title: Birth anomalies and obstetric history as risks for childhood tumors of the central nervous system.
abstract: OBJECTIVE
  The causes of childhood central nervous system (CNS) tumors are largely unknown. Birth characteristics have been examined as possible risk factors for childhood CNS tumors, although the studies have been underpowered and inconclusive. We hypothesized that birth anomalies and a mother's history of previous pregnancy losses, as a proxy for genetic defects, increase the risk for CNS tumors.
  
  
  METHODS
  From the California Cancer Registry, we identified 3733 patients aged 0 to 14 years with CNS tumors, diagnosed from 1988 through 2006 and linked to a California birth certificate. Four controls were matched to each patient. We calculated odds ratios (ORs) for the reported presence of a birth defect and for history of pregnancy losses by using logistic regression, adjusted for race, Hispanic ethnicity, maternal age, birth weight, and birth order.
  
  
  RESULTS
  Offspring from mothers who had ≥ 2 fetal losses after 20 weeks' gestation had a threefold risk for CNS tumors (OR: 3.13 [95% confidence interval (CI): 1.32-7.41]) and a 14-fold risk for high-grade glioma (OR: 14.28 [95% CI: 1.56-130.65]). Birth defects increased risk for the CNS cancers medulloblastoma (OR: 1.70 [95% CI: 1.12-2.57]), primitive neuroectodermal tumor (OR: 3.64 [95% CI: 1.54-8.56]), and germ cell tumors (OR: 6.40 [95% CI: 2.09-19.56]).
  
  
  CONCLUSIONS
  Multiple pregnancy losses after 20 weeks' gestation and birth defects increase the risk of a childhood CNS tumor. Previous pregnancy losses and birth defects may be surrogate markers for gene defects in developmental pathways that lead to CNS tumorigenesis.
authors.affiliation: Division of Child Neurology, Stanford University, 750 Welch Rd, Suite 317, Palo Alto, CA 94304.  spartap@stanford.edu.
authors.forename: Sonia
authors.initials: S
authors.lastname: Partap
authors.forename: Jane
authors.initials: J
authors.lastname: MacLean
authors.forename: Julie
authors.initials: J
authors.lastname: Von Behren
authors.forename: Peggy
authors.initials: P
authors.lastname: Reynolds
authors.forename: Paul G
authors.initials: PG
authors.lastname: Fisher
mesh_terms: D000026:Abortion, Habitual / Q000453:epidemiology* / Q000235:genetics; D000328:Adult; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D016543:Central Nervous System Neoplasms / Q000453:epidemiology* / Q000235:genetics; D000013:Congenital Abnormalities / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008527:Medulloblastoma / Q000453:epidemiology*; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology*; D018242:Neuroectodermal Tumors, Primitive / Q000453:epidemiology*; D011247:Pregnancy