Maternal type 1 diabetes mellitus and atopic dermatitis in offspring: A nationwide cohort study.

BACKGROUND

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases of childhood and contributes substantially to early-life morbidity. Maternal metabolic and allergic conditions have been linked to offspring atopic disease; however, the effect of maternal type 1 diabetes mellitus (T1DM), a chronic autoimmune condition, on AD risk in offspring has not been well defined.

OBJECTIVES

To examine the association between maternal T1DM during pregnancy and the prevalence of atopic dermatitis in offspring.

METHODS

We conducted a nationwide retrospective cohort study using electronic medical records from Clalit Health Services, Israel's largest health maintenance organization. Singleton live births between January 1, 2010, and December 31, 2023, were included, with follow-up through December 31, 2024. Maternal T1DM and offspring AD were identified using International Classification of Diseases, 10th Revision codes. Multivariable logistic regression models were used to estimate associations, adjusting for maternal age, socioeconomic status, smoking status, gestational age, infant sex, delivery mode, ethnicity, allergic rhinitis, and follow-up duration.

RESULTS

The cohort included 311,708 mother-child pairs, of whom 1104 (0.35%) were born to mothers with T1DM. Atopic dermatitis was more prevalent among offspring of mothers with T1DM compared with those without T1DM (29% vs 26%). In adjusted analyses, maternal T1DM was associated with increased odds of AD in offspring (odds ratio 1.15; 95% confidence interval 1.00-1.32). Additional independent predictors included male sex, maternal smoking, maternal allergic rhinitis, higher socioeconomic status, and shorter gestational age. Maternal hemoglobin A1c levels >6.5% were not associated with AD prevalence.

CONCLUSIONS

In this large population-based cohort, maternal T1DM was associated with an increase in the prevalence of AD in offspring. While the magnitude of the effect is small, these findings suggest that maternal autoimmune status may contribute to early-life atopic risk.