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Pre- and perinatal risk factors for childhood leukaemia and other malignancies: a Scottish case control study
P A McKinney1, E Juszczak, E Findlay
1Scottish Cancer Intelligence Unit, ISD Scotland, Trinity Park House, Edinburgh, UK.
Insights
Early childhood infections may lower leukemia risk, while birth asphyxia increases it. Maternal education and pregnancy infections show complex associations with other childhood cancers.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Environmental Health
Background:
- Childhood cancers, including leukemia, lymphoma, CNS tumors, and other solid tumors, represent a significant health concern.
- Identifying prenatal, delivery, and neonatal risk factors is crucial for understanding and preventing childhood cancers.
Purpose of the Study:
- To investigate risk factors for childhood cancers in the prenatal, delivery, and neonatal periods.
- To analyze associations between specific risk factors and different cancer types in children.
Main Methods:
- A case-control study involving Scottish children aged 0-14 years.
- Age- and sex-matched controls were selected.
- Data were abstracted from maternal hospital obstetric records; conditional logistic regression was used for analysis.
Main Results:
- Neonatal infection was associated with a reduced risk of acute lymphoblastic leukemia (ALL) (OR 0.49, 95% CI 0.26-0.95).
- Asphyxia at birth significantly increased leukemia risk, specifically ALL.
- For other solid tumors, higher maternal education was linked to lower risk, while pregnancy antibiotic use and respiratory infections were associated with increased risk.
Conclusions:
- Early exposure to infections may protect against childhood ALL.
- Birth asphyxia is a risk factor for childhood leukemia.
- Maternal factors like education and infections during pregnancy have complex associations with other childhood solid tumors.
Abstract:
A case control study of Scottish children aimed to identify risk factors for leukaemia and other cancers operating in the prenatal environment, during delivery and neonatally. Cases (0-14 years) were age-and sex- matched to two population-based controls and details abstracted from the mother's hospital obstetric notes. Analyses of 144 leukaemias (124 acute lymphoblastic leukaemias (ALL)), 45 lymphomas, 75 central nervous system (CNS) tumours and 126 'other solid tumours' were conducted using conditional logistic regression. The presence of a neonatal infection significantly reduced the risk of ALL (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.26-0.95), particularly in 0- to 4-year-olds. Positive swab tests confirmed 47% of ALL cases with any infection and 46% of controls. This is consistent with the hypothesis that early exposure to infections may reduce the risk of childhood ALL. Asphyxia at birth significantly increased the risk of leukaemia, which was accounted for by ALL. For the 'other solid tumours' higher levels of maternal education were inversely associated with risk (OR 0.59, 95% CI 0.37-0.94) but positively associated with antibiotics (OR 2.16 95% CI 1.10-4.25) and respiratory tract infections (OR 14.1, 95% CI 1.76-113.7) in pregnancy. No obvious plausible patterns of risk were detected either within or across disease subgroups.