title: Fertility treatments, congenital malformations, fetal loss, and childhood acute leukemia: the ESCALE study (SFCE).
abstract: BACKGROUND
  This study investigated the relationships between childhood acute leukemia (AL) and selective maternal and birth characteristics, including congenital malformations and the use of fertility treatment, for which the literature remains scarce.
  
  
  METHODS
  The national registry-based case-control study ESCALE was carried out in France in 2003-2004. Population controls were frequency matched with cases on age and gender. Data were obtained from structured telephone questionnaires. Odds ratios (OR) and their 95% confidence intervals were estimated using unconditional regression models adjusted for potential confounders.
  
  
  RESULTS
  In all, 764 cases of AL (648 lymphoblastic AL (acute lymphoblastic leukemia, ALL) and 101 myeloblastic AL) and 1,681 controls were included. The AL cases' mothers reported congenital malformations more frequently than the controls' mothers (OR = 1.5 [1.0-2.4]). ALL was significantly associated with the use of fertility treatment for the index pregnancy (OR = 1.9 [1.3-2.8]). In particular, ALL was associated with ovulation induction only (OR = 2.6 [1.6-4.3]), but not with in vitro fertilization (IVF, OR = 1.0 [0.4-2.3]) or artificial insemination (OR = 1.3 [0.5-3.9]). A positive association was also observed for the difficulty of becoming pregnant without fertility treatment (OR = 1.5 [1.0-2.1]). AL was positively associated with a history of voluntary abortion (OR = 1.4 [1.1-1.8]) but not with a history of spontaneous (OR = 0.8 [0.7-1.0]) or therapeutic (OR = 0.7 [0.5-1.1]) abortion.
  
  
  CONCLUSIONS
  The results suggest that subfertility in itself and ovulation induction may be associated with ALL, and support a positive association with congenital malformations. The links with the various types of fertility drugs and the underlying causes of infertility need to be investigated further.
authors.affiliation: Department of Environmental Epidemiology of Cancers, INSERM, Villejuif, France. jeremie.rudant@inserm.f
authors.forename: Jérémie
authors.initials: J
authors.lastname: Rudant
authors.forename: Alicia
authors.initials: A
authors.lastname: Amigou
authors.forename: Laurent
authors.initials: L
authors.lastname: Orsi
authors.forename: Thomas
authors.initials: T
authors.lastname: Althaus
authors.forename: Guy
authors.initials: G
authors.lastname: Leverger
authors.forename: André
authors.initials: A
authors.lastname: Baruchel
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
authors.forename: Brigitte
authors.initials: B
authors.lastname: Nelken
authors.forename: Geneviève
authors.initials: G
authors.lastname: Plat
authors.forename: Gérard
authors.initials: G
authors.lastname: Michel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sirvent
authors.forename: Pascal
authors.initials: P
authors.lastname: Chastagner
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ducassou
authors.forename: Xavier
authors.initials: X
authors.lastname: Rialland
authors.forename: Denis
authors.initials: D
authors.lastname: Hémon
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Clavel
mesh_terms: D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000453:epidemiology*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D007938:Leukemia / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*