Fetal programming of early-onset type 2 diabetes : a Swedish nationwide cohort and sibling analysis
Amadou, Coralie ; Wei, Yuxia ; Tuomi, Tiinamaija LU
; Feychting, Maria
and Carlsson, Sofia
(2025)
In European Journal of Epidemiology
40(7).
p.845-857
- Abstract
Incidence of early-onset (< 40 years) type 2 diabetes (T2D) is increasing. While multiple risk factors have been identified, particularly obesity and low socioeconomic status, early-life factors are hypothesised to play a role via fetal programming. We investigated sociodemographic and early-life factors in relation to early-onset T2D using a family-based design that accounts for shared genetic and environmental factors. We included 1,814,062 individuals born in Sweden 1983 to 2002 with follow-up data until 2020, and identified early-onset (age 19–39) T2D cases (n = 3505) through National Diabetes, Patient and Prescribed Drug Registers. Perinatal and sociodemographic factors were retrieved from registers. We used a cohort and sibling... (More)
Incidence of early-onset (< 40 years) type 2 diabetes (T2D) is increasing. While multiple risk factors have been identified, particularly obesity and low socioeconomic status, early-life factors are hypothesised to play a role via fetal programming. We investigated sociodemographic and early-life factors in relation to early-onset T2D using a family-based design that accounts for shared genetic and environmental factors. We included 1,814,062 individuals born in Sweden 1983 to 2002 with follow-up data until 2020, and identified early-onset (age 19–39) T2D cases (n = 3505) through National Diabetes, Patient and Prescribed Drug Registers. Perinatal and sociodemographic factors were retrieved from registers. We used a cohort and sibling design, with multivariable-adjusted Cox proportional hazards regression. Sociodemographic factors associated with early-onset T2D included low parental education, single parenthood, younger parental age and non-Swedish origin. The latter association did not remain after mutual adjustment. Regarding perinatal factors, a higher incidence was noted in relation to lower birth weight (hazard ratio 2.38 [95% confidence interval: 1.98–2.87] and 1.43[1.33–1.54] for < 2500 g and 2500-3500 g, respectively, vs 3500-4500 g), small-for-gestational-age (SGA) (2.24[1.96–2.56]), large-for-gestational-age (LGA) (1.19[1.01–1.39]), and maternal obesity (2.34[2.04–2.69]), diabetes (1.59[1.36–1.85]), smoking (1.59[1.48–1.71]), and infection (1.21[1.03–1.41]) during pregnancy. In the sibling analysis, only low birth weight and SGA remained associated with early-onset T2D. Early-onset T2D is associated with sociodemographic and multiple perinatal factors; only growth restriction likely reflects fetal programming, while other perinatal-related associations might involve confounders. This study highlights the need for early-life, targeted strategies to prevent T2D and reduce health inequities.
(Less)
- author
- Amadou, Coralie
; Wei, Yuxia
; Tuomi, Tiinamaija
LU
; Feychting, Maria
and Carlsson, Sofia
- organization
- publishing date
- 2025-07
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Birth weight, Early-onset type 2 diabetes, Fetal programming, Maternal diabetes, Perinatal factors, Preterm birth
- in
- European Journal of Epidemiology
- volume
- 40
- issue
- 7
- pages
- 13 pages
- publisher
- Springer
- external identifiers
-
- scopus:105009292504
- pmid:40553354
- ISSN
- 0393-2990
- DOI
- 10.1007/s10654-025-01261-6
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © The Author(s) 2025.
- id
- 0d438b7a-27ee-4a79-a185-3dc0a757ee8c
- date added to LUP
- 2025-12-15 12:50:38
- date last changed
- 2025-12-16 03:00:14
@article{0d438b7a-27ee-4a79-a185-3dc0a757ee8c,
abstract = {{<p>Incidence of early-onset (< 40 years) type 2 diabetes (T2D) is increasing. While multiple risk factors have been identified, particularly obesity and low socioeconomic status, early-life factors are hypothesised to play a role via fetal programming. We investigated sociodemographic and early-life factors in relation to early-onset T2D using a family-based design that accounts for shared genetic and environmental factors. We included 1,814,062 individuals born in Sweden 1983 to 2002 with follow-up data until 2020, and identified early-onset (age 19–39) T2D cases (n = 3505) through National Diabetes, Patient and Prescribed Drug Registers. Perinatal and sociodemographic factors were retrieved from registers. We used a cohort and sibling design, with multivariable-adjusted Cox proportional hazards regression. Sociodemographic factors associated with early-onset T2D included low parental education, single parenthood, younger parental age and non-Swedish origin. The latter association did not remain after mutual adjustment. Regarding perinatal factors, a higher incidence was noted in relation to lower birth weight (hazard ratio 2.38 [95% confidence interval: 1.98–2.87] and 1.43[1.33–1.54] for < 2500 g and 2500-3500 g, respectively, vs 3500-4500 g), small-for-gestational-age (SGA) (2.24[1.96–2.56]), large-for-gestational-age (LGA) (1.19[1.01–1.39]), and maternal obesity (2.34[2.04–2.69]), diabetes (1.59[1.36–1.85]), smoking (1.59[1.48–1.71]), and infection (1.21[1.03–1.41]) during pregnancy. In the sibling analysis, only low birth weight and SGA remained associated with early-onset T2D. Early-onset T2D is associated with sociodemographic and multiple perinatal factors; only growth restriction likely reflects fetal programming, while other perinatal-related associations might involve confounders. This study highlights the need for early-life, targeted strategies to prevent T2D and reduce health inequities.</p>}},
author = {{Amadou, Coralie and Wei, Yuxia and Tuomi, Tiinamaija and Feychting, Maria and Carlsson, Sofia}},
issn = {{0393-2990}},
keywords = {{Birth weight; Early-onset type 2 diabetes; Fetal programming; Maternal diabetes; Perinatal factors; Preterm birth}},
language = {{eng}},
number = {{7}},
pages = {{845--857}},
publisher = {{Springer}},
series = {{European Journal of Epidemiology}},
title = {{Fetal programming of early-onset type 2 diabetes : a Swedish nationwide cohort and sibling analysis}},
url = {{http://dx.doi.org/10.1007/s10654-025-01261-6}},
doi = {{10.1007/s10654-025-01261-6}},
volume = {{40}},
year = {{2025}},
}