Season of birth and multiple sclerosis: a systematic review and multivariate meta-analysis
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REVIEW
Season of birth and multiple sclerosis: a systematic review and multivariate meta‑analysis Katerina G. Pantavou1 · Pantelis G. Bagos1 Received: 23 December 2018 / Revised: 24 April 2019 / Accepted: 26 April 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Season of birth is considered to be associated with multiple sclerosis (MS) although some findings opposing to this assumption raise doubts about the seasonality pattern in MS births. The present work synthesizes the evidence of previous published studies aiming at examining whether the month of birth is associated with a higher number of MS births. Pubmed and Scopus were systematically searched and a multivariate meta-analysis of case–control studies was conducted. Data of healthy controls births were retrieved from census reports when not included in the studies. For comparisons, October was set as a reference month and autumn (September–October–November) as a reference season. The meta-analysis included studies that provided the number of MS births for each month or season. Twenty-two eligible studies were included in the meta-analysis involving twenty-four different populations and overall 145,672 MS patients and 75,169,550 healthy controls. The multivariate analysis supports that MS births in spring are higher compared to autumn [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.04, 1.24]. Univariate analyses confirm the same for April (OR 1.12, 95% CI 1.05, 1.21), March (OR 1.05, 95% CI 1.00, 1.11) and May (OR 1.07, 95% CI 1.00, 1.14). A reduction of MS births was found in November (OR 0.96, 95% CI 0.93, 0.99). The month and the season of birth are significantly associated with MS births. Keywords Multiple sclerosis · MS · Month of birth · Season of birth
Introduction Multiple sclerosis (MS) is an inflammatory disorder of the brain and spinal cord that damages myelin (the protective sheath that covers nerve fibers) and axons [1]. This damage causes communication problems between the brain and the rest of the body, resulting in a wide range of signs and symptoms including motor, sensory, visual and autonomic systems. MS is a complex disease of the central nervous system that just in the last decades has given full clinicopathological characterization whereas its etiology remains unclear [1].
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-019-09346-5) contains supplementary material, which is available to authorized users. * Pantelis G. Bagos [email protected] 1
Department of Computer Science and Biomedical Informatics, University of Thessaly, Papasiopoulou 2‑4, 35100 Lamia, Greece
Previous studies suggest that the etiology of MS involves genetic susceptibility, lifestyle, environmental exposure and their interactions [2]. Heritability has been found to increase the relative risk of MS [3, 4]. The HLA complex genes and especially the HLA class I and II genes are most commonly associated with the incidence of MS [2]. Smoking and passive smoking, Epstein–Barr
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