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Prelabor cesarean delivery and early-onset acute childhood leukemia risk

Thomas P Thomopoulos1, Alkistis Skalkidou, Nick Dessypris

  • 1aDepartment of Hygiene, Epidemiology and Medical Statistics, School of Medicine bFirst Department of Pediatrics, 'Aghia Sophia' Children's Hospital, School of Medicine, University of Athens cDepartment of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital dDepartment of Pediatric Haematology-Oncology, 'Aghia Sophia' Children's Hospital eHaematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, 'Aghia Sophia' Children's Hospital fFirst Department of Obstetrics and Gynecology, 'Alexandra' Hospital, School of Medicine, University of Athens, Athens gSecond Department of Pediatrics, AHEPA General Hospital, Aristotelion University of Thessaloniki hDepartment of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki iDepartment of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece jDepartment of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (ECP)
|March 21, 2015
PubMed

Insights

Cesarean delivery (CD) is linked to a higher risk of early-onset acute lymphoblastic leukemia (ALL), especially the B-ALL subtype, particularly when performed before labor. This finding suggests a need to re-evaluate prelabor CD practices.

Area of Science:

  • Pediatric Oncology
  • Reproductive Medicine
  • Epidemiology

Background:

  • Cesarean delivery (CD) is a common birth method with potential long-term health implications for offspring.
  • The association between CD and childhood cancers, particularly acute lymphoblastic leukemia (ALL), requires further investigation.

Purpose of the Study:

  • To examine the impact of prelabor and during-labor CD on the risk of early-onset ALL (≤3 years), specifically the B-ALL subtype.
  • To investigate the association between CD and acute myeloid leukemia (AML) in early childhood.

Main Methods:

  • Analysis of 1099 incident ALL cases (957 B-ALL) and 131 AML cases with matched controls from a nationwide registry (1996-2013).
  • Multivariate regression models were used to assess the risk associated with prelabor and during-labor CD.
  • Stratification by age (0-14 years) and specific leukemia subtypes (B-ALL, AML).

Main Results:

  • No significant association was found between CD (prelabor or during-labor) and ALL or AML in the 0-14 age range.
  • Birth by CD significantly increased the risk of early-onset ALL (ORCD=1.57), primarily driven by prelabor CD (ORprelaborCD=1.66).
  • The risk was even higher for early-onset precursor B-ALL (ORCD=1.66, ORprelaborCD=1.79), with no association for early-onset AML.

Conclusions:

  • Prelabor CD is associated with an increased risk of early-onset ALL, particularly the precursor B-ALL subtype.
  • This association may be linked to the absence of fetal exposure to stress hormones during vaginal or during-labor CD.
  • Findings suggest a potential need to re-evaluate prelabor CD practices and explore methods to mimic vaginal delivery effects.

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