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Prematurity Linked with Elevated Insulin Levels

March 10, 2014

Prematurity Linked with Elevated Insulin Levels

  1. Robin Steinhorn, MD

Premature infants exhibit long-lasting elevations of plasma insulin levels.

  1. Robin Steinhorn, MD

Growing evidence indicates that fetal and early life events lay the foundation for metabolic health or disease later in life. During the last decade, a link has been established between preterm birth and development of insulin resistance and type 2 diabetes in childhood and adulthood. However, whether alterations in insulin homeostasis are detectable at birth is not known.

Researchers prospectively evaluated plasma insulin levels from birth and to age 6.5 years in 1358 singleton children without major birth defects from an urban minority population (the Boston Birth Cohort). Each child had at least two insulin levels obtained (a cord blood sample at birth and a subsequent sample between ages 6 months and 6.5 years). About 30% of the population was born prematurely (<36 weeks).

Cord blood insulin levels were strongly and inversely associated with gestational age, independent of birth weight for gestational age (P<0.001 for linear trend). Compared with cord blood insulin levels in full-term infants, insulin levels were 1.13-fold higher in early term infants (37–38 weeks' gestation), 1.45-fold in late preterm infants (34–36 weeks), and 2.05-fold in early preterm infants (<34 weeks). Adjustment for covariables (including maternal race, cigarette smoking, parity, birth weight for gestational age, maternal diabetes, and leptin levels at birth) did not alter the association. In addition, cord blood insulin levels at birth were significant predictors of insulin levels in early childhood.

Comment

This population of predominantly urban and minority children had a high incidence of prematurity accompanied by long-lasting, gestational age-dependent elevations in plasma insulin levels. The findings suggest that preterm birth is an independent risk factor for later development of insulin resistance and could pave the way for identifying vulnerable populations that could benefit from preventive strategies.

Dr. Steinhorn is Professor and Chair of Pediatrics, University of California Davis Medical Center, Sacramento.

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Reader Comments (1)

walter mcphee

ideal wt is important

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