Maternal and birth characteristics and childhood rhabdomyosarcoma: a report from the Children’s Oncology Group

Abstract

Purpose Previous assessments of childhood rhabdomyosarcoma have indicated maternal and birth characteristics may be associated with tumor development, however, much work remains to identify novel and confirm suspected risk factors. Our objective was to evaluate the associations between maternal and birth characteristics and childhood rhabdomyosarcoma. Methods This case-control study included 322 cases and 322 pair-matched controls. Cases were enrolled in a trial run by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls were identified using random digit dialing and were individually matched to cases on race, sex, and age. Families of the case and control subjects participated in a telephone interview, which captured information on maternal characteristics (birth control use, number of prenatal visits, anemia, and abnormal bleeding during pregnancy) and birth characteristics (birth weight, preterm birth, and type of delivery (vaginal vs. Cesarean)). Conditional logistic regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for age, race, sex, household income, and parental education. As the two most common histologic types of rhabdomyosarcoma are embryonal (n=215) and alveolar (n=66), we evaluated effect heterogeneity of these exposures. Results The only characteristic that was associated with childhood rhabdomyosarcoma, and statistically significant, was abnormal vaginal bleeding during pregnancy (OR=1.75, 95% CI=1.12–2.74). Birth control use (OR=1.45, 95% CI=0.96–2.18), anemia during pregnancy (OR=1.27, 95% CI=0.81–1.99), and preterm birth (OR=2.51, 95% CI=0.74–8.49) were positively associated with childhood rhabdomyosarcoma, but were not statistically significant. Low birth weight (aOR=4.46, 95% CI=1.41–14.1) and high birth weight (aOR=2.41, 95% CI=1.09–5.35) were strongly associated with alveolar rhabdomyosarcoma. However, these factors did not display significant effect heterogeneity between histologic types (p>0.15 for all characteristics). Conclusions Overall, we found little evidence that these maternal and birth characteristics are strongly associated with childhood rhabdomyosarcoma.

Perinatal and familial risk factors for soft tissue sarcomas in childhood through young adulthood: A population‐based assessment in 4 million live births

“…However, this finding has not been evaluated or reported for other STS subtypes. Additionally, in our subtype analyses, we did observe an association between preterm birth and RMS, which has been reported in previous and independent assessments . As with the association with congenital malformations, the underlying mechanisms supporting the role of fetal growth and preterm delivery on STS are not yet established.…”

“…Maternal BMI, gestational hypertension, gestational diabetes, preeclampsia, Cesarean delivery, geographic setting of birth residence and income were not associated with subsequent STS risk. While some of these factors have been associated with STS subtypes in previous assessments (e.g., Cesarean delivery and RMS), none are considered to be well‐established risk factors for these malignancies.…”

“…Additionally, in our subtype analyses, we did observe an association between preterm birth and RMS, which has been reported in previous and independent assessments. 27 As with the association with congenital malformations, the underlying mechanisms supporting the role of fetal growth and preterm delivery on STS are not yet established. It has been suggested that growth factors such as IGF-I and IGF-II may be Pre-pregnancy body mass index (BMI) data collection began in 1982.…”

The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report From the Children's Oncology Group

“…Further studies are needed to validate our findings. Our findings add to the growing body of literature, suggesting a protective role of routine vaccinations in childhood cancer and specifically in childhood RMS.prenatal X-ray exposure,[5] parental drug use,[6] advanced maternal age, and large for gestational age at birth [7] in the etiology of childhood RMS. However, few of these factors have been validated in independent assessments.…”

“…We evaluated the following questionnaire items related to immunizations: "Is your child up-to-date on his immunizations"; "Has your child had the following immunizations: (1) diphtheria, tetanus, and pertussis (DPT), (2) measles, mumps, and rubella (MMR), (3) oral polio vaccine (OPV), (4) hepatitis B, (5) smallpox, and (6) bacillus Calmette-Guérin"; and "How many doses of these immunizations did your child receive." In addition, the parents were asked about the child's infection history: "Did your child have any of the following infections before diagnosis: (1) chicken pox, (2) mumps, (3) German measles (rubella), (4) red measles (rubeola), (5) whooping cough, (6) scarlet fever, (7) rheumatic fever, (8) pneumonia, (9) tuberculosis, (10) other lung infections, (11) infectious mononucleosis, and (12) meningitis. "…”