{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T03:30:03Z","timestamp":1783827003080,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T00:00:00Z","timestamp":1648512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det om H\u00e4lsa, Arbetsliv och V\u00e4lf\u00e4rd","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008550","name":"Diabetesfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008550","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Our aim was to synthesize current evidence on the association between parental smoking and incidence of type 1 diabetes and islet autoantibody positivity (IA) in the offspring by conducting a systematic review and meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched Medline, Embase, and Cochrane Library until January 21, 2021, for human studies with parental tobacco use as exposure, type 1 diabetes or IA as outcome, and hazard, risk, or odds ratios as effect estimates. Summary relative risks (RR) and 95% confidence intervals (CI) were estimated with random\u2010effects models. Heterogeneity was quantified with the I<jats:sup>2<\/jats:sup>\u00a0statistic, bias with the ROBINS\u2010I tool, and the certainty of evidence with the GRADE tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 535 records of which 23 were eligible including 25\u00a0927 cases of type 1 diabetes. Maternal smoking during pregnancy was associated with a reduced risk of type 1 diabetes (<jats:italic>n<\/jats:italic>\u00a0=\u00a022, RR 0.78, CI 0.71\u20130.86,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>=69%). Including only studies with low to moderate risk of bias indicated similar results with less heterogeneity (<jats:italic>n<\/jats:italic>\u00a0=\u00a014, RR 0.73, CI 0.68\u20130.79,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a044%). The certainty of evidence was graded as high. There was no clear association between type 1 diabetes and neither maternal (<jats:italic>n<\/jats:italic>\u00a0=\u00a06, RR 0.95, CI 0.78\u20131.14,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%) nor paternal (<jats:italic>n<\/jats:italic>\u00a0=\u00a06, RR 0.90, 0.70\u20131.17,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a068%) smoking during childhood. Furthermore, the association between maternal smoking during pregnancy and IA was weak (<jats:italic>n<\/jats:italic>\u00a0=\u00a04, RR 0.86, CI 0.44\u20131.65,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a071%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Maternal smoking during pregnancy may reduce the risk of type 1 diabetes in the offspring. Further studies are needed to elucidate potential mechanisms underlying this association.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registration<\/jats:title><jats:p>Prospero CRD42021236717.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14830","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T18:27:52Z","timestamp":1647368872000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Parental smoking, type 1 diabetes, and islet autoantibody positivity in the offspring: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6009-8738","authenticated-orcid":false,"given":"Jessica","family":"Edstorp","sequence":"first","affiliation":[{"name":"Institute of Environmental Medicine Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3640-3827","authenticated-orcid":false,"given":"Anna\u2010Maria","family":"Lampousi","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9497-2331","authenticated-orcid":false,"given":"Sofia","family":"Carlsson","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00316-2"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0913"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-2348"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-020-05111-w"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1111\/obr.12858","article-title":"The influence of maternal body mass index, maternal diabetes mellitus, and maternal smoking during pregnancy on the risk of childhood\u2010onset type 1 diabetes mellitus in the offspring: Systematic review and meta\u2010analysis of observational studies","volume":"8","author":"Hidayat K","year":"2019","journal-title":"Obes Rev"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.ad"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.12836"},{"key":"e_1_2_9_10_1","first-page":"563","article-title":"Environmental risk factors for type 1 diabetes mellitus development","volume":"8","author":"Boljat A","year":"2017","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00400261"},{"key":"e_1_2_9_12_1","first-page":"732","article-title":"Environmental factors associated with childhood\u2010onset type 1 diabetes mellitus: An exploration of the hygiene and overload hypotheses","volume":"8","author":"D'Angeli MA","year":"2008","journal-title":"Arch Pediatr Adolesc Med"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.317"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-013-3122-7"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-015-3580-1"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-1130"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000911"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2004.01282.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-014-9985-1"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12994"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-281"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102007\u2010973829"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.12.3.209"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh159"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/78.6.1128"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-005-0878-1"},{"key":"e_1_2_9_27_1","first-page":"43","article-title":"Paternal smoking is associated with a decreased prevalence of type 1 diabetes mellitus among offspring in two national British birth cohort studies (NCDS and BCS70)","volume":"1","author":"Toschke AM","year":"2007","journal-title":"J Perinat Med"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-006-0236-1"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199705)14:5<390::AID-DIA364>3.0.CO;2-E"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5448.2011.00758.x"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-06-0427"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.300.3.876"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.660342"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.110.169961"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd1797"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.RA118.004617"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01536701"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199403243301202"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.13.1428"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphs.2014.12.016"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1210\/en.2012-1452"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.13613"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4308-1"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-1419"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03729-1"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.14830","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.14830","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.14830","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T21:41:07Z","timestamp":1700343667000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.14830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,29]]},"references-count":44,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1111\/dme.14830"],"URL":"https:\/\/doi.org\/10.1111\/dme.14830","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,29]]},"assertion":[{"value":"2021-08-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14830"}}