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Preterm birth and risk of type 1 and type 2 diabetes: a national cohort study
Casey Crump1,2, Jan Sundquist3,4,5, Kristina Sundquist6,7,8
1Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA. casey.crump@mssm.edu.
Insights
Preterm birth increases the risk of developing type 1 and type 2 diabetes throughout life. This risk is present from childhood into adulthood, with stronger associations for type 2 diabetes in females.
Area of Science:
- Endocrinology and Metabolism
- Perinatal Medicine
- Public Health
Background:
- Preterm birth (gestational age <37 weeks) is linked to early-life insulin resistance.
- Limited large-scale studies have explored long-term diabetes risks following preterm birth, including sex-specific differences.
- Understanding these risks is crucial for clinicians managing a growing population of preterm-born adults.
Purpose of the Study:
- To investigate the association between preterm birth and the risk of type 1 and type 2 diabetes from childhood into adulthood.
- To examine potential sex-specific differences in these diabetes risks.
- To assess the influence of shared familial factors on these associations.
Main Methods:
- A national cohort study of over 4.1 million singletons born in Sweden (1973-2014).
- Follow-up for type 1 and type 2 diabetes diagnoses and pharmacy data until the end of 2015.
- Cox regression analysis adjusted for confounders and co-sibling analyses for familial factors.
Main Results:
- Preterm birth was inversely associated with the risk of both type 1 and type 2 diabetes.
- Adjusted hazard ratios for preterm birth were elevated for type 1 diabetes (1.21 <18 yrs, 1.24 18-43 yrs) and type 2 diabetes (1.26 <18 yrs, 1.49 18-43 yrs).
- Associations with type 2 diabetes were significantly stronger in females than males, and familial factors only partially explained the risks.
Conclusions:
- Preterm birth is associated with an increased risk of type 1 and type 2 diabetes extending into early and mid-adulthood.
- The findings highlight the need for early preventive evaluation and long-term diabetes monitoring in preterm-born individuals.
- Sex-specific differences, particularly for type 2 diabetes, warrant further investigation and tailored clinical approaches.
Aims/Hypothesis:
Preterm birth (gestational age <37 weeks) has been associated with insulin resistance early in life. However, no large population-based studies have examined risks of type 1 and type 2 diabetes and potential sex-specific differences from childhood into adulthood. Clinicians will increasingly encounter adults who were born prematurely and will need to understand their long-term risks. We hypothesised that preterm birth is associated with increased risks of type 1 and type 2 diabetes into adulthood.
Methods:
A national cohort study was conducted of all 4,193,069 singletons born in Sweden during 1973-2014, who were followed up for type 1 and type 2 diabetes identified from nationwide diagnoses and pharmacy data to the end of 2015 (maximum age 43 years; median age at the end of follow-up 22.5 years). Cox regression was used to adjust for potential confounders, and co-sibling analyses assessed the influence of shared familial (genetic and/or environmental) factors.
Results:
In 92.3 million person-years of follow-up, 27,512 (0.7%) and 5525 (0.1%) people were identified with type 1 and type 2 diabetes, respectively. Gestational age at birth was inversely associated with both type 1 and type 2 diabetes risk. Adjusted HRs for type 1 and type 2 diabetes at age <18 years associated with preterm birth were 1.21 (95% CI, 1.14, 1.28) and 1.26 (95% CI, 1.01, 1.58), respectively, and at age 18-43 years were 1.24 (95% CI, 1.13, 1.37) and 1.49 (95% CI, 1.31, 1.68), respectively, compared with full-term birth. The associations between preterm birth and type 2 (but not type 1) diabetes were stronger among females (e.g. at age 18-43 years, females: adjusted HR, 1.75; 95% CI, 1.47, 2.09; males: 1.28; 95% CI, 1.08, 1.53; p < 0.01 for additive and multiplicative interaction). These associations were only partially explained by shared genetic or environmental factors in families.
Conclusions/Interpretation:
In this large national cohort, preterm birth was associated with increased risk of type 1 and type 2 diabetes from childhood into early to mid-adulthood. Preterm-born children and adults may need early preventive evaluation and long-term monitoring for diabetes.
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