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Published on: November 20, 2015
Preterm birth and random plasma insulin levels at birth and in early childhood
Guoying Wang1, Sara Divall2, Sally Radovick2
1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Preterm birth is linked to higher insulin levels at birth and in early childhood, suggesting potential long-term metabolic health risks. This association between lower gestational age and elevated insulin warrants further investigation for implications in insulin resistance and type 2 diabetes development.
Area of Science:
- Endocrinology
- Neonatal Health
- Metabolic Disorders
Background:
- Previous research indicates a link between preterm birth and insulin resistance in later life.
- However, whether altered insulin homeostasis is detectable at birth and persists through childhood remains unclear.
Purpose of the Study:
- To determine if preterm birth is associated with elevated plasma insulin levels at birth.
- To investigate if this association persists into early childhood.
Main Methods:
- A prospective birth cohort study included 1358 children.
- Plasma insulin levels were measured at birth (cord blood) and in early childhood (median age 1.4 years).
- Participants were categorized into four gestational age groups: full term (≥39 wk), early term (37-38 wk), late preterm (34-36 wk), and early preterm (<34 wk).
Main Results:
- Higher insulin levels were observed at birth and in early childhood with decreasing gestational age.
- Specifically, early preterm infants (<34 wk) had significantly higher insulin levels at birth (2.05-fold) and in early childhood (1.31-fold) compared to full-term infants.
- The association was attenuated after adjusting for postnatal weight gain and was not significant after adjusting for birth insulin levels. Infants in the top insulin tertile at birth were more likely to remain in the top tertile in childhood.
Conclusions:
- An inverse association exists between gestational age and elevated plasma insulin levels at birth and in early childhood.
- These findings suggest that preterm birth may be a risk factor for altered insulin homeostasis from birth.
- Further research is needed to explore the implications for future insulin resistance and type 2 diabetes development.
Importance:
Although previous reports have linked preterm birth with insulin resistance in children and adults, it is not known whether altered insulin homeostasis is detectable at birth and tracks from birth through childhood.
Objective:
To investigate whether preterm birth is associated with elevated plasma insulin levels at birth and whether this association persists into early childhood.
Design, Setting, And Participants:
A prospective birth cohort of 1358 children recruited at birth from 1998 to 2010 and followed-up with prospectively from 2005 to 2012 at the Boston Medical Center in Massachusetts.
Main Outcomes And Measures:
Random plasma insulin levels were measured at 2 time points: at birth (cord blood) and in early childhood (venous blood). The median age was 1.4 years (interquartile range [IQR], 0.8-3.3) among 4 gestational age groups: full term (≥39 wk), early term (37-38 wk), late preterm (34-36 wk), and early preterm (<34 wk).
Results:
The geometric mean of insulin levels at birth were 9.2 µIU/mL (95% CI, 8.4-10.0) for full term; 10.3 µIU/mL (95% CI, 9.3-11.5) for early term; 13.2 µIU/mL (95% CI, 11.8-14.8) for late preterm; and 18.9 µIU/mL (95% CI, 16.6-21.4) for early preterm. In early childhood, these levels were 11.2 µIU/mL (95% CI, 10.3-12.0) for full term; 12.4 µIU/mL (95% CI, 11.3-13.6) for early term; 13.3 µIU/mL (95% CI, 11.9-14.8) for late preterm; and 14.6 µIU/mL (95% CI, 12.6-16.9) for early preterm. Insulin levels at birth were higher by 1.13-fold (95% CI, 0.97-1.28) for early term, 1.45-fold (95% CI, 1.25-1.65) for late preterm, and 2.05-fold (95% CI, 1.69-2.42) for early preterm than for those born full term. In early childhood, random plasma insulin levels were 1.12-fold (95% CI, 0.99-1.25) higher for early term, 1.19-fold (95% CI, 1.02-1.35) for late preterm, and 1.31-fold (95% CI, 1.10-1.52) for early preterm than those born full term. The association was attenuated after adjustment for postnatal weight gain and was not significant after adjustment for insulin levels at birth. Infants ranked in the top insulin tertile at birth were more likely to remain in the top tertile (41.2%) compared with children ranked in the lowest tertile (28.6%) in early childhood.
Conclusions And Relevance:
There was an inverse association between gestational age and elevated plasma insulin levels at birth and in early childhood. The implications for future development of insulin resistance and type 2 diabetes warrant further investigation.
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