Maternal gestational diabetes and offspring type 1 diabetes: a familial or a pregnancy-specific association?
Notice bibliographique
Résumé
Background: Pediatric type 1 diabetes (T1D) often remains undiagnosed until the patient present to the emergency room with potentially lethal diabetic ketoacidosis. Understanding early indicators of T1D is crucial for timely detection. Previous studies demonstrate that maternal gestational diabetes (GDM) is a risk factor for offspring T1D development. However, it remains unclear whether this association is primarily driven by pregnancy factors such as the effects of in utero hyperglycemia on developing β-cells or by shared familial factors (genetic and/or behavioural) promoting insulin resistance. To address these possibilities, we leveraged GDM during a first pregnancy as an indicator of familial factors and evaluated its association with T1D in a second-born offspring. We hypothesize that if familial factors play an important role, GDM during the first pregnancy would be associated with T1D in the second child. Alternatively, if in utero factors are predominant, we would not expect such an association, as first-pregnancy factors could not directly impact the second born. Methods: Using health administrative and vital statistics databases from the Canadian province of Quebec, we studied 485,220 second-born offspring of families with two consecutive deliveries between 1990 and 2012, with follow-up data to April 2019. We examined offspring from birth to 22 years of age. More than 85% of diabetes in children and youth is T1D in Quebec, termed diabetes hereafter. We calculated descriptive statistics and offspring diabetes incidence rates. We compared GDM in the first, second, and both pregnancies to the absence of diabetes in either pregnancy in terms of diabetes hazards for the second-born. We included preexisting maternal and paternal diabetes in these models and also examined their associations with second-born diabetes. We created separate adjusted models for children (from birth until 12 years) and for youth (12 to 22 years). Findings: A total of 1845 subjects (960 children and 865 youth) developed T1D over an average of 11.7 years. In children, we did not identify associations between GDM at either the first, second, or both pregnancies with T1D in the second-born. Maternal (HR 2.38, 95% CI 1.60-3.53) and paternal (HR 6.60, 95% CI 4.80-9.06) pre-existing diabetes were conclusively associated with second-born diabetes in this age group. Among youth, GDM in the first pregnancy only (HR 1.54, 95% CI 1.05-2.25), GDM in the second pregnancy only (HR 1.62, 95% CI 1.17-2.26) and GDM in both pregnancies (HR 2.59, 95% CI 1.78-3.76) were associated with diabetes in the second born as were maternal pre-existing diabetes (HR 4.88, 95% CI 3.37-7.08), and paternal pre-existing diabetes (HR 4.35, 95% CI 2.71-6.97).Interpretation: In the second-born offspring of women with two consecutive singleton deliveries, GDM in the first pregnancy only and in the second pregnancy only are similarly associated with T1D in youth. This similarity suggests that familial factors are predominant in associations between GDM and diabetes in youth. The highest hazards occur with GDM in both pregnancies. Pre-existing diabetes in either parent is associated with T1D development in both childhood and youth; the association is stronger for paternal diabetes than maternal diabetes in childhood but similar in youth. Our findings underscore the importance of querying GDM, not only during pregnancy with the patient but also during other pregnancies
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».