Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study

Diabetologia, Nov 2017

Aims/hypothesis Genetic and environmental factors are believed to cause type 1 diabetes. The aim of this study was to investigate the influence of maternal BMI and gestational weight gain on the subsequent risk of childhood type 1 diabetes. Methods Children in the Swedish National Quality Register for Diabetes in Children were matched with control children from the Swedish Medical Birth Register. Children were included whose mothers had data available on BMI in early pregnancy and gestational weight gain, giving a total of 16,179 individuals: 3231 children with type 1 diabetes and 12,948 control children. Results Mothers of children with type 1 diabetes were more likely to be obese (9% [n = 292/3231] vs 7.7% [n = 991/12,948]; p = 0.02) and/or have diabetes themselves (2.8% [n = 90/3231] vs 0.8% [n = 108/12,948]; p < 0.001) compared with mothers of control children. Gestational weight gain did not differ significantly between the two groups of mothers. In mothers without diabetes, maternal obesity was a significant risk factor for type 1 diabetes in the offspring (p = 0.04). A child had an increased risk of developing type 1 diabetes if the mother had been obese in early pregnancy (crude OR 1.20; 95% CI 1.05, 1.38; adjusted OR 1.18; 95% CI 1.02, 1.36). Among children with type 1 diabetes (n = 3231) there was a difference (p < 0.001) in age at onset in relation to the mother’s BMI. Among children in the oldest age group (15–19 years), there were more mothers who had been underweight during pregnancy, while in the youngest age group (0–4 years) the pattern was reversed. Conclusions/interpretation Maternal obesity, in the absence of maternal diabetes, is a risk factor for type 1 diabetes in the offspring, and influences the age of onset of type 1 diabetes. This emphasises the importance of a normal maternal BMI to potentially decrease the incidence of type 1 diabetes.

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Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study

Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case-control study Nina Lindell 0 1 2 3 4 Annelie Carlsson 0 1 2 3 4 Ann Josefsson 0 1 2 3 4 Ulf Samuelsson 0 1 2 3 4 Abbreviations IOM MBR SALAR 0 1 2 3 4 0 Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden 1 Department of Obstetrics and Gynaecology, Linköping University , S-581 85 Linköping , Sweden 2 Nina Lindell 3 Division of Paediatrics, Linköping University , Linköping , Sweden 4 Department of Clinical Sciences, Lund University, Skåne University Hospital , Lund , Sweden Aims/hypothesis Genetic and environmental factors are believed to cause type 1 diabetes. The aim of this study was to investigate the influence of maternal BMI and gestational weight gain on the subsequent risk of childhood type 1 diabetes. Methods Children in the Swedish National Quality Register for Diabetes in Children were matched with control children from the Swedish Medical Birth Register. Children were included whose mothers had data available on BMI in early pregnancy and gestational weight gain, giving a total of 16,179 individuals: 3231 children with type 1 diabetes and 12,948 control children. Results Mothers of children with type 1 diabetes were more likely to be obese (9% [n = 292/3231] vs 7.7% [n = 991/ 12,948]; p = 0.02) and/or have diabetes themselves (2.8% [n = 90/3231] vs 0.8% [n = 108/12,948]; p < 0.001) compared with mothers of control children. Gestational weight gain did not differ significantly between the two groups of mothers. In mothers without diabetes, maternal obesity was a significant risk factor for type 1 diabetes in the offspring (p = 0.04). A child had an increased risk of developing type 1 diabetes if the mother had been obese in early pregnancy (crude OR 1.20; Age at onset; BMI; Gestational weight gain; Obesity; Pregnancy; Type 1 diabetes - 95% CI 1.05, 1.38; adjusted OR 1.18; 95% CI 1.02, 1.36). Among children with type 1 diabetes (n = 3231) there was a difference (p < 0.001) in age at onset in relation to the mother’s BMI. Among children in the oldest age group (15– 19 years), there were more mothers who had been underweight during pregnancy, while in the youngest age group (0–4 years) the pattern was reversed. Conclusions/interpretation Maternal obesity, in the absence of maternal diabetes, is a risk factor for type 1 diabetes in the offspring, and influences the age of onset of type 1 diabetes. This emphasises the importance of a normal maternal BMI to potentially decrease the incidence of type 1 diabetes. SWEDIABKIDS Introduction Institute of Medicine Swedish Medical Birth Register Association of Local Authorities and Regions Swedish National Quality Register for Diabetes in Children Type 1 diabetes is one of the most common chronic diseases in children and young adults, and the incidence has increased worldwide in recent decades [ 1, 2 ]. Since the 1980s, the increase has been around 3% annually and the disease currently affects about 500,000 children worldwide [3]. Second to Finland, Sweden has the highest incidence of type 1 diabetes in the world [ 2 ]. About 2% of children with diabetes in Sweden are diagnosed with type 2 diabetes [ 4 ]. The aetiology of type 1 diabetes is multifactorial, and both genetic and environmental factors are thought to contribute [ 5 ]. The period in which the rapid increase has occurred is too short to be explained by genetic shifts, and is therefore believed to be influenced by environmental factors [ 6 ]. In parallel with the increased incidence of type 1 diabetes, a significant increase in obesity in the general population has been observed worldwide. In the USA almost 35% of women aged 20–39 are obese [ 7 ] and 48% of US women start their pregnancy being overweight [ 8 ]. In Sweden the number of pregnant obese women has doubled since the 1990s; in 2013, 25% of women were overweight and 13% were obese in early pregnancy [ 9 ]. Some studies have shown a relationship between high maternal pre-gestational BMI and high gestational weight gain and subsequent risk of insulin resistance, obesity and type 2 diabetes in the offspring [ 10–12 ]. Only a few studies, however, have looked at maternal BMI and/or gestational weight gain and subsequent risk of type 1 diabetes in the offspring, and such studies have produced conflicting results [ 5, 13–18 ]. The aim of this study was to further investigate the possible effect of maternal BMI and gestational weight gain on the subsequent risk of childhood type 1 diabetes in the offspring, using data from the Swedish National Quality Register for Diabetes in Children (SWEDIABKIDS) and the Swedish Medical Birth Register (MBR). Methods SWEDIABKIDS is a national quality register (https:// swediabkids.ndr.nu/) [ 19 ] that includes approximately 99% of children and adolescents with diabetes in Sweden. It was introduced stepwise and rand (...truncated)


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Nina Lindell, Annelie Carlsson, Ann Josefsson, Ulf Samuelsson. Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study, Diabetologia, 2017, pp. 1-8, DOI: 10.1007/s00125-017-4481-2