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Perinatal risk factors for early onset of Type 1 diabetes in a 2000-2005 birth cohort
C S Algert1, A McElduff, J M Morris
1Kolling Institute of Medical Research, University of Sydney, Sydney. calgert@med.usyd.edu.au
Insights
Maternal Type 1 diabetes and being small for gestational age are key factors in early-onset Type 1 diabetes. Healthcare providers should consider size-for-gestational-age over birth weight for risk assessment.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Type 1 diabetes onset in children under six years old presents a significant public health concern.
- Identifying perinatal risk factors is crucial for early intervention and prevention strategies.
Purpose of the Study:
- To investigate perinatal risk factors associated with the onset of Type 1 diabetes in children before the age of six.
- To analyze a large Australian birth cohort from 2000-2005 for early-onset Type 1 diabetes risk factors.
Main Methods:
- Utilized linked delivery and hospital admission records from 2000-2007 for a cohort of 502,040 live births.
- Identified Type 1 diabetes cases using International Classification of Diseases 10 (ICD-10) codes.
- Analyzed perinatal factors including maternal diabetes, birth presentation (preterm birth, C-section), size-for-gestational-age, and maternal age.
Main Results:
- Identified 272 hospital admissions for new-onset diabetes.
- Maternal Type 1 diabetes significantly increased risk (RR 6.33).
- Late preterm birth (RR 1.64), caesarean section (RR 1.30), and increasing maternal age (RR 1.13 per 5 years) were associated with increased risk.
- Being small-for-gestational-age was protective (RR 0.48), while birth weight alone was not significant.
Conclusions:
- Size-for-gestational-age is a more consistent predictor of early-onset Type 1 diabetes risk than birth weight.
- Maternal Type 1 diabetes, late preterm birth, caesarean delivery, and advanced maternal age are significant perinatal risk factors.
- Assessing size-for-gestational-age is recommended over birth weight thresholds for evaluating diabetes risk in young children.
Aims:
To examine perinatal risk factors for the onset of Type 1 diabetes before 6 years of age, in a 2000-2005 Australian birth cohort.
Methods:
Data from longitudinally linked delivery and hospital admission records (until June 2007) were analysed. Diabetes in mothers and children was identified from International Classification of Diseases 10 diagnosis codes in the hospital records.
Results:
There were 272 children admitted to hospital with a first diagnosis of diabetes out of 502 040 live births. Incidence for the infants born in 2000 was 16.0 per 100 000 person-years. Maternal Type 1 diabetes was a significant risk factor [crude relative risk (RR) 6.33], but maternal Type 2 diabetes and gestational diabetes were not significantly associated with diabetes in the child. Late preterm birth (34-36 weeks) (RR 1.64) and caesarean section (RR 1.30) increased the risk of a diabetes admission. Size-for-gestational-age was significantly associated with onset of diabetes (small-for-gestational age RR 0.48), but neither birth weight categories nor birth weight as a continuous variable were associated with risk of diabetes. Increasing maternal age was associated with an increased risk of diabetes in the child (RR 1.13 for each additional 5 years of age).
Conclusions:
This study identified risk factors associated with onset of Type 1 diabetes before 6 years of age, in a recent birth cohort. Size-for-gestational-age had a consistent association with risk of early onset of Type 1 diabetes, small size being protective. Size-for-gestational-age measures should be preferred to birth weight thresholds when assessing risk of diabetes.
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