Children born to mothers with autoimmune diseases face a 57% higher risk of developing type 1 diabetes (T1D) later in life, according to a large-scale study published October 26, 2026, in JAMA Pediatrics. Researchers analyzing data from over 1 million Swedish children found that this elevated risk persists even when adjusting for multiple maternal health factors, suggesting a complex interplay between family history and early-life development.
Findings from the Swedish Cohort Study
The study, led by Huan Zhang of the Karolinska Institute, tracked 1,455,645 live-born children in Sweden between 2001 and 2014. During a median follow-up period of 15.3 years, 10,273 children were diagnosed with T1D. Medscape reported that 6.1% of the total cohort had been exposed to maternal autoimmune disease during pregnancy. These children were found to be more likely to be born preterm or large for gestational age compared to those not exposed to such conditions.
After adjusting for variables such as maternal parity and cardiovascular disease, the researchers identified a hazard ratio of 1.57 for T1D among offspring of mothers with autoimmune conditions. When further adjusting for maternal T1D, the association remained significant at 4.51.
Paternal Conditions Elevate Offspring Susceptibility
The research team observed that paternal autoimmune disease also correlates with an increased risk for offspring, elevating it by 51%. Research shows that genetic factors passed through families may contribute to how diseases affect multiple generations.
In a cousin analysis designed to account for shared genetic backgrounds and family environments, the association between maternal autoimmune disease and offspring T1D remained, though it was attenuated. Xingbo Mo, a coauthor of the study and professor at Nanjing Medical University, noted that while this comparison helps control for familial factors, it cannot fully isolate genetic or environmental influences or establish a definitive intrauterine effect.
Variations in Disease-Specific Risk
The risk levels varied depending on the specific maternal or paternal autoimmune condition. Rheumatoid arthritis showed a similar impact on offspring risk regardless of which parent was affected, with hazard ratios of 1.83 for mothers and 1.79 for fathers. Other conditions showed gender-specific differences:
* Autoimmune thyroiditis: The risk was stronger for offspring of affected fathers (HR 2.28) than for those of affected mothers (HR 1.45).
* Maternal-specific conditions: Ankylosing spondylitis (HR 2.00), vitiligo (HR 1.91), and celiac disease (HR 1.70) were significantly associated with T1D risk in children.
* Paternal-specific conditions: Sarcoidosis was linked to a 64% increased risk in offspring.
Clinical Implications for Screening
Despite these findings, researchers caution against immediate changes to clinical screening protocols. Mo emphasized that the study was observational and not designed to assess the cost-effectiveness or safety of routine screening for islet autoantibodies. While some international consensus reports suggest prioritizing relatives of people with autoimmune diseases for T1D screening, the absolute risk for most children in the study remained low.
William A. Hagopian, a pediatric endocrinologist at the Indiana University School of Medicine who was not involved in the study, noted that the biological mechanisms—such as why ankylosing spondylitis, which is linked to HLA-B27, might influence T1D risk—remain unclear. He suggested that because obtaining a comprehensive family history is often difficult in clinical practice, focusing on easily identifiable conditions like thyroid disease might be a more practical approach for future risk stratification.
Study Shows Parental Disease Raises Risk
Does having two parents with autoimmune disease increase the risk further?
Yes, the study found that the risk for T1D in offspring increases progressively with the number of affected parents, with the highest risk observed in children exposed to autoimmunity from both parents.
Does this study prove that autoimmune diseases during pregnancy cause T1D?
No, the study is observational and cannot establish causality. Researchers noted that they could not fully account for all factors, such as viral exposures during pregnancy or specific genetic predispositions, which may also contribute to the observed associations.
What are the next steps for research in this field?
Future research is needed to determine how to effectively use this risk data for stratification and to establish whether specific groups should be prioritized for screening, taking into account local resources and the availability of follow-up care.