Abstract
BackgroundReports have suggested that children born by caesarean initiated before labour onset may be at increased risk of developing acute lymphoblastic leukaemia (ALL). However, with most data being derived from case‐control study interviews, information on the underpinning reasons for caesarean section is sparse, and evidence is conflicting.ObjectivesUse clinical records compiled at the time of delivery to investigate the association between childhood ALL and caesarean delivery; examining timing in relation to labour onset, and reasons for the procedure.MethodsData are from the UK Childhood Cancer Study, a population‐based case‐control study conducted in the 1990s, when caesarean section rates were relatively low, in England, Scotland, and Wales. Children with ALL were individually matched to two controls on sex, date of birth, and region of residence. Information on mode of delivery and complications was abstracted from obstetric records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression models adjusted for matching variables and relevant covariates.ResultsAround 75% of the 1034 cases and 1914 controls were born through unassisted vaginal delivery. Caesarean delivery was as frequent in cases and controls (OR 1.07, 95% CI 0.84, 1.36). No association was observed between ALL and caesarean delivery either during or before labour, with adjusted ORs of 1.08 (95% CI 0.78, 1.48) and 1.09 (95% CI 0.78, 1.53), respectively. For B‐cell ALL, the ORs were 1.14 (95% CI 0.81, 1.59) for caesarean during labour and 1.21 (95% CI 0.85, 1.72) for prelabour. The underpinning reasons for caesarean delivery differed between cases and controls; with preeclampsia, although very rare, being more common amongst cases born by caesarean (OR 8.91, 95% CI 1.48, 53.42).ConclusionsOur obstetric record‐based study found no significant evidence that caesarean delivery increased the risk of childhood ALL, either overall or when carried out before labour.
Highlights
Reports have suggested that children born by caesarean initiated before labour onset may be at increased risk of developing acute lymphoblastic leukaemia (ALL)
Findings from the majority of studies examining the relationship with caesarean delivery have provided little support for this hypothesis,[3,4,5,6,7,8,9] some investigators observed that children delivered by caesarean,[10] especially if performed before the onset of labour,[11,12] may be at increased Acute lymphoblastic leukaemia (ALL) risk
No significant associations between prelabour caesarean delivery and childhood ALL were noted, with Odds ratios (OR) of 1.09 for any prelabour caesarean; 1.07 for planned prelabour, and 1.16 for emergency prelabour
Summary
Reports have suggested that children born by caesarean initiated before labour onset may be at increased risk of developing acute lymphoblastic leukaemia (ALL). The characteristic incidence peak between 2 and 5 years of age[1] has provided the foundation for several aetiological hypotheses, most notably, concerning a potential role of exogenous factors on the emergent immune system and subsequent risk of ALL.[2] In this context, it has been suggested that because children born by caesarean delivery may not be subject to the same hormonal and microbial challenges as those born vaginally, their immune development could be altered, which in turn could increase their risk of ALL. A further case-control study, finding no overall association with caesarean delivery, either before or during labour, reported an increased risk with prelabour caesarean among children diagnosed with ALL before three years of age[13]; and a Californian birth record linkage study reported a 20% increased risk of ALL with caesarean delivery (pre- and post-labour combined) in children aged 2-4 years.[11]. The Californian record linkage study used “elective” as a marker for prelabour.[11]
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