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Associations between birthweight, gestational age at birth and subsequent type 1 diabetes in children under 12: a retrospective cohort study in England, 1998-2012.
Diabetologia 2018; 61(3):616-625D

Abstract

AIMS/HYPOTHESIS

With genetics thought to explain only 40-50% of the total risk of type 1 diabetes, environmental risk factors in early life have been proposed. Previous findings from studies of type 1 diabetes incidence by birthweight and gestational age at birth have been inconsistent. This study aimed to investigate the relationships between birthweight, gestational age at birth and subsequent type 1 diabetes in England.

METHODS

Data were obtained from a population-based database comprising linked mother-infant pairs using English national Hospital Episode Statistics from 1998 to 2012. In total, 3,834,405 children, categorised by birthweight and gestational age at birth, were followed up through record linkage to compare their incidence of type 1 diabetes through calculation of multivariable-adjusted HRs.

RESULTS

Out of 3,834,405 children, 2969 had a subsequent hospital diagnosis of type 1 diabetes in childhood. Children born preterm (<37 weeks) or early term (37-38 weeks) experienced significantly higher incidence of type 1 diabetes than full term children (39-40 weeks) (HR 1.19 [95% CI 1.03, 1.38] and 1.27 [95% CI 1.16, 1.39], respectively). Children born at higher than average birthweight (3500-3999 g or 4000-5499 g) after controlling for gestational age experienced higher incidence of type 1 diabetes than children born at medium birthweight (3000-3499 g) (HR 1.13 [95% CI 1.03, 1.23] and 1.16 [95% CI 1.02, 1.31], respectively), while children at low birthweight (<2500 g) experienced lower incidence (0.81 [95% CI 0.67, 0.98]), signifying a statistically significant trend (p trend 0.001).

CONCLUSIONS/INTERPRETATION

High birthweight for gestational age and low gestational age at birth are both independently associated with subsequent type 1 diabetes. These findings help contextualise the debate about the potential role of gestational and early life environmental risk factors in the pathogenesis of type 1 diabetes, including the potential roles of insulin sensitivity and gut microbiota.

Authors+Show Affiliations

Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK. raphael.goldacre@dph.ox.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29128935

Citation

Goldacre, Raphael R.. "Associations Between Birthweight, Gestational Age at Birth and Subsequent Type 1 Diabetes in Children Under 12: a Retrospective Cohort Study in England, 1998-2012." Diabetologia, vol. 61, no. 3, 2018, pp. 616-625.
Goldacre RR. Associations between birthweight, gestational age at birth and subsequent type 1 diabetes in children under 12: a retrospective cohort study in England, 1998-2012. Diabetologia. 2018;61(3):616-625.
Goldacre, R. R. (2018). Associations between birthweight, gestational age at birth and subsequent type 1 diabetes in children under 12: a retrospective cohort study in England, 1998-2012. Diabetologia, 61(3), pp. 616-625. doi:10.1007/s00125-017-4493-y.
Goldacre RR. Associations Between Birthweight, Gestational Age at Birth and Subsequent Type 1 Diabetes in Children Under 12: a Retrospective Cohort Study in England, 1998-2012. Diabetologia. 2018;61(3):616-625. PubMed PMID: 29128935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations between birthweight, gestational age at birth and subsequent type 1 diabetes in children under 12: a retrospective cohort study in England, 1998-2012. A1 - Goldacre,Raphael R, Y1 - 2017/11/11/ PY - 2017/07/14/received PY - 2017/10/12/accepted PY - 2017/11/13/pubmed PY - 2018/11/6/medline PY - 2017/11/13/entrez KW - Birthweight KW - England/epidemiology KW - Gestational age KW - Hospital Episode Statistics KW - Large for gestational age KW - National Health Service KW - Preterm KW - Record linkage KW - Small for gestational age KW - Type 1 diabetes mellitus SP - 616 EP - 625 JF - Diabetologia JO - Diabetologia VL - 61 IS - 3 N2 - AIMS/HYPOTHESIS: With genetics thought to explain only 40-50% of the total risk of type 1 diabetes, environmental risk factors in early life have been proposed. Previous findings from studies of type 1 diabetes incidence by birthweight and gestational age at birth have been inconsistent. This study aimed to investigate the relationships between birthweight, gestational age at birth and subsequent type 1 diabetes in England. METHODS: Data were obtained from a population-based database comprising linked mother-infant pairs using English national Hospital Episode Statistics from 1998 to 2012. In total, 3,834,405 children, categorised by birthweight and gestational age at birth, were followed up through record linkage to compare their incidence of type 1 diabetes through calculation of multivariable-adjusted HRs. RESULTS: Out of 3,834,405 children, 2969 had a subsequent hospital diagnosis of type 1 diabetes in childhood. Children born preterm (<37 weeks) or early term (37-38 weeks) experienced significantly higher incidence of type 1 diabetes than full term children (39-40 weeks) (HR 1.19 [95% CI 1.03, 1.38] and 1.27 [95% CI 1.16, 1.39], respectively). Children born at higher than average birthweight (3500-3999 g or 4000-5499 g) after controlling for gestational age experienced higher incidence of type 1 diabetes than children born at medium birthweight (3000-3499 g) (HR 1.13 [95% CI 1.03, 1.23] and 1.16 [95% CI 1.02, 1.31], respectively), while children at low birthweight (<2500 g) experienced lower incidence (0.81 [95% CI 0.67, 0.98]), signifying a statistically significant trend (p trend 0.001). CONCLUSIONS/INTERPRETATION: High birthweight for gestational age and low gestational age at birth are both independently associated with subsequent type 1 diabetes. These findings help contextualise the debate about the potential role of gestational and early life environmental risk factors in the pathogenesis of type 1 diabetes, including the potential roles of insulin sensitivity and gut microbiota. SN - 1432-0428 UR - https://www.unboundmedicine.com/medline/citation/29128935/Associations_between_birthweight_gestational_age_at_birth_and_subsequent_type_1_diabetes_in_children_under_12:_a_retrospective_cohort_study_in_England_1998_2012_ L2 - https://dx.doi.org/10.1007/s00125-017-4493-y DB - PRIME DP - Unbound Medicine ER -