Maternal respiratory infections in early pregnancy increases the risk of type 1 diabetes

Abstract

Background/Objective: Is exposure to maternal infections and use of antibiotics in the prenatal period associated with increased risk of T1D, regardless of genetic risk? Methods: Data on infections and use of antibiotics during pregnancy were collected from questionnaires at birth from parents to 16 292 children in the All Babies in Southeast Sweden (ABIS) cohort and validated against national diagnosis registers. As of November 2017, 137 ABIS children had developed T1D, 72 boys and 65 girls (0.8% of the original cohort). Results: More cases were born in spring and summer than fall and winter. However, onset of T1D appeared to be more common in either summer or winter. In univariate analyses, respiratory tract infection in the first trimester (P = .002) and gastroenteritis during pregnancy (P = .04) were associated with later risk of T1D in the offspring. Other types of infection or antibiotic treatment were not associated with an increased risk. In a multiple logistic regression model, a mother with an autoimmune disease (P < .001), father with T1D (P < .001) and respiratory tract infection during the first trimester (P = .005) remained as risk factors for T1D in the offspring. In children with neutral HLA alleles antibiotic treatment may increase the risk of T1D (P = .01, OR 3.46, 95% CI 1.25-9.55). Conclusions: In the general population there seems to be an association between seasonal maternal respiratory tract infection in the first trimester of pregnancy and later risk of T1D in the offspring. HLA may play a role for the effect of exposure to infections and antibiotics.

Viruses and Type 1 Diabetes: From Enteroviruses to the Virome

“…A growing body of epidemiological data supports the role of RTIs in the development of IA and T1D [ 22 , 182 , 183 , 184 , 185 , 186 ]. This includes a recent report from the All Babies in Southeast Sweden (ABIS) cohort, demonstrating that maternal RTIs during pregnancy, particularly in the third gestational month, significantly increase the risk of T1D in the offspring (OR 4.1, 95% CI 2.2–7.5; p < 0.001) [ 187 ]. Current data on the association of RTIs and T1D are limited to self-reported or clinically diagnosed history of infections, with molecular data for RTIs in IA/T1D cohort studies lacking [ 22 , 47 , 183 , 187 , 188 , 189 , 190 ].…”

“…This includes a recent report from the All Babies in Southeast Sweden (ABIS) cohort, demonstrating that maternal RTIs during pregnancy, particularly in the third gestational month, significantly increase the risk of T1D in the offspring (OR 4.1, 95% CI 2.2–7.5; p < 0.001) [ 187 ]. Current data on the association of RTIs and T1D are limited to self-reported or clinically diagnosed history of infections, with molecular data for RTIs in IA/T1D cohort studies lacking [ 22 , 47 , 183 , 187 , 188 , 189 , 190 ]. The proposition of the respiratory tract as an alternate source of primary infection resulting in secondary pancreatic infection is not out of the question, with higher rates of RTI recently linked to increased risk of IA in at-risk children.…”

Viruses and Type 1 Diabetes: From Enteroviruses to the Virome

“…A growing body of epidemiological data support the role of RTIs in the development of IA and T1D [22,[178][179][180][181][182]. This includes a recent report from the All Babies in Southeast Sweden (ABIS) cohort demonstrating that maternal RTIs during pregnancy, particularly in the third gestational month, significantly increase the risk of T1D in the offspring (OR 4.1, 95% CI 2.2-7.5; P < 0.001) [183]. Current data on the association of RTIs and T1D are limited to self-reported or clinically diagnosed history of infections, with molecular data for RTIs in IA/T1D cohort studies lacking [22,48,179,[183][184][185][186].…”

“…This includes a recent report from the All Babies in Southeast Sweden (ABIS) cohort demonstrating that maternal RTIs during pregnancy, particularly in the third gestational month, significantly increase the risk of T1D in the offspring (OR 4.1, 95% CI 2.2-7.5; P < 0.001) [183]. Current data on the association of RTIs and T1D are limited to self-reported or clinically diagnosed history of infections, with molecular data for RTIs in IA/T1D cohort studies lacking [22,48,179,[183][184][185][186]. The proposition of the respiratory tract as an alternate source of primary infection resulting in secondary pancreatic infection is not out of the question, with higher rates of RTI recently linked to increased risk of IA in at-risk children.…”

Perinatal risk factors for type 1 diabetes in children and adolescents

“…Most of these cohort studies are being performed on children at high genetic risk of T1D, for example The Environmental Determinants of Diabetes in the Young (TEDDY) study 17 , the Trial to Reduce Insulin Dependent Diabetes Mellitus (IDDM) in the Genetically at Risk (TRIGR) 89 , the BABYDIAB study 54 , the Diabetes and Autoimmunity Study in the Young (DAISY) 87 and the type 1 Diabetes Prediction and Prevention (DIPP) study 18 . However, the All Babies in Southeast Sweden (ABIS) 90 study is, in contrast, a large cohort study of the general population.…”