Am J Epidemiol 2004; 160:3-10.
Copyright © 2004 by the Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Perinatal Factors and Development of Islet Autoimmunity in Early Childhood
The Diabetes Autoimmunity Study in the Young
1 Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, CO.
2 Norwegian Institute of Public Health, Oslo, Norway.
3 Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO.
4 Department of Human Genetics, Roche Molecular Systems, Inc., Alameda, CA.
5 Department of Obstetrics and Gynecology, Kaiser Permanente and St. Joseph Hospital, Denver, CO.
The objective of this study was to test whether maternal age at delivery, child’s birth order, cesarean section, complicated delivery, maternal smoking during pregnancy, or neonatal jaundice predict islet autoimmunity in children at genetically increased risk of type 1 diabetes in a birth cohort with blood draws at ages 9, 15, and 24 months and yearly thereafter. Newborns with diabetes-associated human leukocyte antigen genotypes (n = 938) and offspring or siblings of persons with type 1 diabetes (n = 428) from the Denver, Colorado, metropolitan area were examined from January 1994 to February 2003. Information on perinatal factors was collected by using questionnaires soon after the birth. Islet autoimmunity was defined as positivity for 
1 autoantibody to glutamic acid decarboxylase65, insulin, or protein tyrosine phosphatase-2/ICA512 at 2 consecutive visits (n = 52; mean follow-up, 3.9 years). Complicated delivery (breech, forceps, vacuum extraction) predicted a higher risk of islet autoimmunity (hazard ratio = 2.10, 95% confidence interval: 1.09, 4.05). Increasing maternal age was related to risk of islet autoimmunity among first-degree relatives of persons with type 1 diabetes (hazard ratios = 3.96 and 8.88 for maternal ages 25–34 and 35 years, respectively, compared with <25 years; p for trend = 0.008. Other factors evaluated were not related to risk of islet autoimmunity. In conclusion, influences in utero or during delivery may affect the fetal immune system.
autoimmunity; child; diabetes mellitus, type I; environment; infant, newborn; perinatal care; pregnancy; prospective studies
Abbreviations: Abbreviations: GADA, glutamic acid decarboxylase65 autoantibodies; HLA, human leukocyte antigen; IAA, insulin autoantibodies; IA-2, protein tyrosine phosphatase-2.
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