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BMC Medicine
Published in: BMC Medicine 1/2022

Open Access 01-12-2022 | Type 1 Diabetes | Research article

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

Authors: Yuxia Wei, Tomas Andersson, Jessica Edstorp, Josefin E. Löfvenborg, Mats Talbäck, Maria Feychting, Sofia Carlsson

Published in: BMC Medicine | Issue 1/2022

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Abstract

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.
Appendix
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Metadata
Title
Maternal smoking during pregnancy and type 1 diabetes in the offspring: a nationwide register-based study with family-based designs
Authors
Yuxia Wei
Tomas Andersson
Jessica Edstorp
Josefin E. Löfvenborg
Mats Talbäck
Maria Feychting
Sofia Carlsson
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Type 1 Diabetes
Published in
BMC Medicine / Issue 1/2022
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-022-02447-5

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