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Orwa SA, Gudnadottir U, Boven A, Pauwels I, Versporten A, Vlieghe E, Brusselaers N. Global prevalence of antibiotic consumption during pregnancy: A systematic review and meta-analysis. J Infect 2024; 89:106189. [PMID: 38844084 DOI: 10.1016/j.jinf.2024.106189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Antibiotic use during pregnancy is widespread with notable variations across regions. METHODS This systematic review and meta-analysis (Prospero protocol CRD42023418979) examines the prevalence and variability of antibiotic use in pregnancy globally and regionally, considering different methodologies and maternal characteristics. We searched Embase, PubMed, and Web of Science for observational studies published in English from the year 2000 and onwards. Random-effect meta-analyses were used to pool the prevalence of antibiotic consumption during pregnancy, presented as percentages with 95% confidence intervals (CI). Joanna Briggs Institute Critical appraisal checklist for prevalence studies was used for bias assessment. FINDINGS Overall, 116 studies (14 from Africa, 24 from the Americas, six from Eastern Mediterranean, 57 from Europe, four from South-East Asia and 11 from Western Pacific) were included (33,821,194 pregnancies). The majority of studies (84.5%) were appraised with a low risk of bias. The prevalence of antibiotic consumption during pregnancy ranged between 0.04 to 90%, with a pooled estimate of 23.6% (95% CI: 20.1-27.5, I2 =100%). Low-income countries had the highest pooled prevalence (45.3%, 95% CI: 15.4-79.1, I2 =99.6%). Regionally, the Western Pacific had the highest pooled prevalence (34.4%, 95% CI: 13.4-64.1, I2 =100%). The prevalence of antibiotic consumption during pregnancy increased over time in the Americas and Western Pacific. The studies exhibited considerable heterogeneity (I2 >95%), and the trim-and-fill method estimated a potential 10% underestimation of the overall pooled prevalence, suggesting publication bias. INTERPRETATION This meta-analysis suggests that about 1/4 of women worldwide use antibiotics during pregnancy. This study suggests a high prevalence of antibiotic consumption during pregnancy with disparities according to region and level of country income, ethnicity and whether antibiotics were prescribed or self-medicated. There was a variability in reported findings across age categories, potential bias from small sample sizes, and language bias from including only studies published in English.
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Affiliation(s)
- Sheila A Orwa
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Unnur Gudnadottir
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Annelies Boven
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium; Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Erika Vlieghe
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nele Brusselaers
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
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Undela K, Joy N, Gurumurthy P, M S S. Knowledge, beliefs, and practice of pregnant women regarding medication use during pregnancy: a hospital-based cross-sectional study. J OBSTET GYNAECOL 2020; 41:522-526. [PMID: 32552304 DOI: 10.1080/01443615.2020.1754368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to assess the knowledge, beliefs, and practice (KBP) of pregnant women on medication use during pregnancy, and to identify the factors influencing KBP. A cross-sectional study was conducted in the Department of Obstetrics & Gynaecology of a tertiary care hospital over a period of nine months. Pregnant women receiving at least one medication were included in the study. A 19-item questionnaire was developed, validated, and used for assessing the KBP of pregnant women. Logistic regression analysis was used to identify the factors influencing the KBP. A total of 422 pregnant women with a mean (SD) age of 24.6 (4.05) years were included in the study. Pregnant women were having less knowledge on 'unsafe medications' and 'important medications' during pregnancy, wrong belief on 'stopping all medications during pregnancy', and less practice of 'asking Pharmacist how to take medications'. It was identified hat the age, education, occupation, and area of living were the factors influencing the knowledge and practice of pregnant women on medication use. This study identified the need for improvement in knowledge and practice of pregnant women who are young, having nil or low level of education, no occupation, and living in rural areas.IMPACT STATEMENTWhat is already known on this subject? Knowledge and beliefs on medication use play a vital role in medication adherence among pregnant women. Crisis in rural healthcare along with socio-demographic conditions and literacy status of Indian women may have contributed to the lack of understanding about use of medications during pregnancy.What the results of this study add? The knowledge of pregnant women was found to be insufficient on 'unsafe medications' and 'important medications' during pregnancy. Majority of the pregnant women believe that it is better for the foetus if they 'stop taking all medications during pregnancy'. 'Not asking Pharmacist how to take medications' is one important practice in India contributes less knowledge on medication use.What the implications are of these findings for clinical practice and/or further research? There is a need for improvement in knowledge and practice of medication use among pregnant women who are young, having nil or low level of education, no occupation, and living in rural areas.
