeding was associated with lower allergy prevalence in the historical cohort (14.8% vs. 24.8%, p = 0.004). Food intolerances increased over time (16.3% to 27.6%, p < 0.001), while respiratory infections showed no significant differences. Conclusions: In this Romanian SGA population, early feeding practices improved substantially over one decade and were associated with more favorable weight outcomes, including a notable reduction in obesity. Mixed feeding emerged as a potential risk factor for early overweight, whereas breastfeeding remained protective. Despite these improvements, former SGA infants continue to exhibit elevated risk for early-onset overweight and obesity, underscoring the need for targeted nutritional counseling and longitudinal monitoring.