Association of cesarean section with risk of childhood leukemia: A meta‐analysis from an observational study

Abstract

Recent studies suggest that children born via cesarean section (CS) are predisposed to immune‐mediated diseases later in life. The association between CS and childhood leukemia was investigated in this meta‐analysis of observational studies. Two researchers independently searched PubMed, Web of Science, Embase, and Cochrane Library for literature on the association between CS and childhood leukemia before February 2022. And pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to determine the link between CS and childhood leukemia. The preliminary search resulted in 1321 articles and 16 articles were finally included after screening. The primary outcome was the risk of leukemia in children born via CS versus those born vaginally. The results revealed that having a CS was associated with an increased risk of childhood leukemia compared to having vaginal section (VS) (OR = 1.07, 95% CI: 1.02–1.13, p = 0.01), especially for acute lymphoblastic leukemia (ALL) (OR = 1.09, 95% CI: 1.03–1.16, p = 0.004). Children delivered via elective CS had a higher risk of ALL (OR = 1.18, 95% CI: 1.07–1.31, p = 0.001), but emergency CS did not. It is worth noting that neither emergency CS nor elective CS were found to be associated with acute myeloid leukemia. Compared to VS, CS increased the risk of leukemia in children, with elective CS significantly increasing ALL risk.

Synthesized evidence for childhood acute lymphoblastic leukemia

“…The evidence was categorized as "little" for cesarean delivery (OR: 1.18, 95% CI: 1.07-1.31) and "some" for maternal diabetes (OR: 1.46, 95% CI: 1.28-1.67), as reported in our previous review. These findings remained unchanged even after the addition of new studies (4,5). In addition, with regard to exposure to extremely low-frequency magnetic fields (ELF-MF), the earlier evaluation of "some" evidence remained unchanged even after the inclusion of an additional systematic review (8).…”