The Association Between Gestational Age and Type 1 Diabetes Mellitus in Children and Adolescents: A Systematic Review and Network Meta‐Analysis

ABSTRACT Background With genetics thought to explain a portion of the overall risk of type 1 diabetes mellitus (T1DM), environmental risk factors in early life have been proposed. Previous studies on the incidence of T1DM in children or adolescents by gestational age at birth have yielded inconsistent results. Objectives To clarify the association between gestational age at birth and T1DM in childhood/adolescence and to offer evidence‐based support for the prevention or screening of T1DM. Data Sources PubMed, Embase, Web of Science, and the Cochrane Library were searched from the inception of the databases to February 7, 2024. Study Selection and Data Extraction Data were extracted using a standardised form created a priori, and quality was assessed using the Newcastle‐Ottawa Scale (NOS). Synthesis Due to the diversity of gestational age groups in the original studies, a Bayesian network meta‐analysis was performed to discuss the association of different gestational ages with the risk of T1DM in childhood/adolescence. Results A total of 13 studies on children/adolescents with T1DM were included. Compared with the gestational age of 39–40 weeks, gestational ages of < 37 weeks (odds ratio [OR] 1.35, 95% credible interval [CrI] 1.19, 1.53), 33–36 weeks (OR 1.19, 95% CrI 1.11, 1.27), and 37–38 weeks (OR 1.26, 95% CrI 1.21, 1.30) were correlated with an increased risk of T1DM, whereas gestational ages of < 32 weeks (OR 0.61, 95% CrI 0.43, 0.88) and < 33 weeks (OR 0.72, 95% CrI 0.59, 0.87) were correlated with a lower risk. Conclusions A higher risk of T1DM was observed in infants born early term or preterm compared to full‐term infants. However, the results of this network meta‐analysis indicate that extremely or very preterm infants were less likely to develop T1DM. Further studies are needed to validate this in the future.