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Association between cesarean delivery and pediatric leukemia: A case-control study using a Japanese administrative

Yohko Nakamura1, Yoshihide Terada2, Naoto Kaneko1

  • 1Chiba Cancer Center Research Institute, Chiba, Japan.

Cancer Epidemiology
|July 14, 2026
PubMed

Insights

Cesarean delivery is not linked to pediatric leukemia risk in Japan, according to a large case-control study. This finding suggests birth mode may not influence childhood cancer development, contrary to some hypotheses.

Area of Science:

  • Pediatric Oncology
  • Epidemiology
  • Immunology

Background:

  • The causes of childhood leukemia are not fully understood.
  • The delayed infection hypothesis proposes that reduced early microbial exposure may lead to immune dysregulation and leukemia.
  • Cesarean delivery's impact on early microbial colonization and immune development warrants investigation for its potential link to pediatric leukemia, especially in Asian populations where findings are inconsistent.

Purpose of the Study:

  • To investigate the association between cesarean delivery and the risk of pediatric leukemia in a Japanese population.
  • To address inconsistencies in previous research regarding birth mode and childhood leukemia.
  • To explore potential links between early-life factors and leukemia etiology.

Main Methods:

  • A large case-control study was conducted using Japanese administrative claims data from 2008-2024.
  • Children with Down syndrome were excluded from the primary analysis due to its strong association with leukemia.
  • Multivariable conditional logistic regression was employed to assess the association between cesarean delivery and pediatric leukemia, controlling for maternal and perinatal factors.

Main Results:

  • In the primary analysis (excluding Down syndrome), cesarean delivery was not significantly associated with pediatric leukemia (OR, 0.7; 95% CI, 0.3-1.4).
  • Pediatric complex chronic conditions showed an association with leukemia risk (OR, 3.9; 95% CI, 2.6-6.0), though this requires cautious interpretation.
  • A sensitivity analysis including children with Down syndrome confirmed no significant association for cesarean delivery, while Down syndrome remained strongly linked to leukemia (OR, 30.3; 95% CI, 4.3-216).

Conclusions:

  • Cesarean delivery was not significantly associated with pediatric leukemia in this Japanese study after excluding children with Down syndrome.
  • The findings suggest that birth mode, specifically cesarean delivery, may not be a significant risk factor for pediatric leukemia in this population.
  • Further research is recommended to explore planned vs. emergency cesarean delivery, genetic factors, and clinical variables in relation to pediatric leukemia risk.
Abstract

Keywords:
Case-control studyCesarean deliveryPediatric leukemia

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