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Affiliation(s)
- Krishna Undela
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Nicy Joy
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Parthasarathi Gurumurthy
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Sujatha M S
- Department of Obstetrics and Gynaecology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
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Alemu BK, Wolle NN. Prescription drug use and potential teratogenicity risk among pregnant women attending maternal and child health clinic of Kemisse General Hospital, Northeast, Ethiopia. BMC Res Notes 2019; 12:592. [PMID: 31533806 PMCID: PMC6751805 DOI: 10.1186/s13104-019-4641-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate medications prescribed for pregnant women and their potential teratogenicity risk in Kemisse General Hospital. RESULT A total of 263 medical records of pregnant women were reviewed, of which 234 pregnant women were prescribed with a total of 430 prescription drugs. The average numbers of drugs per pregnant women was found to be 1.84. Most pregnant women 166 (63.2%) were in the third trimester and more than half of them (51.3%) were multigravida. The maximum number of drugs were prescribed in the second trimester 162 (37.67%) followed by third trimester 143 (33.26%). Supplemental drugs were the most widely used medications 297 (69.07%) and followed by 82 (19.1%) drugs from category B; 54 (12.6%) drugs from category C; and the rest 7 (1.6%) drugs from category D. There was no any drug from category X. Moreover, approximately one third of the pregnant women encountered with drugs from category B, C and D. However, there were no FDA category C and D drugs prescribed in first trimester.
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Affiliation(s)
- Belete Kassa Alemu
- Department of Pharmacy, Pharmacology and Toxicology Unit, College of Medicine and Health Sciences, Wollo University, P.o.box 1145, Dessie, Ethiopia.
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Devkota R, Khan GM, Alam K, Regmi A, Sapkota B. Medication utilization pattern for management of pregnancy complications: a study in Western Nepal. BMC Pregnancy Childbirth 2016; 16:272. [PMID: 27644958 PMCID: PMC5029070 DOI: 10.1186/s12884-016-1068-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/13/2016] [Indexed: 01/17/2023] Open
Abstract
Background Drugs used during pregnancy can adversely affect the health and life of the mother and unborn child. However, the fact that drugs are needed to mitigate complications during pregnancy cannot be avoided. The present study was designed to identify the common complications during pregnancy and assess the medications that have been used to mitigate those complications in an attempt to improve drug prescribing during pregnancy. Methods A hospital based cross sectional study was conducted at Manipal Teaching Hospital, Nepal in 275 pregnant women presenting with at least one complication and the drugs prescribed for the management of those complications were analyzed. Results Majority of the patients in this study were in the age group 20–24 (44 %) and in the third trimester (53.8 %). Maximum patients complained pain (back, abdominal, lower abdominal, neck, pelvic) as primary complication (24.3 %) which was followed by nausea/vomiting, upper respiratory tract complications, acid reflux disease and others. Of the total prescriptions eighty six (86) did not have any medicines prescribed to the patients except multivitamins and nutritional supplements. The average drugs prescribed per patient was 2.78 in outpatient setting and 5.41 in in-patients. Ranitidine, hyoscine butylbromide, paracetamol were the most frequently prescribed medications. Antimicrobials comprised 12.8 % of total drugs prescribed and 18 % of total drugs were fixed dose combinations. Two hundred and thirty four (234) prescriptions out of 275 were prescribed by brand names. Most of the prescribed drugs were from FDA pregnancy category B and C. Conclusion The present finding showed that pregnant patients were prescribed medications almost only when necessary and those considered safe during pregnancy were chosen to a large extent. However, few teratogenic drugs (2.49 % of total drugs prescribed) were also found to be prescribed which might need further assessments. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1068-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - G M Khan
- Pokhara University, Kaski, Nepal
| | | | - Amisha Regmi
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Admasie C, Wasie B, Abeje G. Determinants of prescribed drug use among pregnant women in Bahir Dar city administration, Northwest Ethiopia: a cross sectional study. BMC Pregnancy Childbirth 2014; 14:325. [PMID: 25233893 PMCID: PMC4177766 DOI: 10.1186/1471-2393-14-325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/16/2014] [Indexed: 01/26/2023] Open
