Maternal reproductive history, fertility treatments and folic acid supplementation in the risk of childhood acute leukemia: the ESTELLE Study
Maternal reproductive history, fertility treatments and folic acid supplementation in the risk of childhood acute leukemia: the ESTELLE Study
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DOI：
10.1007/s10552-014-0429-8
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发表时间：
2014-10-01
影响因子：
2.3
通讯作者：
Clavel, Jacqueline
中科院分区：
文献类型：
--
作者：
Ajrouche, Roula;Rudant, Jeremie;Clavel, Jacqueline
探讨生育治疗和其他怀孕条件（不孕症、节育怀孕、产妇流产史）和叶酸补充剂在儿童白血病（CL）病因学中的潜在作用。ESTELLE研究纳入了2010-2011年在法国诊断的747例CL[636例急性淋巴细胞白血病（ALL）和100例急性髓母细胞白血病（AML）]和1421例与年龄和性别频率匹配的人群对照。数据来自对母亲进行的结构化电话问卷调查。比值比（OR）及其95%置信区间使用经潜在混杂因素调整的无条件回归模型估计。对于指数妊娠，CL与妊娠困难[OR 0.9(0.7-1.2)]、体外受精[OR 0.6(0.3-1.5)]或使用任何生育治疗[OR 0.8(0.5-1.1)]无关。CL与避孕后怀孕无显著相关性[OR为1.2(0.8-1.8)]，但与第三代口服避孕药呈正相关[OR为4.3 (1.2-16.2)]；然而，这个结果是基于小数字的。怀孕期间补充叶酸与CL无关，但在怀孕前3个月开始补充叶酸与CL呈负相关[OR 0.7(0.5-1.0)]。此外，孕产妇死产和流产史分别与ALL [OR 2.6(1.1-5.9)]和AML [OR 1.8(1.1-2.8)]相关。研究结果并不表明不孕症和生育治疗是CL的危险因素。他们认为，死产和流产的产妇史可能在CL病例的母亲中更常见，并且在孕前补充叶酸可能会降低CL的风险。
To investigate the potential involvement of fertility treatments and other conditions of becoming pregnant (infertility, getting pregnant on birth control, maternal history of fetal loss) and folic acid supplements in the etiology of childhood leukemia (CL).The ESTELLE study included 747 cases of CL [636 cases of acute lymphoblastic leukemia (ALL) and 100 of acute myeloblastic leukemia (AML)] diagnosed in France in 2010-2011 and 1,421 population controls frequency-matched with the cases on age and gender. Data were obtained from structured telephone questionnaires administered to mothers. The odds ratios (OR) and their 95 % confidence intervals were estimated using unconditional regression models adjusted for potential confounders.CL was not associated with difficulty in becoming pregnant [OR 0.9 (0.7-1.2)], in vitro fertilisation [OR 0.6 (0.3-1.5)] or the use of any fertility treatment [OR 0.8 (0.5-1.1)] for the index pregnancy. CL was not significantly associated with becoming pregnant on contraception [OR 1.2 (0.8-1.8)], but a positive association was observed for third generation oral contraception [OR 4.3 (1.2-16.2)]; however, the result is based on small numbers. Folic acid supplementation during pregnancy was not associated with CL, but an inverse borderline association was observed for supplementation initiated in the 3 months preceding pregnancy [OR 0.7 (0.5-1.0)]. In addition, maternal histories of stillbirth and miscarriage were associated with ALL [OR 2.6 (1.1-5.9)] and AML [OR 1.8 (1.1-2.8)], respectively.The findings do not suggest that infertility and fertility treatments are risk factors for CL. They suggest that maternal histories of stillbirth and miscarriage may be more frequent among mothers of CL cases and that folic acid supplementation during preconception may reduce the risk of CL.