Maternal health conditions during pregnancy and acute leukemia in children with Down syndrome: A Children's Oncology Group study.
BACKGROUND
Children with Down syndrome (DS) have about a 20-fold increased risk of developing leukemia. Early childhood infections may protect against acute lymphoid leukemia (ALL) in children with and without DS. We examined whether maternal infections and health conditions during pregnancy were associated with acute leukemia in children with DS.


METHODS
We conducted a case-control study of 158 children with DS and leukemia (including 97 cases with acute lymphoblastic leukemia (ALL) and 61 cases with acute myeloid leukemia (AML)) and 173 children with DS during the period 1997-2002. Maternal interview included information about 14 maternal conditions during gestation that are likely to induce an inflammatory response. We evaluated their prevalence in cases and controls. Five of these were common enough to allow analyses by leukemia subtype.


RESULTS
Vaginal bleeding was the most frequent (18% cases, 25% controls) and was associated with a reduced risk (odds ratio (OR) = 0.57; 95% confidence interval (CI) = 0.33-0.99) for all cases combined. Other variables, while showing a potential trend toward reduced risk had effect estimates, which were imprecise and not statistically significant. In contrast, amniocentesis was marginally associated with an increased risk of AML (OR = 2.06, 95% CI = 0.90-4.69).


CONCLUSIONS
Data from this exploratory investigation suggest that some health conditions during pregnancy may be relevant in childhood leukemogenesis. Larger epidemiological studies and other model systems (animal, clinical studies) may provide a clearer picture of the potential association and mechanisms.
Ognjanovic
Simona
S
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA. ognja001@umn.edu
Puumala
Susan
S
Spector
Logan G
LG
Smith
Franklin O
FO
Robison
Leslie L
LL
Olshan
Andrew F
AF
Ross
Julie A
JA
D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000453:epidemiology*; D011247:Pregnancy; D012307:Risk Factors