Parental smoking, type 1 diabetes, and islet autoantibody positivity in the offspring: A systematic review and meta‐analysis

Edstorp, Jessica; Lampousi, Anna-Maria; Carlsson, Sofia

doi:10.1111/dme.14830

Cited by 13 publications

(9 citation statements)

References 48 publications

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“…This nationwide prospective study shows that children exposed to maternal smoking during pregnancy have a 22% lower risk of developing type 1 diabetes during childhood compared to their unexposed siblings. This confirms the results of previous observational studies [3,45] and suggests that maternal smoking during pregnancy has the potential to prevent offspring type 1 diabetes.…”

Section: Main Findingssupporting

confidence: 91%

“…We addressed this association using cohort, sibling, and cousin designs, the latter two of which allowed us to control for potential unmeasured confounders shared within families. The observed association between maternal smoking during pregnancy and offspring type 1 diabetes was consistent across the three designs, and the effect size was in line with the RR of 0.78, observed in a recent meta-analysis based on 22 studies [4]. It was also consistent with the pooled RR of 0.72 reported in another meta-analysis based on five population-based prospective studies [3].…”

Section: Main Findings In Relation To Previous Studiessupporting

confidence: 88%

“…Previous studies on the link between maternal smoking during pregnancy and offspring type 1 diabetes include 15 cohort and 13 case-control studies based on European, US, and Australian populations [4]. We addressed this association using cohort, sibling, and cousin designs, the latter two of which allowed us to control for potential unmeasured confounders shared within families.…”

Section: Main Findings In Relation To Previous Studiesmentioning

confidence: 99%

“…Maternal smoking during pregnancy was reported to be associated with a reduced risk of type 1 diabetes in the offspring in a number of studies [3,4], including large prospective studies from Sweden [5], Norway [6], Australia [3], and Finland [7]. Since these are observational studies, the results can be confounded because mothers who smoke during pregnancy may differ from other women in ways including child-rearing practices and genetic factors, which may affect the offspring's risk of type 1 diabetes but were not adjusted for in most previous studies [3,5,[7][8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Maternal smoking during pregnancy and type 1 diabetes in the offspring: a nationwide register-based study with family-based designs

Wei

Andersson

Edstorp

et al. 2022

BMC Med

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Background Maternal smoking during pregnancy was reported to be associated with a reduced risk of type 1 diabetes in the offspring. We investigated whether this association is consistent with a causal interpretation by accounting for familial (shared genetic and environmental) factors using family-based, quasi-experimental designs. Methods We included 2,995,321 children born in Sweden between 1983 and 2014 and followed them for a diagnosis of type 1 diabetes until 2020 through the National Patient, Diabetes and Prescribed Drug Registers. Apart from conducting a traditional cohort study, we performed a nested case–control study (quasi-experiment) comparing children with type 1 diabetes to their age-matched siblings (or cousins). Information on maternal smoking during pregnancy was retrieved from the Swedish Medical Birth Register. Multivariable adjusted Cox proportional hazards regression and conditional logistic regression were used. Results A total of 18,617 children developed type 1 diabetes, with a median age at diagnosis of 9.4 years. The sibling and cousin comparison design included 14,284 and 7988 of these children, respectively. Maternal smoking during pregnancy was associated with a 22% lower risk of offspring type 1 diabetes in the full cohort (hazard ratio 0.78, 95% confidence interval [CI] 0.75–0.82). The corresponding odds ratio was 0.78 (95% CI 0.69–0.88) in the sibling and 0.72 (95% CI 0.66–0.79) in the cousin comparison analysis. Conclusions This nationwide, family-based study provides support for a protective effect of maternal smoking on offspring type 1 diabetes. Mechanistic studies are needed to elucidate the underlying pathways behind this link.

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Section: Main Findingssupporting

confidence: 91%

Section: Main Findings In Relation To Previous Studiessupporting

confidence: 88%

Section: Main Findings In Relation To Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal smoking during pregnancy and type 1 diabetes in the offspring: a nationwide register-based study with family-based designs

Wei

Andersson

Edstorp

et al. 2022

BMC Med

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“…Smoking is associated with an increased risk of type 2 diabetes ( 64 ). In contrast, a reduced risk of type 1 diabetes is consistently observed in the offspring of mothers who smoked during pregnancy ( 65 ). Earlier findings based on the Norwegian HUNT-study and data collected between 1984 and 2008 suggested that smokers may have a reduced risk of LADA ( 66 ).…”

Section: Lifestyle or Environmental Factorsmentioning

confidence: 99%

Lifestyle or Environmental Influences and Their Interaction With Genetic Susceptibility on the Risk of LADA

Carlsson

2022

Front. Endocrinol.

