Maternal Age at Birth and Childhood Type 1 Diabetes: A Pooled Analysis of 30 Observational Studies

  1. Chris R. Cardwell1,
  2. Lars C. Stene2,3,
  3. Geir Joner4,
  4. Max K. Bulsara5,
  5. Ondrej Cinek6,
  6. Joachim Rosenbauer7,
  7. Johnny Ludvigsson8,
  8. Mireia Jané9,
  9. Jannet Svensson10,
  10. Michael J. Goldacre11,
  11. Thomas Waldhoer12,
  12. Przemysława Jarosz-Chobot13,
  13. Suely G.A. Gimeno14,
  14. Lee-Ming Chuang15,
  15. Roger C. Parslow16,
  16. Emma J.K. Wadsworth17,
  17. Amanda Chetwynd18,
  18. Paolo Pozzilli19,
  19. Girts Brigis20,
  20. Brone Urbonaitė21,
  21. Sandra Šipetić22,
  22. Edith Schober23,
  23. Gabriele Devoti24,
  24. Constantin Ionescu-Tirgoviste25,
  25. Carine E. de Beaufort26,
  26. Denka Stoyanov27,
  27. Karsten Buschard28 and
  28. Chris C. Patterson1
  1. 1Centre for Public Health, Queen's University Belfast, Belfast, U.K.;
  2. 2Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway;
  3. 3Oslo Research Centre, Oslo University Hospital, Oslo, Norway;
  4. 4Institute of Health Management and Health Economics, University of Oslo, Oslo, Norway;
  5. 5Institute of Health and Rehabilitation Research, University of Notre Dame, Freemantle, Australia;
  6. 6The 2nd Medical School, Charles University, Prague, Czech Republic;
  7. 7Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Institute at Dusseldorf University, Dusseldorf, Germany;
  8. 8Department of Paediatrics and Diabetes Research Centre, Linkoping University, Linkoping, Sweden;
  9. 9Public Health Division, Department of Health, Barcelona, Spain;
  10. 10Pediatric Department, Glostrup University Hospital, Glostrup, Denmark;
  11. 11Department of Public Health, Oxford University, Oxford, U.K.;
  12. 12Department of Epidemiology, Medical University of Vienna, Vienna, Austria;
  13. 13Department of Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland;
  14. 14Preventive Medicine Department, Federal University of Sao Paulo, Sao Paulo, Brazil;
  15. 15Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;
  16. 16Paediatric Epidemiology Group, University of Leeds, Leeds, U.K.;
  17. 17Centre for Occupational and Health Psychology, Cardiff University, Cardiff, U.K.;
  18. 18Mathematics & Statistics Department, Lancaster University, Lancaster, U.K.;
  19. 19University Campus Bio-Medico, Rome, Italy;
  20. 20Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia;
  21. 21Institute of Endocrinology, Kaunas University of Medicine, Kaunas, Lithuania;
  22. 22Institute of Epidemiology, School of Medicine, Belgrade University, Belgrade, Serbia;
  23. 23Department of Paediatrics, Medical University of Vienna, Vienna, Austria;
  24. 24Department of Social Sciences and Communication, University of Lecce, Lecce, Italy;
  25. 25Nutrition and Metabolic Diseases Clinic, “N. Paulescu” Institute of Diabetes, Bucharest, Romania;
  26. 26Clinique Pediatrique, Luxembourg, Luxembourg;
  27. 27Children's Diabetic Centre, Sofia, Bulgaria;
  28. 28Bartholin Instituttet, Rigshospitalet, Copenhagen, Denmark.
  1. Corresponding author: Chris Cardwell, c.cardwell{at}


OBJECTIVE The aim if the study was to investigate whether children born to older mothers have an increased risk of type 1 diabetes by performing a pooled analysis of previous studies using individual patient data to adjust for recognized confounders.

RESEARCH DESIGN AND METHODS Relevant studies published before June 2009 were identified from MEDLINE, Web of Science, and EMBASE. Authors of studies were contacted and asked to provide individual patient data or conduct prespecified analyses. Risk estimates of type 1 diabetes by maternal age were calculated for each study, before and after adjustment for potential confounders. Meta-analysis techniques were used to derive combined odds ratios and to investigate heterogeneity among studies.

RESULTS Data were available for 5 cohort and 25 case-control studies, including 14,724 cases of type 1 diabetes. Overall, there was, on average, a 5% (95% CI 2–9) increase in childhood type 1 diabetes odds per 5-year increase in maternal age (P = 0.006), but there was heterogeneity among studies (heterogeneity I2 = 70%). In studies with a low risk of bias, there was a more marked increase in diabetes odds of 10% per 5-year increase in maternal age. Adjustments for potential confounders little altered these estimates.

CONCLUSIONS There was evidence of a weak but significant linear increase in the risk of childhood type 1 diabetes across the range of maternal ages, but the magnitude of association varied between studies. A very small percentage of the increase in the incidence of childhood type 1 diabetes in recent years could be explained by increases in maternal age.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received August 6, 2009.
    • Accepted October 23, 2009.
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  1. Diabetes vol. 59 no. 2 486-494
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