Maternal and Perinatal Exposures Are Associated With Risk for Pediatric-Onset Multiple Sclerosis
Jennifer S Graves1, Tanuja Chitnis2, Bianca Weinstock-Guttman3
1Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, California; jennifer.graves@ucsf.edu.
Insights
Maternal illness during pregnancy and pesticide exposure may increase the risk of pediatric multiple sclerosis (MS). Cesarean delivery, however, may reduce MS risk in children. Further research is needed to confirm these findings.
Area of Science:
- Environmental Health
- Pediatric Neurology
- Epidemiology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Pediatric-onset MS (POMS) presents unique diagnostic and management challenges.
- Understanding environmental risk factors for POMS is crucial for prevention and early intervention.
Purpose of the Study:
- To investigate the association between prenatal, pregnancy, and postpartum environmental factors and the risk of pediatric MS.
- To identify potential modifiable risk factors for POMS.
Main Methods:
- A case-control study involving children diagnosed with MS or clinically isolated syndrome and healthy controls.
- Comprehensive environmental questionnaires completed by parents, capturing perinatal and other exposures.
- Multivariable logistic regression analyses to assess the association of environmental factors with MS risk, adjusting for confounders.
Main Results:
- Maternal illness during pregnancy was associated with a 2.3-fold increased odds of pediatric MS.
- Cesarean delivery was linked to a 60% reduction in the odds of pediatric MS.
- Exposure to pesticides and paternal occupation in gardening were associated with increased odds of pediatric MS.
Conclusions:
- Maternal health during pregnancy and delivery mode (cesarean section) may influence the risk of pediatric MS.
- Pesticide exposure represents a novel potential risk factor for pediatric MS requiring further investigation.
- These findings highlight the importance of environmental factors in the etiology of POMS.
Objective:
To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children.
Methods:
This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status.
Results:
Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20-4.21, P = .01) and cesarean delivery with 60% reduction (95% CI 0.20-0.82, P = .01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardening-related occupation (odds ratio [OR] 2.18, 95% CI 1.14-4.16, P = .02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06-2.81, P = .03) were both associated with increased odds to have pediatric MS.
Conclusion:
Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.