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BackgroundLADA is a common form of diabetes described as a mix between type 1 and type 2 diabetes. Understanding of how genes and environmental factors interact in the development of LADA is central for future efforts to prevent the disease. This review aims to synthesize the literature on lifestyle factors linked to LADA risk and discuss their potential interaction with genetic susceptibility.FindingsCurrent knowledge on environmental risk factors for LADA is primarily based on observational data from Scandinavian populations. Increasing evidence suggest that lifestyle factors promoting type 2 diabetes such as obesity, sedentariness, low birth weight and smoking, is implicated in the risk of LADA. Data from mendelian randomization studies support that the link between LADA and obesity, low birth weight and smoking is causal. Limited evidence indicates that dietary factors including consumption of red meat, coffee and sweetened beverages may increase the risk while consumption of alcohol and omega-3 fatty acids may reduce the risk. Several lifestyle factors, including smoking and obesity, seem to interact with human leukocyte antigen genes associated with autoimmunity, conferring much stronger effects on disease risk among those exposed to both factors.SummaryAvailable studies suggest that lifestyle modification has the potential for prevention of LADA, particularly for individuals with high risk of disease such as those with genetic susceptibility. Research into risk factors of LADA is however limited, confirmations are warranted, many factors remain to be explored, and there is a need for intervention studies to assess causality

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Smoking, use of smokeless tobacco, HLA genotypes and incidence of latent autoimmune diabetes in adults

et al. 2022

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Aims/hypotheses Smoking and use of smokeless tobacco (snus) are associated with an increased risk of type 2 diabetes. We investigated whether smoking and snus use increase the risk of latent autoimmune diabetes in adults (LADA) and elucidated potential interaction with HLA high-risk genotypes. Methods Analyses were based on Swedish case–control data (collected 2010–2019) with incident cases of LADA (n=593) and type 2 diabetes (n=2038), and 3036 controls, and Norwegian prospective data (collected 1984–2019) with incident cases of LADA (n=245) and type 2 diabetes (n=3726) during 1,696,503 person-years of follow-up. Pooled RRs with 95% CIs were estimated for smoking, and ORs for snus use (case–control data only). The interaction was assessed by attributable proportion (AP) due to interaction. A two-sample Mendelian randomisation (MR) study on smoking and LADA/type 2 diabetes was conducted based on summary statistics from genome-wide association studies. Results Smoking (RRpooled 1.30 [95% CI 1.06, 1.59] for current vs never) and snus use (OR 1.97 [95% CI 1.20, 3.24] for ≥15 box-years vs never use) were associated with an increased risk of LADA. Corresponding estimates for type 2 diabetes were 1.38 (95% CI 1.28, 1.49) and 1.92 (95% CI 1.27, 2.90), respectively. There was interaction between smoking and HLA high-risk genotypes (AP 0.27 [95% CI 0.01, 0.53]) in relation to LADA. The positive association between smoking and LADA/type 2 diabetes was confirmed by the MR study. Conclusions/interpretation Our findings suggest that tobacco use increases the risk of LADA and that smoking acts synergistically with genetic susceptibility in the promotion of LADA. Data availability Analysis codes are shared through GitHub (https://github.com/jeseds/Smoking-use-of-smokeless-tobacco-HLA-genotypes-and-incidence-of-LADA). Graphical abstract

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Parental smoking, type 1 diabetes, and islet autoantibody positivity in the offspring: A systematic review and meta‐analysis

Cited by 13 publications

References 48 publications

Maternal smoking during pregnancy and type 1 diabetes in the offspring: a nationwide register-based study with family-based designs

Maternal smoking during pregnancy and type 1 diabetes in the offspring: a nationwide register-based study with family-based designs

Lifestyle or Environmental Influences and Their Interaction With Genetic Susceptibility on the Risk of LADA

Smoking, use of smokeless tobacco, HLA genotypes and incidence of latent autoimmune diabetes in adults

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