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Risk of diabetes among young adults born preterm in Sweden
Casey Crump1, Marilyn A Winkleby, Kristina Sundquist
1Department of Medicine, Stanford University, Palo Alto, California, USA. kccrump@stanford.edu
Insights
Preterm birth, including late preterm birth, is linked to a slightly higher risk of needing diabetes medication in young adulthood. This association highlights public health concerns due to rising preterm births and diabetes prevalence.
Area of Science:
- Public Health
- Endocrinology
- Perinatal Medicine
Background:
- Previous research suggests a link between preterm birth and later-life diabetes, but results for late preterm births are inconsistent.
- Existing studies often have limitations, such as excluding outpatient data or failing to assess risk across all gestational ages.
Purpose of the Study:
- To investigate the association between preterm birth and subsequent diabetes medication prescription in a large national cohort of young adults.
- To specifically examine the risk associated with late preterm birth (gestational age 35-36 weeks).
Main Methods:
- A national cohort study included 630,090 infants born in Sweden between 1973-1979.
- Follow-up for diabetes medication prescription occurred from 2005-2009, covering ages 25.5-37.0 years.
- Comprehensive medication data were sourced from all Swedish outpatient and inpatient pharmacies.
Main Results:
- Individuals born preterm had modestly increased odds of receiving diabetes medication compared to those born full term (adjusted OR 1.13).
- This increased risk was also observed for late preterm births (gestational age 35-36 weeks).
- Specific medication use showed 1.5% of preterm births received insulin and/or oral diabetes medications versus 1.2% of full-term births.
Conclusions:
- Preterm birth, encompassing late preterm birth, is associated with a modestly elevated risk of developing diabetes in young Swedish adults.
- These findings are significant given the rising rates of preterm birth and the substantial burden of diabetes, especially when diagnosed early in life.
- The study underscores the importance of long-term health monitoring for individuals born preterm.
Objective:
Previous studies have suggested that preterm birth is associated with diabetes later in life. These studies have shown inconsistent results for late preterm births and have had various limitations, including the inability to evaluate diabetic outpatients or to estimate risk across the full range of gestational ages. Our objective was to determine whether preterm birth is associated with diabetes medication prescription in a national cohort of young adults.
Research Design And Methods:
This was a national cohort study of 630,090 infants born in Sweden from 1973 through 1979 (including 27,953 born preterm, gestational age <37 weeks), followed for diabetes medication prescription in 2005-2009 (ages 25.5-37.0 years). Medication data were obtained from all outpatient and inpatient pharmacies throughout Sweden.
Results:
Individuals born preterm, including those born late preterm (gestational age 35-36 weeks), had modestly increased odds ratios (ORs) for diabetes medication prescription relative to those born full term, after adjusting for fetal growth and other potential confounders. Insulin and/or oral diabetes medications were prescribed to 1.5% of individuals born preterm compared with 1.2% of those born full term (adjusted OR 1.13 [95% CI 1.02-1.26]). Insulin without oral diabetes medications was prescribed to 1.0% of individuals born preterm compared with 0.8% of those born full term (1.22 [1.08-1.39]).
Conclusions:
Preterm birth, including late preterm birth, is associated with a modestly increased risk of diabetes in young Swedish adults. These findings have important public health implications given the increasing number of preterm births and the large disease burden of diabetes, particularly when diagnosed in young adulthood.
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