Common maternal infections during pregnancy and childhood leukaemia in the offspring: findings from six international birth cohorts
Common maternal infections during pregnancy and childhood leukaemia in the offspring: findings from six international birth cohorts
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DOI：
10.1093/ije/dyab199
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发表时间：
2021-09-14
影响因子：
7.7
通讯作者：
Dwyer, Terence
中科院分区：
文献类型：
--
作者：
He, Jian-Rong;Hirst, Jane E.;Dwyer, Terence
以往的流行病学研究发现，孕产妇感染与儿童白血病呈正相关；然而，来自前瞻性队列研究的证据很少。我们的目的是使用大规模的前瞻性数据来检验这些关联。方法数据来自澳大利亚、丹麦、以色列、挪威、英国和美国六个以人口为基础的出生队列（招募时间为1950 -2000年）。主要结局是儿童白血病和急性淋巴细胞白血病（ALL）；次要结局是急性髓性白血病（AML）和任何儿童癌症。暴露包括孕妇在怀孕期间自我报告的感染[流感样疾病、普通感冒、任何呼吸道感染、阴道鹅口疮、阴道感染和尿路感染（包括膀胱炎）]和感染相关症状（发烧和腹泻）。采用多水平Cox模型估计协变量校正风险比（HR）和95%置信区间（CI）。结果312 879名儿童中位随访13.6年，共发现167例白血病，包括129例ALL和33例AML。母体尿路感染与任何白血病(HR （95% CI) 1.68(1.10-2.58)）、ALL亚型（1.49(0.87-2.56)）和AML亚型（2.70(0.93-7.86)）的风险增加相关，但与任何癌症（1.13(0.85-1.51)）无关。呼吸道感染与任何白血病[1.57(1.06-2.34)]、ALL[1.43(0.94-2.19)]、AML[2.37(1.10-5.12)]和任何癌症[1.33(1.09-1.63)]的风险增加相关；流感样疾病表现出类似的模式，但估计不那么精确。没有证据表明其他感染与任何结果之间存在联系。结论妊娠期尿路和呼吸道感染可能与儿童白血病有关，但由于其罕见，绝对风险很小。
Background Previous epidemiological studies have found positive associations between maternal infections and childhood leukaemia; however, evidence from prospective cohort studies is scarce. We aimed to examine the associations using large-scale prospective data. Methods Data were pooled from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA (recruitment 1950s-2000s). Primary outcomes were any childhood leukaemia and acute lymphoblastic leukaemia (ALL); secondary outcomes were acute myeloid leukaemia (AML) and any childhood cancer. Exposures included maternal self-reported infections [influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections and urinary tract infection (including cystitis)] and infection-associated symptoms (fever and diarrhoea) during pregnancy. Covariate-adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated using multilevel Cox models. Results Among 312 879 children with a median follow-up of 13.6 years, 167 leukaemias, including 129 ALL and 33 AML, were identified. Maternal urinary tract infection was associated with increased risk of any leukaemia [HR (95% CI) 1.68 (1.10-2.58)] and subtypes ALL [1.49 (0.87-2.56)] and AML [2.70 ([0.93-7.86)], but not with any cancer [1.13 (0.85-1.51)]. Respiratory tract infection was associated with increased risk of any leukaemia [1.57 (1.06-2.34)], ALL [1.43 (0.94-2.19)], AML [2.37 (1.10-5.12)] and any cancer [1.33 (1.09-1.63)]; influenza-like illness showed a similar pattern but with less precise estimates. There was no evidence of a link between other infections and any outcomes. Conclusions Urinary tract and respiratory tract infections during pregnancy may be associated with childhood leukaemia, but the absolute risk is small given the rarity of the outcome.