Preterm birth is strongly associated with high plasma insulin levels at birth and during early childhood, with the level of hyperinsulinemia rising as prematurity increases, according to a study of a subset of children enrolled in the prospective Boston Birth Cohort.
The study is the first "to investigate the association between preterm birth and random plasma insulin levels at birth and in early childhood in a large, prospective, U.S. birth cohort ... [and it] fills a gap in the knowledge base regarding insulin levels during early developmental periods in children born preterm," according to Dr. Guoying Wang of the department of population, family, and reproductive health at Johns Hopkins University, Baltimore, and her associates.
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Preterm birth is strongly associated with high plasma insulin levels at birth and during early childhood, with the level of hyperinsulinemia rising as prematurity increases, according to the study.
In the subset of 1,358 infants, gestational age was inversely associated with insulin levels in a dose-response fashion, regardless of birth weight. Cord-blood insulin levels at birth were 1.13-fold higher in 343 early-term neonates, compared with 597 neonates born full-term, and also were 1.45-fold higher in 256 late-preterm neonates and 2.05-fold higher in 162 early-preterm neonates. Similarly, plasma insulin levels in early childhood followed the same pattern in comparison with full-term neonates: They were 1.12-fold higher in children who had been born at early term, 1.19-fold higher in those who had been born late-preterm, and 1.31-fold higher in those who had been born early-preterm, the investigators reported Feb. 11 in JAMA.
These findings confirm and extend those of previous studies reporting a relationship between preterm birth and altered insulin homeostasis manifested by increased insulin resistance throughout childhood and into middle age. They suggest that insulin resistance exhibited by adolescents and adults who had been born preterm may have originated in utero, and that preterm birth may be a risk factor for the future development of type 2 diabetes, the investigators said (JAMA 2014;311:587-96).
In an editorial accompanying this report, Mark Hanson, D.Phil., of the National Institute for Health Research’s Nutrition Biomedical Research Centre at the University of Southampton (England), agreed that these findings strengthen the argument for a trajectory of diabetes risk that commences very early in life. The results "reveal just how early the first steps toward prevention of diabetes may be possible and raise the prospect that ... early-life interventions" could help reduce diabetes risk in adulthood, he said (JAMA 2014;311:575-6).
The Boston Birth Cohort is supported by grants from the March of Dimes, the Food Allergy Initiative, and the National Institutes of Health. Dr. Wang reported no financial conflicts of interest; one associate reported ties to Novo Nordisk. Dr. Hanson reported ties to Nestec, Danone, and other companies.