Maria Elizangela Ramos Junqueira
University of São Paulo, Brazil
Title: Cesarean section and risk of acute lymphoblastic leukemia in children and adolescents: a meta-analysis of case-control studies
Biography
Biography: Maria Elizangela Ramos Junqueira
Abstract
Background: Cesarean section has been associated with development of leukemia.
Objective: To review systematically studies conducted on the association of cesarean section and acute lymphoblastic leukemia (ALL) in children and adolescents.
Methods: Eligible studies were sought in Pubmed, Lilacs, Scielo, Scopus, CINAHL until April 30th, 2018. Inclusion criteria: case-control studies published in English, Spanish and Portuguese with children and adolescents aged 0-19 years from all world geographic regions. Exclusion criteria: studies without data on cesarean section, and studies with animals, in vitro and reviews. Data from identified studies were examined by two investigators, who reported the odds ratios (OR) and corresponding 95% confidence intervals (95% CI). Analyses were performed separately with the entire sample of studies and with the set of studies without subjects with Down syndrome, because it is a risk factor for leukemia. Random-effects models were used to calculate summary effect estimates. Analyses were conducted using Stata Statistical Software, version 14.
Results: Seventeen case-control studies (N=19211 cases/56339 controls) and nine case-control studies (N=9396 cases/25367 controls) without subjects with Down syndrome were included. Cesarean section was associated with increasing risk of ALL in the entire sample of studies [OR 1.075, 95% CI 1.000-1.157]. For studies without subjects with Down syndrome, cesarean section was also associated with ALL [OR 1.063, 95% CI 0.928-1.216].
Conclusion: Cesarean section presented a discreet increased risk for LLA. However, considering the high cesarean rates in some parts of the world, this factor may be relevant for the incidence of ALL in children and adolescents.