title: Perinatal and neonatal determinants of childhood type 1 diabetes. A case-control study in Yorkshire, U.K.
abstract: OBJECTIVE
  To identify environmental factors that exert their effect in the perinatal and neonatal period and influence the subsequent onset of insulin dependent (type 1) diabetes during childhood.
  
  
  METHODS
  A population-based case-control study of data abstracted from the hospital obstetric and neonatal records of 196 children with type 1 diabetes and 325 age- and sex-matched control subjects. Analysis of matched sets by conditional logistic regression was conducted for a range of perinatal and neonatal factors.
  
  
  RESULTS
  A significantly raised risk was observed for illnesses in the neonatal period (OR 1.61, 95% CI 1.06-2.44), the majority of which were infections and respiratory difficulties. Exclusive breast feeding as the initial feeding method was significantly protective (OR 0.65, 95% CI 0.45-0.94). There were no significant associations with high- or low-birth weight, being firstborn or small-for-dates. All factors significant (5% level) for the entire dataset, that is, maternal age, type 1 diabetes in mothers, preeclampsia, delivery by cesarean section, neonatal illnesses, and initial breast feeding were modeled and the OR remained significant for all variables other than cesarean section.
  
  
  CONCLUSIONS
  The findings are based on medical record data that cannot be subject to biased recall of mothers. Neonatal illnesses increased and initial breast feeding decreased the risk of childhood type 1 diabetes. Further determinants of risk are mothers with type 1 diabetes, older mothers, and preeclampsia during pregnancy.
authors.affiliation: Paediatric Epidemiology Group, University of Leeds, U.K.
authors.forename: P A
authors.initials: PA
authors.lastname: McKinney
authors.forename: R
authors.initials: R
authors.lastname: Parslow
authors.forename: K A
authors.initials: KA
authors.lastname: Gurney
authors.forename: G R
authors.initials: GR
authors.lastname: Law
authors.forename: H J
authors.initials: HJ
authors.lastname: Bodansky
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D001942:Breast Feeding; D016022:Case-Control Studies; D002585:Cesarean Section; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000209:etiology*; D004739:England / Q000453:epidemiology; D004777:Environment; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D015999:Multivariate Analysis; D011225:Pre-Eclampsia; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D012044:Regression Analysis; D012307:Risk Factors