Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Int J Epidemiol. 2022 Jun 13;51(3):769-777. doi: 10.1093/ije/dyab199.
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.
背景:先前的流行病学研究发现,母体感染与儿童白血病之间存在正相关关系;然而,来自前瞻性队列研究的证据却很少。我们旨在使用大规模的前瞻性数据来检验这些关联。
方法:本研究的数据来自澳大利亚、丹麦、以色列、挪威、英国和美国的六个基于人群的出生队列(招募时间为 20 世纪 50 年代至 2000 年代)。主要结局是任何儿童白血病和急性淋巴细胞白血病(ALL);次要结局是急性髓细胞白血病(AML)和任何儿童癌症。暴露因素包括母亲自我报告的感染(流感样疾病、普通感冒、任何呼吸道感染、阴道假丝酵母菌病、阴道感染和尿路感染(包括膀胱炎))和感染相关症状(发热和腹泻)。使用多层次 Cox 模型估计调整协变量后的危险比(HR)和 95%置信区间(CI)。
结果:在 312879 名儿童中,中位随访时间为 13.6 年,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])和亚型 ALL[1.49[0.87-2.56])和 AML[2.70[0.93-7.86])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])风险增加相关;流感样疾病也表现出类似的模式,但估计值不太精确。没有证据表明其他感染与任何结果之间存在关联。
结论:妊娠期间的尿路感染和呼吸道感染可能与儿童白血病有关,但考虑到该结果罕见,绝对风险较小。
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