Maternal and birth characteristics in relation to childhood leukaemia

Abstract

Our objective was to investigate the association of childhood leukaemia with selected maternal and birth characteristics by conducting a population-based case-control study using linked cancer registry and birth certificate records for Washington State. We compared maternal and infant characteristics of 595 Washington-born residents <20 years old with leukaemia diagnosed during 1981-2003, and 5,950 control children, using stratified analysis and logistic regression. Maternal age 35+ years (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.1, 2.0), infant birthweight 4,000+ g (OR 1.4; 95% CI 1.1, 1.8), neonatal jaundice (OR 1.5; 95% CI 1.1, 2.1), and Down's syndrome (OR 31.3; 95% CI 6.4, 153.4) were associated with an increased risk of leukaemia. Among women with 2+ pregnancies, having at least two prior early (<20 weeks' gestation) fetal deaths was also associated with an increased risk (OR 1.5; 95% CI 0.97, 2.1). Maternal unmarried status (OR 0.7; 95% CI 0.6, 0.9) and African American race (OR 0.5; 95% CI 0.3, 0.9) were associated with a decreased risk. These results were more marked for acute lymphocytic leukaemia (ALL) than for acute myeloid leukaemia (AML), and for leukaemia diagnosed <5 years of age. These results may provide clues to the aetiology of childhood leukaemia. Genetic epidemiological studies are needed to expand our knowledge of inherent and possibly prenatal influences on the occurrence of this disease.

Reproductive history, infertility treatment, and the risk of acute leukemia in children with down syndrome

“…[15][16][17][20][21][22][23][24] One study demonstrated an inverse association. 14 In the current study, we did not observe an increased risk of leukemia because of prior fetal loss either overall or within the ALL or AML subgroups.…”

“…Relative risks for advanced maternal age and childhood leukemia fluctuated around 1.3 in Little's review of >25 studies published before 1998 11 ; several subsequent studies have reported similar findings. 10,16,19,23,44 A small casecontrol study in Mexico examined at maternal age as a risk factor for acute leukemia in children with DS and reported no association. 45 Age was associated with acute leukemia risk as a continuous and categorical variable.…”

“…Previous studies in children without DS have indicated no or little elevation in risk for advanced maternal age, [10][11][12][13][14][15][16][17][18][19] prior fetal loss, 12,[14][15][16][17][20][21][22][23][24][25] prior contraceptive use, 15,[26][27][28] time between births, 16,22 and birth order. 12,[14][15][16]20,21,[29][30][31] However, those factors may have a greater impact on the development of leukemia in children with DS, because trisomy 21 may represent a first genetic ''hit,'' and stronger associations may be expected than those reported in studies of children without DS.…”

Retrospective Cohort Study of Phototherapy and Childhood Cancer in Northern California

“…Three studies from northern Europe found no association. [15][16][17] In contrast, a Washington State study 18 reported an adjusted odds ratio (OR) of 2.5 (95% confidence interval [CI], 1.0-6.2) for all childhood leukemias (excluding infants with Down syndrome), and a Swedish matched case-control study 19 reported an OR of 7.5 (95% CI, 1.8-31.9) for myelogenous leukemia. After infants with Down syndrome were excluded from the Swedish study, the association was no longer statistically significant (OR 4.3; 95% CI, 0.9-21.9).…”

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

“…However, the potential for harm from hospitalization and treatment of hyperbilirubinemia has not been adequately researched, and recent findings of a possible association between phototherapy and childhood leukemia may affect the risk/benefit analysis. 21,22 HOW IS OVERDIAGNOSIS HARMFUL?…”