BMJ 2001;323:369 ( 18 August )

Papers

Maternal and paternal age at delivery, birth order, and risk of childhood onset type 1 diabetes: population based cohort study

Lars C Stene, research fellow, ^a Per Magnus, professor, ^b Rolv T Lie, professor, ^c Oddmund Søvik, professor, ^d Geir Joner, consultant paediatrician, ^a the Norwegian Childhood Diabetes Study Group. 

^a Diabetes Research Centre, Aker and Ullevål University Hospitals, Department of Paediatrics, Ullevål Hospital, N-0407 Oslo, Norway, ^b Section of Epidemiology, Department of Population Health Sciences, National Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway, ^c Medical Birth Registry of Norway, Haukeland Hospital, N-5021 Bergen, Norway, ^d Department of Paediatrics, Haukeland Hospital

Correspondence to: L C Stene lars.christian.stene{at}folkehelsa.no

Objective: To estimate the associations of maternal and paternal age at delivery and of birth order with the risk of childhood onset type 1 diabetes.
Design: Cohort study by record linkage of the medical birth registry and the national childhood diabetes registry in Norway.
Setting: Norway.
Subjects: All live births in Norway between 1974 and 1998 (1.4 million people) were followed for a maximum of 15 years, contributing 8.2 million person years of observation during 1989-98. 1824 cases of type 1 diabetes diagnosed between 1989 and 1998 were identified.
Main outcome measures: Incidence of type 1 diabetes.
Results: There was no association between maternal age at delivery and type 1 diabetes among firstborn children, but among fourthborn children there was a 43.2% increase in incidence of diabetes for each five year increase in maternal age (95% confidence interval 6.4% to 92.6%). Each increase in birth order was associated with a 17.9% reduction in incidence (3.2% to 30.4%) when maternal age was 20-24 years, but the association was weaker when maternal age was 30 years or more. Paternal age was not associated with type 1 diabetes after maternal age was adjusted for.
Conclusions: Intrauterine factors and early life environment may influence the risk of type 1 diabetes. The relation of maternal age and birth order to risk of type 1 diabetes is complex.

What is already known on this topic Maternal age at birth is positively associated with risk of childhood onset type 1 diabetes Studies of the effect of birth order on risk of type 1 diabetes have given inconsistent results What does this study add? In a national cohort, risk of diabetes in firstborn children was not associated with maternal age Increasing maternal age was a risk factor in children born second or later The strength of the association increased with increasing birth order

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