Preterm Birth and Subsequent Risk of Acute Childhood Leukemia: a Meta-Analysis of Observational Studies

Abstract

Background: Preterm birth (PTB) has been recognized as a crucial long term risk factor for multiple non-communicable diseases. However, studies between the relationship of PTB and the risk of acute childhood leukemia have yielded inconclusive results. Therefore, we performed a meta-analysis to systematically review the current literature to investigate whether PTB is associated with increased risk of acute childhood leukemia. Methods: Three electronic databases (PubMed, Web of Science, and EMBASE) were searched up to December 1st, 2015. Relevant studies reporting the association between PTB and subsequent risk of acute childhood leukemia were included for further evaluation. Statistical analysis was performed using Revmen 5.3 and Stata 10.0. Results: A total of 12 studies for acute childhood leukemia, eight studies for acute lymphoblastic leukemia (ALL), and seven studies for acute myeloid leukemia (AML) were included in the current meta-analyses. We calculated pooled odds ratio (OR) and 95% confidence interval (CI) to evaluate the relationship between PTB and acute childhood leukemia as well as its two subtypes: ALL and AML. Our results suggested that PTB was significantly associated with increased risk of acute childhood leukemia (OR = 1.09, 95% CI = 1.02-1.17, P = 0.01) and AML (OR = 1.42, 95% CI = 1.21-1.67, P < 0.01). However, PTB was not significantly associated with an increased risk of ALL (OR = 1.04, 95% CI = 0.96-1.13, P = 0.29). Conclusion: Our data showed that PTB increased the risk of AML. Further studies are required to explore causality and dissect the biological mechanisms involved.

Gestational age and childhood leukemia: A meta-analysis of epidemiologic studies

“…Subgroup analyses by study types further showed postterm birth increased the risk of childhood leukemia and ALL in cohort studies. A previous manuscript published by Huang et al [9] found that preterm delivery was associated with increased risk of acute childhood leukemia and AML; there was no significant relationship between preterm birth and ALL. The same trend with different results were reported in our article, mainly because we brought into different studies that relied on a diverse search strategy and inclusion criteria.…”

“…The same trend with different results were reported in our article, mainly because we brought into different studies that relied on a diverse search strategy and inclusion criteria. In addition, the analysis reported by Huang et al [9] did not examine postterm delivery. We added six new studies [11,13,14,17,19,23] and investigated the relationships among postterm delivery and childhood leukemia, ALL and AML.…”

“…important determinants of the relationships among fetal growth and leukemia, ALL and AML [4,9,28,29]. Moreover, the expression levels of IGF-1, IGF-2 and insulin-like growth factor binding protein (IGFBP)-3 were found to increase with gestational age, while that of IGFBP-2 was observed to decrease in fetal blood [30][31][32].…”

“…Huang et al [9] published a meta-analysis in 2016 that indicated preterm birth was related to a higher risk of acute childhood leukemia and AML. Nevertheless, no significant association was found for ALL.…”

Cancer risk in children and young adults born preterm: A systematic review and meta-analysis

“…A recent meta-analysis evaluating the impact of preterm birth on childhood leukemias also noted no increase in the risk of ALL or all leukemias combined, but found a modest increase in the risk of AML[38]. However, the studies included for summary effects were older and numerous samples were entirely duplicated.…”