Premature birth linked to increased diabetes risk later in life, finds study

Preterm birth may be a risk factor for the development of diabetes later in life.

USA: Children who are born prematurely are at a higher risk of developing type 1 and type 2 diabetes from childhood into early to mid-adulthood, a recent study published in the journal Diabetologia has found. The associations between preterm birth and type 2 diabetes (not type 1 diabetes) were significantly stronger among females.

Based on the results, the authors recommend that children and adults born prematurely may require early preventive evaluation and long-term follow-up for timely detection and treatment of diabetes. Apart from family history and unhealthy lifestyle factors, early life exposures have been identified as potential risk factors for diabetes development later in life.

The largest earlier studies of preterm birth and diabetes have focused on childhood (age <15 years) and demonstrated an increased risk of type 1 diabetes in preterm-born children. A fewer smaller studies have also reported associations with type 2 diabetes in mid-adulthood. However, no large cohort studies have examined the risks of type 1 and type 2 diabetes and potential sex-specific differences from childhood into adulthood.

To address these knowledge gaps, Casey Crump, Icahn School of Medicine at Mount Sinai, New York, USA, and colleagues conducted this national cohort study of over 4 million people in Sweden to examine associations between gestational age at birth and risk of type 1 or type 2 diabetes up to age 43 years, the maximum follow-up currently possible in this large cohort, to assess whether these associations differ according to sex or fetal growth, and to explore for potential confounding by shared familial (genetic and/or environmental) factors using co-sibling analyses.

The study was conducted on 4,193,069 singletons born in Sweden during 1973–2014. They 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).

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Commenting on the possible mechanism of action behind their findings, the authors explained, "preterm birth has been shown to interrupt the development of pancreatic beta cells, which are formed predominantly during the third trimester. In addition, preterm birth also alters immune functioning including T cell response," they wrote.