Cesarean section and risk of childhood leukemia: a systematic review and meta-analysis
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META-ANALYSIS
Cesarean section and risk of childhood leukemia: a systematic review and meta‑analysis Li‑Li Jiang1 · Yin‑Yan Gao1 · Wen‑Bo He1 · Ting Gan1 · Hou‑Qian Shan1 · Xue‑Mei Han1 Received: 21 June 2019 / Accepted: 13 January 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
Abstract Background A large number of studies pointed that being delivered by cesarean section (CS) would affect the health outcomes of offspring, however, whether CS would affect the risk of childhood leukemia remained uncertain. This study conducted a meta-analysis to quantitatively evaluate whether being delivered by CS would influence the onset of childhood leukemia. Methods PubMed, Embase and Web of Science databases were searched from 3rd June, 1950 to 13th October, 2019 to identify the literature, which examined the relationship between CS and childhood leukemia. This study used Newcastle–Ottawa Scale to assess the quality of literature. Subgroup analyses were conducted on region, mode of delivery, design of the study and number of confounders adjusted. Egger’s test and Begg’s test were performed to evaluate possible publication bias. Results The pooled odds ratio (OR) estimates illustrated that children delivered by CS had a higher risk of developing leukemia [OR 1.10, 95% confidence interval (CI) 1.04–1.17, P = 0.002] and lymphoblastic leukemia (OR 1.12, 95% CI 1.03–1.23, P = 0.009), while a significant association for myeloid leukemia was not observed (OR 1.05, 95% CI 0.92–1.20, P = 0.451). Results of subgroup analyses indicated that elective CS would increase the risk of childhood lymphoblastic leukemia (OR 1.16, 95% CI 1.06–1.27, P = 0.002). However, a statistical relationship between emergency CS and lymphoblastic leukemia was not observed (OR 1.07, 95% CI 0.93–1.23, P = 0.364). Conclusions CS would increase the risk of childhood lymphoblastic leukemia. It is worth noting that subgroup analyses shows that elective CS rather than emergency CS increases the risk of lymphoblastic leukemia in offspring. Keywords Cesarean section · Leukemia · Lymphoblastic leukemia · Meta-analysis
Introduction Leukemia is one of the most common cancers in children, which accounts for around 30.33% of the diagnosed childhood cancers [1]. Among the different types of acute leukemia diagnosed in children, acute lymphoblastic leukemia (ALL) accounts for about 80% [2]. Moreover, the morbidity of childhood ALL in all ethnicities combined has increased nearly 1% per year since 1973 [3]. However, the etiology Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12519-020-00338-4) contains supplementary material, which is available to authorized users. * Xue‑Mei Han [email protected] 1
School of Public Health, Lanzhou University, Lanzhou 73000, China
of childhood leukemia remains uncertain. Researches have hypothesized that the development of the immune system and the reactions to infection might influence the incidence of childhood leukemia [4]. Grieves hypothesized that immu
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