Autoimmune destruction of the pancreatic bgr;-cells may well beginin uteroor at about the time of birth. Most but not all previous studies note a correlation between type 1 (insulin-dependent) diabetes in childhood and advanced maternal age. This population-based case-control study enrolled 196 children diagnosed as having type 1 diabetes and 325 control children matched for age and gender. The goal was to identify any environmental factors that might influence the onset of diabetes in childhood.Roughly 95 percent of both case and control subjects were white. Exclusive breast-feeding seemed to protect against diabetes. The risk of diabetes increased in the presence of certain postdelivery illnesses, chiefly infections and respiratory problems (including birth asphyxia). Hospitalization patterns were similar for case and control subjects. On univariate analysis, a maternal age older than 35 years correlated with childhood diabetes, as did type 1 diabetes in the mother and delivery by cesarean section. Cesarean delivery was no longer a significant factor after further analysis, and maternal age was of only borderline significance. No particular significance was attached to high or low birth weight, being the first born, or being a small-for-gestational-age infant.Neither the degree of maturation at birth nor birth size seem to strongly predict the development of childhood type 1 diabetes. It is not clear whether the apparent benefit from breast-feeding relates to the presence in cowsrsquo; milk of proteins that dispose to diabetes. Part of the reason why excessive illness correlates with diabetes may be that diabetic or preeclamptic mothers are more likely to have their newborn infants closely monitored. Older maternal age and maternal type 1 diabetes do seem to be important risk factors for childhood diabetes.Diabetes Care 1999;22colon;928ndash;932
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