title: Prenatal exposure to bereavement and type-2 diabetes: a Danish longitudinal population based study.
abstract: BACKGROUND
  The etiology of type-2 diabetes is only partly known, and a possible role of prenatal stress in programming offspring for insulin resistance has been suggested by animal models. Previously, we found an association between prenatal stress and type-1 diabetes. Here we examine the association between prenatal exposure to maternal bereavement during preconception and pregnancy and development of type-2 diabetes in the off-spring.
  
  
  METHODS
  We utilized data from the Danish Civil Registration System to identify singleton births in Denmark born January 1(st) 1979 through December 31(st) 2008 (N = 1,878,246), and linked them to their parents, grandparents, and siblings. We categorized children as exposed to bereavement during prenatal life if their mothers lost an elder child, husband or parent during the period from one year before conception to the child's birth. We identified 45,302 children exposed to maternal bereavement; the remaining children were included in the unexposed cohort. The outcome of interest was diagnosis of type-2 diabetes. We estimated incidence rate ratios (IRRs) from birth using log-linear poisson regression models and used person-years as the offset variable. All models were adjusted for maternal residence, income, education, marital status, sibling order, calendar year, sex, and parents' history of diabetes at the time of pregnancy.
  
  
  RESULTS
  We found children exposed to bereavement during their prenatal life were more likely to have a type-2 diabetes diagnosis later in life (aIRR: 1.31, 1.01-1.69). These findings were most pronounced when bereavement was caused by death of an elder child (aIRR: 1.51, 0.94-2.44). Results also indicated the second trimester of pregnancy to be the most sensitive period of bereavement exposure (aIRR:2.08, 1.15-3.76).
  
  
  CONCLUSIONS
  Our data suggests that fetal exposure to maternal bereavement during preconception and the prenatal period may increase the risk for developing type-2 diabetes in childhood and young adulthood.
authors.forename: Jasveer
authors.initials: J
authors.lastname: Virk
authors.affiliation: Aarhus University, Aarhus, Denmark.
authors.forename: Jiong
authors.initials: J
authors.lastname: Li
authors.forename: Mogens
authors.initials: M
authors.lastname: Vestergaard
authors.forename: Carsten
authors.initials: C
authors.lastname: Obel
authors.forename: Jette Kolding
authors.initials: JK
authors.lastname: Kristensen
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001601:Bereavement; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D005260:Female; D006117:Grief; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D018811:Maternal Exposure; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology