Respiratory infections in pregnancy and early life-association with the development of islet autoimmunity and type 1 diabetes in children: systematic review and meta-analysis of observational studies.
Claire J Sung, Orlaith M Plowman, Anna J Maxwell, William D Rawlinson, Maria E Craig, Ki Wook Kim
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引用次数: 0
Abstract
Background: Respiratory tract infections (RTIs) in pregnancy and early childhood are potential environmental triggers of islet autoimmunity (IA) and type 1 diabetes (TD). We reviewed the association between gestational and childhood RTIs and the development of IA or T1D in the offspring.
Methods: Systematic review and meta-analysis, analysed using random effects models, of observational human studies from Medline and EMBASE, without language restriction, from inception until Jan 6, 2025. The inclusion criteria were cohort, case-control, nested case control or retrospective cohort studies investigating confirmed RTI in childhood or pregnancy by reported history or detection by throat swab before/at IA seroconversion and/or T1D diagnosis in children aged < 18 years. The study is registered with PROSPERO, CRD42020193860.
Findings: The systematic review included 26 studies of childhood RTIs involving 12,236,305 participants (14,646 cases, 12,221,659 controls) and four studies of gestational RTIs involving 109,976 participants (979 cases, 108,997 controls). Study design and quality varied, with moderate to high statistical heterogeneity. Meta-analysis of 15 studies demonstrated that childhood RTIs were significantly associated T1D (OR 1.47, 95% CI 1.23-1.75, p < 0.0001) but not significantly associated with IA. Meta-analysis of studies investigating gestational RTIs and T1D found no significant associations and only one of the studies found an association between maternal RTIs in the first trimester based on history and T1D in the offspring (OR 2.31, 95% CI 1.32-4.04, p = 0.002).
Interpretation: Our analysis suggests childhood RTIs were significantly associated with risk of T1D, highlighting the need to further investigate the association between childhood RTIs using molecular testing and subsequent risk of IA/T1D.
背景：妊娠期和幼儿期呼吸道感染（RTIs）是胰岛自身免疫（IA）和1型糖尿病（TD）的潜在环境触发因素。我们回顾了妊娠期和儿童期rti与后代IA或T1D发展之间的关系。方法：采用随机效应模型对Medline和EMBASE中从开始到2025年1月6日无语言限制的观察性人体研究进行系统评价和荟萃分析。纳入标准为队列研究、病例对照研究、巢式病例对照研究或回顾性队列研究，调查年龄< 18岁的儿童在IA血清转化和/或T1D诊断之前或期间通过报告病史或咽拭子检测证实的儿童期或妊娠期RTI。该研究已注册为PROSPERO， CRD42020193860。结果：系统评价包括26项儿童rti研究，涉及12236305名受试者（14646例，12221659名对照），4项妊娠rti研究，涉及109976名受试者（979例，108997名对照）。研究设计和质量各不相同，具有中等到高度的统计异质性。15项研究的荟萃分析显示，儿童RTIs与T1D显著相关（OR 1.47, 95% CI 1.23-1.75, p < 0.0001），但与IA无显著相关。对调查妊娠期rti和T1D的研究进行荟萃分析，发现没有显著关联，只有一项研究发现基于病史的妊娠早期母亲rti与后代T1D之间存在关联（OR 2.31, 95% CI 1.32-4.04, p = 0.002）。解释：我们的分析表明，儿童RTIs与T1D风险显著相关，强调需要进一步研究儿童RTIs与随后IA/T1D风险之间的关系。资助：JDRF， NHMRC。
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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