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Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based
Nina Lindell1,2, Annelie Carlsson3, Ann Josefsson4,5
1Department of Obstetrics and Gynaecology, Linköping University, S-581 85, Linköping, Sweden. nina.lindell@liu.se.
Insights
Maternal obesity during pregnancy increases the risk of childhood type 1 diabetes. This finding highlights the importance of maintaining a healthy maternal body mass index (BMI) to potentially reduce type 1 diabetes incidence.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Type 1 diabetes is a complex autoimmune disease with suspected genetic and environmental influences.
- Maternal health during pregnancy is increasingly recognized as a potential factor in offspring health outcomes.
- Understanding modifiable risk factors is crucial for developing preventative strategies for type 1 diabetes.
Purpose of the Study:
- To examine the association between maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risk of type 1 diabetes in children.
- To investigate if maternal obesity influences the age of onset for type 1 diabetes in offspring.
Main Methods:
- A case-control study utilizing Swedish national health registers.
- Inclusion of 3,231 children diagnosed with type 1 diabetes and 12,948 matched control children.
- Data on maternal pre-pregnancy BMI and gestational weight gain were analyzed.
Main Results:
- Mothers of children with type 1 diabetes had higher rates of obesity and pre-existing diabetes compared to control mothers.
- Maternal obesity in early pregnancy was a significant risk factor for type 1 diabetes in offspring (adjusted OR 1.18).
- Gestational weight gain did not show a significant difference between groups, but maternal BMI affected the age of type 1 diabetes onset.
Conclusions:
- Maternal obesity, independent of maternal diabetes, is a risk factor for childhood type 1 diabetes.
- Maternal pre-pregnancy BMI is linked to the age of onset of type 1 diabetes in children.
- Maintaining a normal maternal BMI may be important for reducing the incidence of type 1 diabetes.
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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