Abstract
Background Drug use during pregnancy may be dangerous to the fetus. There is high consumption of prescribed drugs among pregnant women. This condition may be much higher in developing countries. There is no sufficient evidence on prescribed drug use among pregnant women in Bahir Dar town. The aim of this study was to assess the level of prescribed drug use and associated factors among pregnant women attending antenatal care (ANC) service at government health centers in Bahir Dar city administration. Methods Institution based cross sectional study was used. Data were collected from randomly selected 510 pregnant women. Data were analyzed using SPSS version 16.0. Back ward stepwise logistic regression model was used and p-values <0.05 were considered statistically significant. Result A total of 510 pregnant women were included in the study of which 88.4% were prescribed at least one drug during pregnancy. Nearly 11% of the pregnant women were prescribed with drugs from category D or X of the US-FDA risk classification. Prescribed drug use among pregnant women was more likely when the pregnancy is wanted, (AOR = 2.4, 95% CI: 1.3 - 4.6), if the mother had maternal illness (AOR = 8.5, 95% CI: 5.4-13.4), when the educational level of ANC provider is diploma (AOR = 2.7, 95% CI: 1.5-4.7) and when number of pregnancies is more (AOR =2.1, 95% CI: 1.3-3.3). Conclusion Prescribed drug use including those with potential harm to the fetus during pregnancy was very high in Bahir Dar city administration. Prescribed drug use is more when the woman had illness, when the woman was multi gravida and when the educational level of ANC provider was low (diploma). It is important to upgrade providers’ educational level and institute prevention of diseases like malaria to reduce the level of prescribed drug use during pregnancy.
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Affiliation(s)
| | | | - Gedefaw Abeje
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Eze UI, Eferakeya AE, Oparah AC, Enato EF. Assessment of prescription profile of pregnant women visiting antenatal clinics. Pharm Pract (Granada) 2014; 5:135-9. [PMID: 25214930 PMCID: PMC4154748 DOI: 10.4321/s1886-36552007000300007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
UNLABELLED Managing medical complications in pregnancy is a challenge to clinicians. OBJECTIVES This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. METHODS Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. RESULTS A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. CONCLUSION The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent antimalarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low.
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Affiliation(s)
- Uchenna I Eze
- Department of Clinical Pharmacy/Biopharmacy, Faculty of Pharmacy, Olabisi Onabanjo University Shagamu Campus, Shagamu ( Nigeria )
| | - Adego E Eferakeya
- Department of Pharmacology &Toxicology, Faculty of Pharmacy, University of Benin , Benin City ( Nigeria )
| | - Azuka C Oparah
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin , Benin City ( Nigeria )
| | - Ehijie F Enato
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin , Benin City ( Nigeria )
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Owusu-Daaku F, Marfo AF, Adjekum WO. Medicines used by pregnant women attending a district hospital in Ghana. Int J Gynaecol Obstet 2011; 115:195-6. [PMID: 21872238 DOI: 10.1016/j.ijgo.2011.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/14/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Frances Owusu-Daaku
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Adhikari A, Biswas S, Gupta RK. Drug utilization pattern in pregnant women in rural areas, India: cross-sectional observational study. J Obstet Gynaecol Res 2011; 37:1813-7. [PMID: 21827569 DOI: 10.1111/j.1447-0756.2011.01618.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the drug-utilization trend of pregnant women in rural areas of central India. MATERIALS AND METHODS This was a prospective, observational study using a questionnaire, face-to-face interview and a prescription audit. RESULTS The majority of the subjects were primigravida (51.4%), from the lower socioeconomic group (71.3%) and with poor formal education. Although the drugs prescribed for them per prescription (2.66) were within rational limits, there was scope for improvement in generic (21%) and essential drugs (18%), antibiotics (9.6%) and injections (10.97%). CONCLUSIONS Morbidity and mortality during the antenatal period occur due to different factors. Regular drug-utilization studies following the guidelines of the World Health Organization and information, education and communication factors related to drug use by pregnant women can be improved.
