title: Blunted hypothalamic-pituitary-adrenal axis and insulin response to psychosocial stress in young adults born preterm at very low birth weight.
abstract: BACKGROUND
  Young adults born preterm at very low birth weight (VLBW, ≤1500 g) have higher levels of cardiovascular risk factors, including impaired glucose regulation, than their term-born peers. This could be mediated through altered hypothalamic-pituitary-adrenal axis (HPAA) response to stress.
  
  
  OBJECTIVE
  To compare HPAA, glucose and insulin responses provoked by psychosocial stress in VLBW subjects versus a comparison group of term-born controls.
  
  
  METHODS
  We studied 54 unimpaired young adults, aged 19-27 years, born at VLBW and a comparison group of 40 adults born at term, group-matched for age, sex and birth hospital, from one regional centre in southern Finland. The participants underwent a standardized psychosocial stress test (Trier Social Stress Test, TSST).
  
  
  METHODS
  In conjunction with TSST, we measured salivary cortisol, plasma ACTH, cortisol, glucose and insulin. Data were analysed with mixed-effects model and multiple linear regression analyses.
  
  
  RESULTS
  Baseline concentrations for cortisol, ACTH, insulin and glucose were similar in VLBW and comparison groups. During TSST, analysed with mixed-effects model, overall concentrations of plasma cortisol were 17·2% lower (95% CI; 3·5 to 28·9) in the VLBW group. The VLBW group also had lower salivary (P = 0·04) and plasma cortisol (P = 0·02) responses to TSST. Insulin and glucose concentrations correlated with changes in cortisol concentrations. Accordingly, VLBW subjects had 26·5% lower increment in insulin (95% CI; 9·8-40·1). Analyses were adjusted for age, sex, body mass index, hormonal contraception, menstrual cycle phase, time of day and parental education.
  
  
  CONCLUSIONS
  VLBW adults have lower HPAA responses to psychosocial stress than term-born controls. This is accompanied by a lower insulin response.
authors.affiliation: Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Kaseva
authors.forename: Karoliina
authors.initials: K
authors.lastname: Wehkalampi
authors.forename: Riikka
authors.initials: R
authors.lastname: Pyhälä
authors.forename: Elena
authors.initials: E
authors.lastname: Moltchanova
authors.forename: Kimmo
authors.initials: K
authors.lastname: Feldt
authors.forename: Anu-Katriina
authors.initials: AK
authors.lastname: Pesonen
authors.forename: Kati
authors.initials: K
authors.lastname: Heinonen
authors.forename: Petteri
authors.initials: P
authors.lastname: Hovi
authors.forename: Anna-Liisa
authors.initials: AL
authors.lastname: Järvenpää
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
authors.forename: Katri
authors.initials: K
authors.lastname: Räikkönen
authors.forename: Eero
authors.initials: E
authors.lastname: Kajantie
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D007328:Insulin / Q000097:blood; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D012307:Risk Factors; D013315:Stress, Psychological / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone