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Size for gestational age affects the risk for type 1 diabetes in children and adolescents: a Swedish national
Nina Lindell1,2, Marie Bladh3,4, Annelie Carlsson5
1Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden. nina.lindell@liu.se.
Insights
Children born large for gestational age (LGA) face a higher risk of type 1 diabetes, while those born small for gestational age (SGA) have a reduced risk. This finding is independent of maternal factors, suggesting birth size is a key environmental influence.
Area of Science:
- Pediatrics
- Endocrinology
- Environmental Health
Background:
- Environmental factors are implicated in type 1 diabetes development.
- Gestational age and birth size are potential modifiable risk factors.
Purpose of the Study:
- To investigate the association between size for gestational age and childhood type 1 diabetes risk.
- To determine if birth size is an independent risk factor for type 1 diabetes.
Main Methods:
- Case-control study using Swedish national registers (2000-2012).
- 9,376 children with type 1 diabetes matched with 37,504 controls.
- Logistic regression analysis adjusting for maternal BMI and diabetes.
Main Results:
- Children with type 1 diabetes were more often born large for gestational age (LGA) and less often small for gestational age (SGA).
- Being born LGA increased type 1 diabetes risk (aOR 1.16; 95% CI 1.02-1.32).
- Being born SGA decreased type 1 diabetes risk (aOR 0.76; 95% CI 0.63-0.92).
Conclusions:
- Size for gestational age significantly impacts childhood type 1 diabetes risk.
- Large for gestational age (LGA) is an independent risk factor for type 1 diabetes.
- Reducing LGA births may help mitigate type 1 diabetes risk.
Aim/Hypothesis:
Environmental factors are believed to contribute to the risk of developing type 1 diabetes. The aim of this study was to investigate how size for gestational age affects the risk of developing childhood type 1 diabetes.
Methods:
Using the Swedish paediatric diabetes quality register and the Swedish medical birth register, children with type 1 diabetes diagnosed between 2000 and 2012 (n = 9376) were matched with four control children (n = 37,504). Small for gestational age (SGA) and large for gestational age (LGA) were defined according to Swedish national standards. Data were initially analysed using Pearson's χ2 and thereafter by single and multiple logistic regression models.
Results:
An equal proportion of children were born appropriate for gestational age, but children with type 1 diabetes were more often born LGA and less often born SGA than control children (4.7% vs 3.5% and 2.0% vs 2.6%, respectively, p < 0.001). In the multiple logistic regression analysis, being born LGA increased (adjusted OR 1.16 [95% CI 1.02, 1.32]) and SGA decreased (adjusted OR 0.76 [95% CI 0.63, 0.92]) the risk for type 1 diabetes, regardless of maternal BMI and diabetes.
Conclusions/Interpretation:
Size for gestational age of Swedish children affects the risk of type 1 diabetes, with increased risk if the child is born LGA and decreased risk if the child is born SGA. Being born LGA is an independent risk factor for type 1 diabetes irrespective of maternal BMI and diabetes. Thus, reducing the risk for a child being born LGA might to some extent reduce the risk for type 1 diabetes.
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