Perinatal Risk Factors for Diabetes in Later Life

Abstract

Objective: Low birth weight is consistently associated with an increased risk of non-insulin dependent diabetes mellitus in adulthood, but the individual contributions from poor fetal growth and preterm birth are not known.

Research design and methods: We identified a cohort of all subjects born preterm or with low birth weight at term at four major delivery units in Sweden from 1925 through 1949. A comparison cohort of subjects was identified within the same source population. Of 6,425 subjects in all, 2,931 were born before 37 weeks of gestation, and 2,176 had a birth weight less than 2,500 grams. Disease occurrence among participants was assessed through nationwide hospital registers from 1987 through 2006.

Results: During follow-up, there were 508 cases of diabetes. Birth weight was strongly negatively associated with risk of diabetes (p for trend <0.0001). Both short gestational duration and poor fetal growth were associated with later diabetes (p for trend < 0.0001 and 0.0004, respectively). Very preterm birth (≤32 weeks of gestation at birth) was associated with a hazard ratio (HR) of 1.67 (95% confidence interval, 1.33 to 2.11), compared with term birth. A birth weight below 2 standard deviations for gestational age was associated with a HR of 1.76 (95% CI, 1.30 to 2.38), compared with a birth weight between mean and one standard deviation above the mean.

Conclusions: Our results suggest that the association between low birth weight and diabetes is due to factors associated with both poor fetal growth and short gestational age.