title: Prelabor cesarean delivery and early-onset acute childhood leukemia risk.
abstract: The long-term impact of cesarean delivery (CD) on the health of the offspring is being explored methodically. We sought to investigate the effect of birth by (a) prelabor and (b) during-labor CD on the risk of early-onset (≤3 years) acute lymphoblastic leukemia (ALL), specifically of its prevailing precursor B (B-ALL) subtype. A total of 1099 incident cases of ALL (957 B-ALL), 131 of acute myeloid leukemia (AML), and their 1 : 1 age-matched and sex-matched controls, derived from the Nationwide Registry for Childhood Hematological Malignancies (1996-2013), were analyzed using multivariate regression models. A null association was found between prelabor and/or during labor CD and either ALL (B-ALL) or AML in the 0-14 age range. By contrast, birth by CD increased significantly the risk of early-onset ALL [odds ratioCD (ORCD)=1.57, 95% confidence interval (CI): 1.10-2.24] mainly on account of prelabor CD (ORprelaborCD=1.66, 95% CI: 1.13-2.43). The respective figures were even higher for the early-onset precursor B-ALL (ORCD=1.66, 95% CI: 1.15-2.40 and ORprelaborCD=1.79, 95% CI: 1.21-2.66), whereas no association emerged for early-onset AML. Prelabor CD, which deprives exposure of the fetus/infant to the presumably beneficial effect of stress hormones released in both vaginal labor and during labor CD, was associated exclusively with an increased risk of early-onset ALL, particularly the precursor B-ALL subtype. If confirmed, these adverse long-term outcomes of CD may point to re-evaluation of prelabor CD practices and prompt scientific discussion on the best ways to simulate the effects of vaginal delivery, such as a precesarean induction of labor.
authors: aDepartment of Hygiene, Epidemiology and Medical Statistics, School of Medicine bFirst Department of Pediatrics, 'Aghia Sophia' Children's Hospital, School of Medicine, University of Athens cDepartment of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital dDepartment of Pediatric Haematology-Oncology, 'Aghia Sophia' Children's Hospital eHaematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, 'Aghia Sophia' Children's Hospital fFirst Department of Obstetrics and Gynecology, 'Alexandra' Hospital, School of Medicine, University of Athens, Athens gSecond Department of Pediatrics, AHEPA General Hospital, Aristotelion University of Thessaloniki hDepartment of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki iDepartment of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece jDepartment of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors: Thomas P
authors: TP
authors: Thomopoulos
authors: Alkistis
authors: A
authors: Skalkidou
authors: Nick
authors: N
authors: Dessypris
authors: George
authors: G
authors: Chrousos
authors: Maria A
authors: MA
authors: Karalexi
authors: Theodoros G
authors: TG
authors: Karavasilis
authors: Margarita
authors: M
authors: Baka
authors: Emmanuel
authors: E
authors: Hatzipantelis
authors: Maria
authors: M
authors: Kourti
authors: Sophia
authors: S
authors: Polychronopoulou
authors: Vasiliki
authors: V
authors: Sidi
authors: Eftichia
authors: E
authors: Stiakaki
authors: Maria
authors: M
authors: Moschovi
authors: Dimitrios
authors: D
authors: Loutradis
authors: Eleni Th
authors: ET
authors: Petridou
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007743:Labor, Obstetric; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000209:etiology*; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult