Mother and child characteristics at birth and early age leukemia: a case-cohort population-based study<sup>,</sup>

Reis, Rejane de Souza; Silva, Neimar de Paula; Santos, Marceli de Oliveira; Oliveira, Julio Fernando Pinto; Thuler, Luiz Claudio Santos; Camargo, Beatriz de; Pombo-de-Oliveira, Maria S.

doi:10.1016/j.jped.2016.12.009

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • J. Pediatr. (Rio J.) 93 (6) • Nov-Dec 2017 • https://doi.org/10.1016/j.jped.2016.12.009 copy

Mother and child characteristics at birth and early age leukemia: a case-cohort population-based study^☆ ☆ Please cite this article as: Reis RS, Silva NP, Santos MO, Oliveira JF, Thuler LC, de Camargo B, et al. Mother and child characteristics at birth and early age leukemia: a case-cohort population-based study. J Pediatr (Rio J). 2017;93:610-8. ^,^☆☆ ☆☆ Study conducted at Instituto Nacional do Câncer (INCA), Centro de Pesquisa, Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The population-based cancer registries (PBCR) and the Information System on Live Births in Brazil (Sistema de Informações sobre Nascidos Vivos [SINASC]) have information that enables the test for risk factors associated with leukemia at an early age. The aim of this study was to identify maternal and birth characteristics associated with early-age acute leukemia (EAL) in Brazil.

Methods:

A case-cohort study was performed using secondary dataset information of PBCR and SINASC. The risk association variables were grouped into (i) characteristics of the child at birth and (ii) characteristics of maternal exposure during pregnancy. The case-control ratio was 1:4. Linkage was performed using R software; odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression models.

Results:

EAL was associated with maternal occupational exposure to chemicals (agricultural, chemical, and petrochemical industry; adjOR: 2.18, 95% CI: 1.16-4.10) and with birth defects (adjOR: 3.62, 95% CI: 1.19-11.00).

Conclusions:

The results of this study, with the identification of EAL risk factors in population-based case-cohort study, strengthen the knowledge and improve databases, contributing to investigations on risk factors associated with childhood leukemia worldwide.

KEYWORDS
Brazil; Early age leukemia; Birth characteristics; Maternal characteristics; Maternal occupation; Birth weight

	Controls (%)	Cases (%)	p-Value	ALL (%)	p-Value	AML (%)	p-Value	NSL (%)	p-Value
	1.088	272		207		41		24
Gender
Female	532 (48.9)	117 (43.0)		87 (42.0)		19 (46.3)		11 (45.8)
Male	555 (51.0)	155 (57.0)		120 (58.0)		22 (53.7)		13 (54.2)
Missing	1 (0.1)	-	0.191	-	0.172	-	0.930	-	0.945

Race
White	465 (42.7)	1215 (46.0)		87 (42.0)		21 (51.2)		17 (70.8)
Non-white	509 (46.8)	140 (51.5)		114 (55.1)		20 (48.8)		6 (25.0)
Missing	114 (10.5)	7 (2.6)	<0.001	6 (2.9)	0.001	-	0.083	1 (4.2)	0.023

Maternal age (years)
<30	818 (75.2)	189 (69.5)		141 (68.1)		29 (70.7)		19 (79.2)
≥30	270 (24.8)	83 (30.5)		66 (31.9)		12 (29.3)		5 (20.8)
Missing	-	-	0.063	-	0.038	-	0.581	-	0.803

Maternal education (years)
≤3	94 (8.6)	25 (9.2)		16 (7.7)		4 (9.8)		5 (20.8)
≥4	954 (87.7)	240 (88.2)		185 (89.4)		37 (90.2)		18 (75.0)
Missing	40 (3.7)	7 (2.6)	0.654	6 (2.9)	0.770	-	0.451	1 (4.2)	0.113

Maternal occupational exposure
Not working	646 (59.4)	158 (58.1)		121 (58.5)		19 (46.3)		18 (75.0)
Chemical^a a Workers in the agricultural, chemical, and petrochemical industry.	30 (2.9)	18 (6.6)		12 (5.8)		6 (14.6)		-
Others	335 (30.8)	77 (27.2)		57 (27.5)		13 (31.7)		4 (16.7)
Missing	77 (7.1)	22 (8.1)	0.015	17 (8.2)	0.117	3 (7.3)	<0.001	2 (8.3)	0.360

Birth order
First	363 (33.4)	90 (33.1)		70 (33.8)		11 (26.8)		9 (37.5)
Second or higher	521 (47.9)	137 (50.4)		105 (50.7)		21 (51.2)		11 (45.8)
Missing	204 (18.8)	45 (16.5)	0.650	32 (15.5)	0.503	9 (22.0)	0.665	4 (16.7)	0.907

Mode of delivery
Vaginal	594 (54.6)	132 (48.5)		98 (47.3)		20 (48.8)		14 (58.3
Cesarean	493 (45.3)	139 (51.5)		108 (52.2)		21 (51.2)		10 (41.7)
Missing	1 (0.1)	1 (0.4)	0.123	1 (0.5)	0.074	-	0.746	-	0.927

Gestational age (weeks)
<37	75 (6.9)	17 (6.3)		12 (5.8)		4 (9.8)		1 (4.2)
37-41	1001 (92.0)	254 (93.4)		194 (93.7)		37 (90.2)		23 (95.8)
>41	12 (1.1)	1 (0.4)		1 (0.5)		-		-
Missing	-	-	0.494	-	0.597	-	0.629	-	0.757

Five-minute Apgar score
≤8	118 (10.8)	30 (11.0)		21 (10.1)		5 (12.2)		4 (16.7)
>8	938 (86.2)	223 (82.0)		170 (82.1)		33 (80.5)		20 (83.3)
Missing	32 (2.9)	19 (7.0)	0.007	16 (7.7)	0.004	3 (7.3)	0.265	-	0.483

Birth weight
≤3000 g	341 (31.3)	80 (29.4)		56 (27.1)		14 (34.1)		10 (41.7)
>3000 g	745 (68.5)	191 (70.2)		150 (72.5)		27 (65.9)		14 (58.3)
Missing	32 (2.9)	1 (0.4)	0.708	1 (0.5)	0.347	-	0.899	-	0.501

Fetal growth
SGA	177 (16.3)	38 (14.0)		26 (12.6)		8 (19.5)		4 (16.7)
AGA	839 (77.1)	220 (80.9)		170 (82.1)		31 (75.6)		19 (79.2)
LGA	69 (6.3)	13 (4.8)		10 (4.8)		2 (4.9)		1 (4.2)
Missing	3 (0.3)	1 (0.4)	0.559	1 (0.5)	0.395	-	0.916	-	0.968

Birth defects
No	1026 (94.3)	250 (91.9)		192 (92.8)		35 (85.4)		23 (95.8)
Yes	7 (0.6)	7 (2.6)		3 (1.4)		3 (7.3)		1 (4.2)
Missing	55 (5.1)	15 (5.5)	0.017	12 (5.4)	0.429	3 (7.3)	<0.001	-	0.072

	Crude OR (95% CI)	p-Value	Adjusted OR (95% CI)	p-Value
Gender
Female	1		1
Male	1.27 (0.97-1.66)	0.08	1.25 (0.93-1.66)	0.137

Maternal age (years)
Per five-year increments	1.11 (1.00-1.22)	0.048	1.08 (0.96-1.21)	0.209
<30	1		1
≥30	1.33 (0.99-1.78)	0.056	1.21 (0.86-1.44)	0.271

Maternal education (years)
≤3	1		1
≥4	0.95 (0.60-1.50)	0.81	0.86 (0.52-1.44)	0.571

Maternal occupational exposure
Not working	1		1
Chemical^a a Workers in the agricultural, chemical, and petrochemical industry.	2.45 (1.33-4.51)	0.004	2.18 (1.16-4.10)	0.002
Others	0.90 (0.66-1.23)	0.514	0.77 (0.55-1.07)	0.123

Birth order
Per order of 1	1.02 (0.93-1.13)	0.621	0.99 (0.89-1.10)	0.820
First	0.94 (0.7-1.27)	0.699	0.96 (0.68-1.34)	0.799
Second or higher	1		1

Mode of delivery
Vaginal	1		1
Cesarean	1.27 (0.97-1.66)	0.08	1.28 (0.95-1.73)	0.104

Gestational age (weeks)
<37	0.89 (0.52-1.54)	0.893	0.79 (0.43-1.46)	0.457
37-41	1		1
>41	0.33 (0.40-2.54)	0.328	-	-

5 minute APGAR
≤8	1.07 (0.70-1.64)	0.758	0.96 (0.60-1.52)	0.861
>8	1		1

Birth weight
Per 500 g increments	1.09 (0.96-1.24)		1.09 (0.95-1.25)
Per 1000 g increments	1.19 (0.93-1.54)	0.167	1.19 (0.91-1.56)	0.196
≤3000 g	1		1
>3000 g	1.09 (0.82-1.46)	0.550	1.05 (0.77-1.44)	0.747

Fetal growth
SGA	0.82 (0.56-1.20)	0.303	0.79 (0.53-1.19)	0.261
AGA	1		1
LGA	0.72 (0.39-0.289)	0.289	0.56 (0.27-1.15)	0.111

Birth defects
No	1		1
Yes	4.10 (1.42-11.81)	0.009	3.62 (1.19-11.00)	0.023

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:mpombo@inca.gov.br (M.S. Pombo-de-Oliveira).