Preterm birth inversely associated with elevated insulin levels during early childhood

Preterm infants are more likely to have elevated insulin levels at birth and in early childhood compared with full-term infants, according to recent study results.

“We found that plasma insulin levels at birth were inversely associated with gestational age in a dose-response fashion, even after adjustment for birth weight for gestational age and other measured prenatal and perinatal variables,” the researchers wrote in JAMA. “This association was also observed in early childhood.”

Xiaobin Wang, MD, MPH, ScD, of the Center on the Early Life Origins of Disease, at Johns Hopkins University Bloomberg School of Public Health, and colleagues enrolled at birth 1,358 infants (418 preterm births; 940 term births) born between 1998 and 2010 and followed them until 2005 to 2012 to determine if preterm birth is associated with elevated insulin levels at birth and if it continues into childhood.

Early-preterm patients had geometric mean of insulin levels of 18.9 mcIU/mL (95% CI, 16.6-21.4) at birth compared with 9.2 mcIU/mL (95% CI, 8.4-10.0) for full-term patients. Levels for early-preterm infants were 14.6 mcIU/mL (95% CI, 12.6-16.9) in early childhood compared with 11.2 mcIU/mL (95% CI, 10.3-12.0) for full-term infants.

Cord blood insulin levels were 2.05-fold (95% CI, 1.69-2.42) higher for early-preterm patients than full-term patients, and early-preterm patients had plasma insulin levels 1.31-fold (95% CI, 1.10-1.52) higher than full-term patients.

“In this prospective, predominately urban minority birth cohort, plasma insulin levels were inversely associated with gestational age at birth and in early childhood,” the researchers wrote. “The implication for early prevention of insulin resistance and type 2 diabetes warrant further investigation.”

In an accompanying editorial, Mark Hanson, DPhil, FRCOG, of the University of Southampton and University Hospital Southampton, United Kingdom, wrote that the study findings “confirm the importance of the developmental origins of health and disease concept to such populations and raise questions about the relative effect size longer term.”

“However, such populations should not be viewed as special cases; they show a continuum on noncommunicable disease risk that is initiated by a range of environmental influences operating across the normal range of early development,” he wrote.

For more information:

Wang G. JAMA. 2014;doi:10.1001/jama.2014.1.

Hanson M. JAMA. 2014;doi:10.1001/jama.2014.2.

Disclosure: See the study for a full list of disclosures.