Maternal Folate Intake and Risk of Childhood Brain and Spinal Cord Tumors: A Systematic Review and Meta-Analysis

Abstract

Background: Many epidemiological studies have investigated the effect of maternal diet and prenatal multivitamin supplementation on pediatric cancer risk. Childhood brain and spinal cord tumors (CBSCT) have been attributed to different possible risk factors. Methods: We conducted a systematic review and meta-analysis on maternal folate intake before and during pregnancy and the risk of CBSCT. We systematically reviewed publications obtained by searching the Insitute for Scientific Information Web of Knowledge and PubMed literature databases. We extracted the risk estimate of the highest and the lowest reported categories of intake from each study and conducted a meta-analysis using a random-effects model. Results: The results of the pooled analysis of all 10 studies, 1 cohort and 9 case-control studies, indicated that maternal folate intake was inversely associated with CBSCT risk (OR 0.77; 95% CI 0.67–0.88, p < 0.001; I² = 51.22%, p = 0.001). Separate analyses on the basis of the source of folate (folic acid supplementation, dietary folate) and in relation to the timing of exposure (before pregnancy, during pregnancy) found that folic acid supplementation was associated with an approximately 23% reduction in ­CBSCT risk (OR 0.77, 95% CI 0.66–0.90, p = 0.001; I² = 53.18%, p = 0.001) and consumption during pregnancy was associated with an approximately 20% reduction in CBSCT risk (OR 0.80, 95% CI 0.67–0.97, p = 0.020; I² = 62.48%, p < 0·001). Conclusions: Maternal consumption of folic acid is associated with a reduced risk of CBSCT. Further investigations are necessary to increase the reliability of the results and estimate the relationship between dose-response and the best outcome.

The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies

“…In this study, there was no significant association between maternal folic acid supplementation and CBT (OR, 1.02; 95% CI, 0.88 to 1.19; p =0.78). This finding was different from the recently published meta-analysis by Chiavarini et al [48], who reported that maternal folic acid intake was inversely associated with the risk of childhood brain and spinal cord tumours (OR, 0.77; 95% CI, 0.67 to 0.88).…”

Maternal smoking, consumption of alcohol, and caffeinated beverages during pregnancy and the risk of childhood brain tumors: a meta-analysis of observational studies

“…Thus, the results of subgroup analyses may not represent all the populations of the involved studies. (3) The number of studies regarding maternal alcohol and caffeinated beverages consumption, as well as the sample sizes in many subgroup analyses, is still insufficient. (4) Mothers exposed to maternal smoking and consumption of beverages during pregnancy are more likely to be exposed to these factors both before conception and after delivery.…”

“…Evidence from animal studies has led to a hypothesis that the central nervous system is susceptible to carcinogenesis during the prenatal period [ 2 ]. Maternal exposures during pregnancy might play a crucial role in the risk of CBTs, as reported in two recent meta-analyses [ 3 , 4 ].…”

Socioeconomic differences in the risk of childhood central nervous system tumors in Denmark: a nationwide register-based case–control study

“…The etiology of childhood CNS tumors is still poorly understood [2,3] and preventive measures to preclude the disease are lacking. A growing body of research has targeted parental lifestyle factors [4][5][6], occupational exposures [7,8], or environmental pollutants [9][10][11][12] as possible risk factors but has hitherto provided inconclusive evidence [2,3,13]. Certain genetic syndromes, exposure to high-dose ionizing radiation, and high or low birth weight [2,3,14,15] are the only wellestablished risk factors to date and those explain only a minor proportion (5-10%) of all cases [2,3].…”