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Affiliation(s)
- Anjan Adhikari
- Department of Pharmacology, R. G. Kar Medical College, Kolkata Department of Anatomy, Bankura Sammilani Medical College, Bankura, Bankura District, West Bengal State, India
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Leppee M, Culig J, Eric M, Boskovic J, Colak N. Vitamin, mineral and iron supplementation in pregnancy: cross-sectional study. ACTA ACUST UNITED AC 2010. [DOI: 10.7124/bc.00014f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Leppee
- Andrija Stampar Institute of Public Health
| | - J. Culig
- Andrija Stampar Institute of Public Health
- School of Medicine Josip Juraj Strossmayer University of Osijek
| | - M. Eric
- School of Medicine, University of Novi Sad
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Rohra DK, Das N, Azam SI, Solangi NA, Memon Z, Shaikh AM, Khan NH. Drug-prescribing patterns during pregnancy in the tertiary care hospitals of Pakistan: a cross sectional study. BMC Pregnancy Childbirth 2008; 8:24. [PMID: 18627607 PMCID: PMC2491594 DOI: 10.1186/1471-2393-8-24] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 07/15/2008] [Indexed: 11/17/2022] Open
Abstract
Background The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outpatient medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected. The drugs were classified according to the pharmacological class and their teratogenic potential. Results All the pregnant women attending the antenatal clinics received a prescription containing at least one drug. A total of 3769 distinct prescriptions given to different women were collected. Majority of the women who received the prescriptions belonged to third trimester (55.4%) followed by second (33.6%) and first trimester (11.0%). On an average, each prescription contained 1.66 ± 0.14 drugs. The obstetricians at Civil Hospital, Karachi and Chandka Medical College Hospital, Larkana showed a tendency of prescribing lesser number of drugs compared to those in other hospitals. Anti-anemic drugs including iron preparations and vitamin and mineral supplements (79.4%) were the most frequently prescribed drugs followed by analgesics (6.2%) and anti-bacterials (2.2%). 739 women (19.6%) received prescriptions containing drugs other than vitamin or mineral supplements. Only 1275 (21.6%) of all the prescribed drugs (n = 6100) were outside this vitamin/mineral supplement class. Out of these 1275 drugs, 29 (2.3%) drugs were prescribed which are considered to be teratogenic. Misoprostol was the most frequently prescribed (n = 6) among the teratogenic drugs followed by carbimazole (n = 5) and methotrexate (n = 5). Twenty nine pregnant women (0.8% of all the women studied) were prescribed these teratogenic drugs. Conclusion Less than one percent of the pregnant women attending tertiary care hospitals in Pakistan are prescribed teratogenic drugs. The prescribing practices of Pakistani physicians are similar to those in western countries.
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Affiliation(s)
- Dileep K Rohra
- Department of Biological & Biomedical Sciences, Aga Khan University, Stadium Road, Karachi, Pakistan.
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Lightfoot TJ, Roman E. Causes of childhood leukaemia and lymphoma. Toxicol Appl Pharmacol 2004; 199:104-17. [PMID: 15313583 DOI: 10.1016/j.taap.2003.12.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Accepted: 12/08/2003] [Indexed: 11/25/2022]
Abstract
Childhood cancer is rare comprising less than 1% of all malignancies diagnosed each year in developed countries. Leukaemia is the commonest form of cancer in children accounting for around a third of all childhood cancer, with acute lymphoblastic leukaemia (ALL) being the most prevalent. Biologically specific subtypes of ALL and acute myeloblastic leukaemia (AML), the other major morphological type of childhood leukaemia, are characterised by chromosomal changes. Whilst over 200 genes have been associated with chromosomal translocations, to date, only MLL, TEL, and AML1 have been linked with childhood leukaemia. Interestingly, there is increasing evidence to support the theory that gene rearrangements such as these may originate in utero. As with many other human diseases, both genetic and environmental factors have been implicated in the aetiology of the disease. Although much has been documented with regard to diet, smoking, alcohol consumption and recreational and prescription drug use during pregnancy, there is no consistent evidence to support a link with any of these factors and childhood leukaemia. However, findings from studies investigating prenatal and early life exposures are often based on small numbers of cases as both the type of cancer and exposure are rare. Furthermore, accurate information relating to past exposures can be difficult to obtain and is often reliant on self-reporting. To further our understanding of the aetiology of childhood leukaemia and lymphoma, there are areas which clearly warrant investigation. These include collection of parental dietary folate data combined with genetic analysis of the folate related genes, in utero exposure to DNA topoisomerase II inhibitors, and the possible effects of assisted reproduction technology on disease susceptibility.
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Affiliation(s)
- Tracy J Lightfoot
- Leukaemia Research Fund Epidemiology and Genetics Unit, Department of Health Sciences, University of York, YO10 5DD, UK.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2003; 12:617-32. [PMID: 14558186 DOI: 10.1002/pds.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:694-700. [PMID: 12938665 DOI: 10.1002/pd.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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