Caesarean sections, prenatal and postnatal conditions and childhood acute lymphoblastic leukaemia: A case-control study in the State of São Paulo, Brazil

•No statistically significant associations between caesarean section and ALL were observed.•Children born by caesarean section had a slight non-significant (NS) increased risk of ALL.•Children under 3 years old born by caesarean section had the highest risk of ALL (NS).•Children of mothers born by c...

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Published in:	Cancer epidemiology Vol. 69; p. 101851
Main Authors:	Junqueira, Maria Elizangela Ramos, de Oliveira, Claúdia T., Tone, Luiz G., Lee, Maria Lúcia de M., de Andréa, Maria Lydia M., Bruniera, Paula, Epelman, Sidnei, Odone Filho, Vicente, Bonilha, Eliana de A., de Freitas, Marina, Okamura, Mirna N., Vico, Eneida R., Stevens, Anthony P., Rabello Neto, Dácio de L, Wünsch Filho, Victor
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-12-2020 Elsevier Limited
Subjects:	Acute lymphoblastic leukemia Adolescent Adult Age Birth weight Births Brazil Caesarean section Cancer Case-Control Studies Case-control study Cesarean section Cesarean Section - statistics & numerical data Child Child, Preschool Childhood acute lymphoblastic leukaemia Children Children & youth Confidence intervals Epidemiology Etiology Female Hospitals Humans Infant Infant, Newborn Interviews Leukemia Mothers Population studies Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology Prenatal and postnatal conditions Regression analysis Risk analysis Risk Factors Sample size Statistical analysis São Paulo Young Adult Brazil SES ALL PAC-DT/UNEB Caesarean section Case-control study Childhood acute lymphoblastic leukaemia DNV SEADE Foundation UNEB USP São Paulo Prenatal and postnatal conditions WHO
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Summary:	•No statistically significant associations between caesarean section and ALL were observed.•Children born by caesarean section had a slight non-significant (NS) increased risk of ALL.•Children under 3 years old born by caesarean section had the highest risk of ALL (NS).•Children of mothers born by caesarean section in the highest educational group had a reduced risk of ALL (NS). Brazil has high rates of caesarean sections, which has been suggested as a risk factor for acute lymphoblastic leukaemia (ALL). In addition, some pre- and postnatal conditions have been identified as relevant in the etiology of ALL. Investigate the association of caesarean sections, pre- and postnatal conditions with childhood ALL in the State of São Paulo. Population-based case-control study including children that are below10 years old. Information on study variables was obtained through face to face interviews, through a questionnaire, and the State of São Paulo Declarations of Live Births database. The conditional and unconditional logistic regression approaches were used to calculate the odds ratio (OR) of the associations between caesarean sections, pre- and postnatal conditions with ALL, and 95 % confidence intervals (95 % CI). We observed a weak and non-statistically significant risk for ALL among children exposed to caesarean sections (unconditional logistic regression OR 1.08; 95 % CI 0.70–1.66; conditional logistic regression OR 1.21; 95 % CI 0.72–2.02), but among children under 3 years old and born through a caesarean sections, the risk of ALL was greater (unconditional logistic regression OR 1.70; 95 % CI 0.69–4.21). A negative association for ALL was observed among children with mothers who reported 12 years of schooling or more (unconditional logistic regression OR 0.34; 95 % CI 0.16−0.69). We found a tenuous suggestive association between caesarean sections and childhood ALL. The mother's high level of education showed an inverse association with ALL.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1877-7821 1877-783X
DOI:	10.1016/j.canep.2020.101851