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Prenatal and Postnatal Exposure to Antibiotics and the Risk of Type 1 Diabetes in Finnish Children: A Registry-based
Leena Hakola1, Annamari Lundqvist2, Mika Gissler3
1Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Department of Public Health, Finnish Institute for Health and Welfare, Helsinki, Finland.
Insights
Antibiotic exposure in early life did not generally increase type 1 diabetes risk. However, specific antibiotic types and timing, such as macrolides before pregnancy, may influence risk in children.
Area of Science:
- Pediatrics
- Epidemiology
- Pharmacology
Background:
- Type 1 diabetes is a significant childhood autoimmune disease.
- The role of environmental factors, including antibiotic exposure, in type 1 diabetes development is under investigation.
Purpose of the Study:
- To investigate the association between prenatal and postnatal antibiotic exposure and the risk of childhood type 1 diabetes.
Main Methods:
- A case cohort study in Finland included 2869 children with type 1 diabetes and 74,263 controls.
- Antibiotic exposure was assessed across various prenatal and postnatal periods using prescription data.
- Weighted Cox proportional hazards regression models were employed for analysis.
Main Results:
- Overall antibiotic exposure showed no association with increased type 1 diabetes risk.
- Exposure to macrolides before pregnancy and sulfonamides/trimethoprim during pregnancy were linked to higher risk.
- Sulfonamides/trimethoprim exposure in the first two years of life was associated with a decreased risk.
Conclusions:
- General prenatal and postnatal antibiotic exposure does not elevate type 1 diabetes risk in offspring.
- Specific antibiotic classes and the timing of exposure may modulate the risk of developing type 1 diabetes.
Objective:
To study whether prenatal and postnatal exposure to antibiotics is associated with the risk of type 1 diabetes in childhood.
Study Design:
This case cohort study included 2869 children diagnosed with type 1 diabetes by the end of 2009 who were born between January 1, 1996, and December 31, 2008, in Finland and a reference cohort (n = 74 263) representing 10% of each birth cohort. Exposure to antibiotics was assessed in different time periods. The data were derived from Special Reimbursement Register, Drug Prescription Register, and Population Register and analyzed with weighted Cox proportional hazards regression models.
Results:
Exposure to any antibiotics before or during pregnancy, in the neonatal ward, during the first year of life, or during the 2 first years of life, was not associated with the risk of type 1 diabetes in the offspring. Exposure to macrolides in the year preceding pregnancy (adjusted hazard ratio [HR], 1.17; 95% CI, 1.02-1.33) and to sulfonamides and trimethoprim during pregnancy (adjusted HR, 1.91; 95% CI, 1.07-3.41) was associated with an increased risk of type 1 diabetes in the offspring. Exposure to sulfonamides and trimethoprim during first 2 years of life was associated with a decreased risk of type 1 diabetes (adjusted HR, 0.84; 95% CI, 0.73-0.97). The number of antibiotic purchases among mothers or children was not associated with type 1 diabetes risk.
Conclusions:
Prenatal and postnatal exposure to antibiotics in general did not increase the risk of type 1 diabetes in the offspring. However, the type of antibiotic and timing of exposure may play a role in type 1 diabetes risk.
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