Preterm birth ‘hidden’ risk factor for diabetes into adulthood
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Type 1 and type 2 diabetes are more likely to develop in individuals who were born preterm vs. those born at full term, according to findings published in Diabetologia.
“Because of improved treatment of preterm birth, over 95% of preterm infants now survive into adulthood. As a result, clinicians will increasingly encounter adult patients who were born prematurely and will need to understand their long-term health risks,” Casey Crump, MD, PhD, professor and vice chair for research in the department of family medicine and community health at the Icahn School of Medicine at Mount Sinai, told Healio. “Our findings suggest that preterm birth survivors have significantly elevated risks of both type 1 and type 2 diabetes in childhood and adulthood.”
Crump and colleagues used data from the Swedish Hospital and Outpatient Registries to assess the number of diabetes diagnoses among residents of Sweden born between 1973 and 2014. The researchers also used the Swedish Birth Registry to assess gestational age at birth, with those born before 39 weeks considered anywhere from extremely preterm (between 22 and 28 weeks) to early term (between 37 and 38 weeks) while those born between 39 and 41 weeks were considered to be born full term.
Risk assessments
According to the researchers, type 1 diabetes occurred in 0.7% of the cohort and type 2 diabetes in 0.1%. Individuals who were born preterm developed type 1 diabetes at a rate of 36.78 cases per 100,000 person-years and type 2 diabetes at a rate of 8.48 cases per 100,000 person-years. Individuals who were born at full term developed type 1 diabetes at a rate of 28.8 cases per 100,000 person-years and type 2 diabetes at a rate of 5.56 cases per 100,000 person-years.
The researchers wrote that there was an inverse association between type 1 and type 2 diabetes development in childhood and adulthood and gestational age. Individuals born preterm had a 21% greater risk for type 1 diabetes before age 18 years (HR = 1.21; 95% CI, 1.14-1.28) and a 24% greater risk for type 1 diabetes in adulthood (HR = 1.24; 95% CI, 1.13-1.37) compared with individuals born at full term. Additionally, individuals born preterm had a 26% greater risk for type 2 diabetes before age 18 years (HR = 1.26; 95% CI, 1.01-1.58) and 49% greater risk for type 2 diabetes in adulthood (HR = 1.49; 95% CI, 1.31-1.68) compared with individuals born at full term.
The researchers also found that women born preterm developed type 2 diabetes at a rate of 9.66 cases per 100,000 person-years while men born preterm developed type 2 diabetes at a rate of 7.52 cases per 100,000 person-years.
“The positive additive interaction indicates that preterm birth accounted for significantly more type 2 diabetes cases among females than males,” the researchers wrote.
In addition, the researchers did not find a major effect on diabetes development among siblings.
“An analysis of siblings suggested that these findings were only partially explained by shared genetic or environmental factors in families, as opposed to direct effects of preterm birth,” Crump said. “Specifically, the association between preterm birth and type 2 diabetes in adulthood appeared independent of shared familial factors. Instead, preterm birth and its treatment may have direct effects on later development of diabetes.”
Clinical implications
Crump said these results should influence how physicians assess diabetes risk at all ages.
“Clinicians should now recognize preterm birth as a chronic condition that predisposes to the development of diabetes across the life course. Physicians currently seldom seek birth histories from adult patients, and thus preterm birth may remain a ‘hidden’ risk factor,” Crump said. “Medical records and history-taking in patients of all ages should routinely include birth history, including gestational age, birth weight and perinatal complications. Such information can help identify those born prematurely and facilitate anticipatory screening and early preventive actions, including patient counseling to promote aggressive lifestyle prevention of diabetes.” – by Phil Neuffer
For more information:
Casey Crump, MD, PhD, can be reached at Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029; email: casey.crump@mssm.edu.
Disclosures: The authors report no relevant financial disclosures.
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Crump C, et al. Diabetologia. 2019;doi:10.1007/s00125-019-05044-z.
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