Type 1 Diabetes Mellitus is associated with Prematurity

Adi Adar ¹ Shlomit Shalitin ^2,3 Ori Eyal ^3,4 Neta Leventhal ⁵ Orit Pinhas-Hamiel ^3,6,7 Milana Levy ⁸ Orna Dally-Gottfried ⁹ Zohar Landau ^3,7,10 Amnon Zung ^11,12 Floris Levy-Khademi ^12,13 David Zangen ^12,14 Yardena Tenenbaum-Rakover ¹⁵ Marianna Rachmiel ^1,3

¹Pediatric Endocrinology Unit, Division of Pediatrics, Assaf Harofeh Medical Center,, Pediatric Endocrinology Unit,
²Schneider Children's Medical Center of Israel, Petah Tikva, Israel, The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center of Childhood Diabetes,
³Tel Aviv University, Sackler School of Medicine,
⁴Dana-Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Pediatric Endocrinology and Diabetes Unit,
⁵Soroka University Medical Center,, Pediatric Endocrinology and Metabolic Unit,
⁶Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer,, Pediatric Endocrinology and Diabetes Unit,
⁷Maccabi Health Care services,, The Juvenile Diabetes Center,
⁸Ruth Rappaport Children`s Hospital, Rambam Health Care Campus,, Pediatric diabetes and Obesity Clinic,
⁹Rebecca Seiff Hospital, Zefat, Israel, The center for Juvenile Diabetes and Pediatric Endocrinology and Pediatric Outpatient Clinics,
¹⁰E. Wolfson Medical Center,, Pediatric Endocrinology and Diabetes Unit,
¹¹Kaplan Medical Center,, Pediatric Endocrinology Unit,
¹²Hebrew University of Jerusalem,, The School of Medicine ,Hebrew University of Jerusalem,
¹³Shaare Zedek Medical Center, Division of Pediatric Endocrinology,
¹⁴Hadassah Hebrew University Medical Center,, Division of Pediatric Endocrinology,
¹⁵Ha'Emek Medical Center and the Rappaport Faculty of Medicine, Technion,, Pediatric Endocrine Unit,

Introduction: The incidence of type 1 diabetes mellitus (T1D) is increasing in the last decades. . Given the modern increase in premature birth and survival we aimed to assess the prevalence of premature birth, among T1D patients in Israel compared to premature birth in the general population.

Methods: This is a multi-center cross sectional population based study, including most registered patients with T1D born between 1990-2013 in Israel. Data included: gestational age, season at birth, age and season at T1D diagnosis and the presence of autoimmune illnesses in the family. The prevalence of prematurity (birth before 37 weeks) among T1DM was compared to the Israeli general population registered data. .

Results: Stud population included 2728 T1D patients, mean age 15.4 ± 5.0 years, 51% males. The prevalence of premature births was 9.0% compared to 7.6% in the general population (p=0.047). The prevalence of early prematurity(prior to 34 weeks) did not differ ( 2.4%, compared to 1.9% respectively, (p=0.128). No differences were shown between preterm-born and full term-born T1D patients in gender, history of autoimmune illnesses and seasonality. Patients born premature were more likely to be diagnosed before 4 years of age ( 22.2% compared to 17.4%, (p=0.08).

Conclusions: Our findings indicate that prematurity might be an independent risk factor for T1D, and may suggest an association between premature birth and T1D pathophysiology. Further studies are required to elucidate this association with additional congenital and postnatal factors.