In the world of neonatology, it’s a well-accepted fact that diabetic mothers are at a higher risk for premature labor. But can a premature birth foster the development of diabetes in preterm children?
A new study published in the February 12th edition of the Journal of the American Medical Association reports that premature children test for higher levels of insulin than many of their full-term peers.
As of yet, researchers have not found a direct correlation between premature birth and type 1, juvenile onset diabetes, though other studies have linked prematurity with a greater tendency to develop type 2, or adult onset diabetes, after the age of 35. With 25.8 million people- about 8.3% of the population- suffering from some form of the disease, many medical disciplines are racing to discover all possible catalysts. Dr. Guoying Wang, director of the Center on the Early Life Origins of Disease at Johns Hopkins University Bloomberg School of Public Health, in Baltimore, pursued a study in response to the growing trend of premature birth, especially among obese mothers or minorities where diabetes is also prevalent.
Dr. Wang’s research followed 1,358 babies born between 1998 and 2010, tracking each child’s insulin levels from their birth until early childhood. The data shows that the body’s inability to properly regulate insulin starts in utero, providing powerful evidence that premature birth may be a risk factor for type 2 diabetes. Furthermore, Wang found the more extreme cases of prematurity had the highest insulin levels. She calls this linkage the “missing piece,” the medical community needs to prevent diabetes before it appears. By identifying babies at risk for insulin resistance right from birth, both their parents and their pediatricians will have a better chance of detecting early warning signs of the disease, and can delay or even inhibit the onset of diabetes with proper weight management, exercise, and a healthy diet throughout childhood and their adult years.
Based on her study’s results, Dr. Wang has called for a more personalized approach to preemie treatment. “Preterm babies should be given optimal nutrition, but their growth trajectory should be carefully monitored,” she stated, stressing the importance of customizing each child’s caloric intake and milk or formula supplementation to their specific treatment needs. Unfortunately, with one out of every nine U.S. babies born premature, many NICUs are too overwhelmed with patients to provide such precisely targeted feeds. While preterm babies need a higher amount of calories to catch up to their full-term peers, caretakers should provide a more “normal” diet once they reach a safer weight, preventing excess weight gain and lowering the risk of insulin resistance. Achieving this delicate balance between “too much” and “not enough” can be challenging for a traditional NICU, prompting many to turn to more innovative, efficient methods of growth tracking and milk delivery to curb future problems. If future studies confirm Wang’s data, NICUs that implement new technologies such as automated milk tracking systems and targeted fortification may see a significant increase in long-term patient health.
Other resources on diabetes, preterm birth and NICU milk tracking: