Maternal stress and offspring type 1 diabetes risk

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Maternal depression or anxiety during pregnancy increases the risk of type 1 diabetes in offspring, according to a recent study published in BMJ Open Diabetes Research & Care.

Type 1 diabetes is among the most common chronic autoimmune disorders, with incidence most common in children aged 5 to 7 years or experiencing puberty. During the past few decades, an increase in type 1 diabetes cases has been observed.

Environmental determinants have been linked to the rise in type 1 diabetes incidence, including viral infections, rapid weight gain, diet, and childhood psychological distress. However, there is little data on how maternal and perinatal factors impact type 1 diabetes risk.

Factors including early gestational obesity, maternal age at pregnancy, and increased birth weight have been linked to type 1 diabetes, but data on maternal stress and type 1 diabetes in offspring remains inconclusive. About 15% to 20% of women are affected by anxiety or depression during pregnancy, making this a clinically relevant topic.

To determine the association between maternal anxiety and depression during pregnancy and offspring type 1 diabetes, investigators conducted a nationwide cohort study including all children born from January 1, 2002, to December 31, 2019. The Medical Birth Register (MBR), containing data on 96% to 98% of births in Sweden, was used to identify participants.

Exclusion criteria included mothers’ migration during pregnancy, multiparous births, any case of offspring death, migration, or type 1 diabetes onset before being aged at least 1 year, and missing identity of child’s parents.

A diagnosis of type 1 diabetes registered in the National Patient Register (NPR) or dispensation of insulin prescription was measured as the primary outcome of the study. The date of diagnosis was used as the date of disease onset, or the date of first insulin prescription when the date of diagnosis was missing.

Maternal anxiety or depression was determined through diagnosis registered in the NPR or use of anxiolytic or antidepressant medication. The MBR identified medication use through maternal self-report, while the Prescribed Drug Register identified medication use through prescriptions dispensed to mothers and fathers.

There were 7 time periods of exposure evaluation, the primary period being during pregnancy, which was defined as 90 days before pregnancy up to delivery. The time from before to after pregnancy was also measured as a secondary exposure.

Covariates included maternal body mass index (BMI) in early pregnancy, age at delivery, parity, highest level of educational attainment, and type 1 diabetes.

The final sample included 1,807,809 mother-child pairs, 6.3% of which showed maternal anxiety or depression during pregnancy and 11.1% from before to after pregnancy. Among cases of maternal anxiety or depression before pregnancy, 62.5% saw continued exposure during pregnancy. Of those exposed after pregnancy, 55.6% had been exposed during pregnancy.

Follow-up lasted a mean 8.6 years after children were aged 1 year. During this time, 0.5% of children developed type 1 diabetes, aged a mean 7.9 years at onset. A history of type 1 diabetes was seen in 0.9% of mothers with anxiety or depression during pregnancy, compared to 0.5% of those without.

An increase in type 1 diabetes risk was found among offspring of mothers with anxiety or depression during pregnancy, beginning when aged about 8 years. This outcome was not impacted by maternal BMI, asthma, or type 1 diabetes. An increased risk was found in cases of exposure only during pregnancy and only after pregnancy, but not only before pregnancy.

No association was found between father’s anxiety and depression and offspring type 1 diabetes risk. However, a positive association between maternal anxiety and depression and offspring risk remained even when siblings of offspring were unexposed.

These results indicated maternal anxiety and depression during pregnancy is associated with increased type 1 diabetes risk in offspring. Investigators recommended further research on through which mechanisms maternal stress impacts outcomes.

Reference:

Smew A, Lundholm C, Gong T, et al. Maternal depression or anxiety during pregnancy and offspring type 1 diabetes: a population-based family-design cohort study. BMJ Open Diabetes Research & Care. 2023;11(2). doi:10.1136/bmjdrc-2023-003303