Perinatal risk factors for pediatric onset type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis, and inflammatory bowel diseases

Laura Räisänen,Kaija-Leena Kolho,Catharina Sarkkola,Heli Viljakainen

doi:10.1007/s00431-021-03987-3

Abstract

Type 1 diabetes mellitus (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), and inflammatory bowel diseases (IBD) are common pediatric autoimmune diseases with unknown risk factors. Using nationwide registers, we searched for their perinatal risk factors. Our study followed up 11,407 children (born 2000–2005) for a median of 16.6 years (from birth to 2018). Of them, 2.15% received primary diagnosis and 0.08% also secondary: 0.89% had DM, 0.60% had AIT, 0.48% had JIA, and 0.25% had IBD. The incidences per 100,000 children/year were 106.1 for DM, 46.0 for AIT, 55.0 for JIA, and 23.7 for IBD. There were more preterm births (< 37 weeks) among children with studied autoimmune diseases compared with the rest of the cohort (8.6% vs. 5.3%, p = 0.035). Among those born preterm, children with studied autoimmune diseases received more postnatal antibiotics compared with other preterm children in the cohort (47.6% vs. 27.7%, p = 0.046). Children with IBD were born to older mothers compared with those without studied diagnoses (33.0 vs 30.2, p = 0.004).Conclusion: Preterm birth was a shared risk factor for autoimmune diseases in our study, especially when combined with postnatal antibiotic treatments. High maternal age was associated with IBD.What is Known:• Type 1 diabetes (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), and inflammatory bowel diseases (IBD) are common pediatric autoimmune diseases• It is unclear whether these diseases have shared risk factors, since there are no previous simultaneous epidemiological nor follow-up studies on them in one cohort What is New:• Preterm births were more common in children with DM, AIT, JIA, or IBD compared with other children in the cohort, and preterm children who developed these diseases recieved more postnatal antibiotics compared with other preterm children• High maternal age was associated with IBD

Highlights

Autoimmune diseases are disorders, where the immune system attacks normal tissues
High maternal age was associated with inflammatory bowel diseases (IBD)
Preterm births were more common in children with diabetes mellitus (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), or IBD compared with other children in the cohort, and preterm children who developed these diseases recieved more postnatal antibiotics compared with other preterm children

Summary

Introduction

Autoimmune diseases are disorders, where the immune system attacks normal tissues. Mutual environmental triggers have not been identified—even when continuously increasing incidence of these diseases (including those with pediatric onset) may suggest their presence [5]. AIT is a disorder of thyroid hormone secretion due to T cell-mediated attack on thyroid gland, causing hypothyroidism [9]. Dysfunction of adaptive immune system in oligo-/polyarticular JIA results in accumulation of activated T cells in synovial membrane [10]. While oligo-/polyarticular JIA stays in the joints, systemic JIA (presenting dysfunction of the innate immune system) could affect extrasynovial tissues as well, eliciting symptoms like spiking fever, rash, serositis, lymphadenopathy, and hepatosplenomegaly [11]. IBD are chronic autoimmune inflammations of gastrointestinal tract, involving T cell infiltration in the gut mucosa [12]. When variations in the location, nature, and severity of inflammation in the colon are present, the term IBD unclassified (IBDU) is used [15]

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