medwireNews: People born prematurely may need to be assessed for type 1 and type 2 diabetes early and monitored in the long term, say researchers after finding these individuals may be at increased risk from childhood into adulthood.
The findings from a study of more than 4 million Swedes born between 1973 and 2014 revealed preterm birth before 37 weeks’ gestation was associated with a 21% increased likelihood of type 1 diabetes and a 26% increased likelihood of type 2 diabetes before the age of 18 years compared with full-term birth (39–41 weeks).
In adulthood, when the participants were aged 18 to 43 years, the likelihood of type 1 diabetes associated with preterm birth had increased to 24%, while that of type 2 diabetes had increased to 49%.
The association for type 2 but not type 1 diabetes was significantly stronger in women than men. For example, preterm birth was associated with a 75% increased likelihood of type 2 diabetes in women aged 18 to 43 years versus a 28% increased risk for men of the same age.
Diabetes was detected from nationwide diagnoses and pharmacy data until the end of 2015, when participants were a median age of 22.5 years.
During 92.3 million person–years of follow-up, 0.7% of the 4,193,069 participants developed type 1 diabetes and 0.1% type 2 diabetes, with a median age at diagnosis of 14.9 and 29.2 years, respectively.
Gestational age at birth was inversely associated with the likelihood of developing diabetes before 18 years of age, with each additional week of gestation associated with a 4% decreased likelihood of type 1 diabetes and a 5% decreased likelihood of type 2 diabetes.
The same was true for the 18–43-year age group, with each additional week of gestation reducing the likelihood of new-onset type 1 diabetes by 4% and type 2 diabetes by 3%.
Preterm babies were more likely than full-term babies to be male or first born and their mothers were more likely than those of babies born at full term to be either younger than 20 years or 40 years or older, have low education levels, smoke, or have diabetes, pre-eclampsia, or other hypertensive disorders during pregnancy.
Co-sibling analyses revealed that the results were only partly explained by shared genetic or environmental factors in families.
Reporting in Diabetologia, Casey Crump (Icahn School of Medicine at Mount Sinai, New York, USA) and co-workers conclude: “Children and adults who were born prematurely may need early preventive evaluation and long- term follow-up for timely detection and treatment of diabetes.”
By Anita Chakraverty
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Diabetologia 2019; doi:10.1007/s00125-019-05044-z