目的:儿童和成人早产儿患1型糖尿病的风险增加。然而,关于整个胎龄的风险模式的信息有限,特别是在极早产(妊娠23-27周)后。我们调查了1型糖尿病在儿童和年轻成年期的风险,在整个出生时的妊娠期。
方法:数据来自芬兰的国家登记册,挪威和瑞典。在每个国家,有关研究参与者和胎龄的信息是从医学出生登记册中收集的,关于1型糖尿病诊断的信息是从国家患者登记册收集的,和教育信息,移民和死亡是从各自的国家登记来源收集的。使用独特的个人身份代码链接个人级别的数据。研究人群包括1987年至2016年期间出生的所有活着的人,他们的出生国是各自的北欧国家。个体被跟踪直到诊断为1型糖尿病,死亡,移民或结束随访(2016年12月31日,芬兰,2017年12月31日在挪威和瑞典)。妊娠年龄被归类为极度早产(23-27周完成),非常早产(28-31周),中度早产(32-33周),晚期早产(34-36周),早期(37-38周),足月(39-41周;参考)和学期结束(42-45周)。使用共同效应逆方差模型,将来自国家特定协变量调整的Cox回归模型的HR和95%CIs组合在荟萃分析中。
结果:在5,501,276个人中,0.2%的人出生时极度早产,0.5%非常早产,0.7%中度早产,4.2%晚期早产,17.7%的早期,69.9%的完整期限,和6.7%的后任期。1型糖尿病诊断记录在12,326(0.8%),芬兰的6364人(0.5%)和16,856人(0.7%),中位年龄分别为8.2、13.0和10.5岁,挪威和瑞典,分别。与足月出生的同龄人相比,早产或早产的个体患1型糖尿病的风险增加(汇总,多重混淆调整后的HR1.12,95%CI1.07,1.18;和1.15,95%CI1.11,1.18)。然而,那些出生在极早产或极早产的人患1型糖尿病的风险降低(校正后HR分别为0.63,95%CI0.45,0.88;和0.78,95%CI0.67,0.92).这些协会在所有三个国家都是相似的。
结论:与足月出生的人相比,晚期早产和早期出生的人患1型糖尿病的风险增加,而极早产或极早产的人患1型糖尿病的风险降低。
OBJECTIVE: Children and adults born preterm have an increased risk of type 1 diabetes. However, there is limited information on risk patterns across the full range of gestational ages, especially after extremely preterm birth (23-27 weeks of gestation). We investigated the risk of type 1 diabetes in childhood and young adulthood across the full range of length of gestation at birth.
METHODS: Data were obtained from national registers in Finland, Norway and Sweden. In each country, information on
study participants and gestational age was collected from the Medical Birth Registers, information on type 1 diabetes diagnoses was collected from the National Patient Registers, and information on education, emigration and death was collected from the respective national register sources. Individual-level data were linked using unique personal identity codes. The
study population included all individuals born alive between 1987 and 2016 to mothers whose country of birth was the respective Nordic country. Individuals were followed until diagnosis of type 1 diabetes, death, emigration or end of follow-up (31 December 2016 in Finland, 31 December 2017 in Norway and Sweden). Gestational age was categorised as extremely preterm (23-27 completed weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), full term (39-41 weeks; reference) and post term (42-45 weeks). HRs and 95% CIs from country-specific covariate-adjusted Cox regression models were combined in a meta-analysis using a common-effect inverse-variance model.
RESULTS: Among 5,501,276 individuals, 0.2% were born extremely preterm, 0.5% very preterm, 0.7% moderately preterm, 4.2% late preterm, 17.7% early term, 69.9% full term, and 6.7% post term. A type 1 diabetes diagnosis was recorded in 12,326 (0.8%), 6364 (0.5%) and 16,856 (0.7%) individuals at a median age of 8.2, 13.0 and 10.5 years in Finland, Norway and Sweden, respectively. Individuals born late preterm or early term had an increased risk of type 1 diabetes compared with their full-term-born peers (pooled, multiple confounder-adjusted HR 1.12, 95% CI 1.07, 1.18; and 1.15, 95% CI 1.11, 1.18, respectively). However, those born extremely preterm or very preterm had a decreased risk of type 1 diabetes (adjusted HR 0.63, 95% CI 0.45, 0.88; and 0.78, 95% CI 0.67, 0.92, respectively). These associations were similar across all three countries.
CONCLUSIONS: Individuals born late preterm and early term have an increased risk of type 1 diabetes while individuals born extremely preterm or very preterm have a decreased risk of type 1 diabetes compared with those born full term.