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Iron Supplementation in Pregnancy and Risk of Gestational Diabetes: A Narrative Review. Nutrients 2022; 14:nu14224791. [PMID: 36432476 PMCID: PMC9695730 DOI: 10.3390/nu14224791] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Pregnant women frequently supplement their diets with iron to treat any cryptic anemia, on the assumption that if anemia is not present, there will be no negative consequences. However, in women who are already iron-replete, it has been suggested that this can lead to iron overload and an increased risk of certain pregnancy complications. One such complication is gestational diabetes. Fourteen clinical trials, case-control or cohort studies (found using Pubmed/Scopus/Web of Science) have investigated links between iron supplementation in pregnancy and risk of gestational diabetes, several of them finding significant associations with increased risk. Potential mechanisms include increased oxidative stress leading to insulin resistance and inadequate compensatory insulin secretion. Current evidence suggests that dietary supplementation with iron in pregnancy may increase a pregnant woman's chance of developing gestational diabetes, although available evidence is somewhat contradictory, and the magnitude of any increased risk appears relatively small. Meta-analyses have suggested the presence of significant heterogeneity in results between studies, urging a degree of caution in interpreting these results. It is currently suggested that advice to pregnant women about whether to supplement their diets with iron or not should consider both their current iron status and their other established risk factors for gestational diabetes.
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Mirghani Dirar A, Doupis J. Gestational diabetes from A to Z. World J Diabetes 2017; 8:489-511. [PMID: 29290922 PMCID: PMC5740094 DOI: 10.4239/wjd.v8.i12.489] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 02/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus (T2DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent well-designed clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.
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Affiliation(s)
- AbdelHameed Mirghani Dirar
- Prince Abdel Aziz Bin Musaad Hospital, Diabetes and Endocrinology Center, Arar 91421, North Zone Province, Saudi Arabia
| | - John Doupis
- Iatriko Paleou Falirou Medical Center, Division of Diabetes and Clinical Research Center, Athens 17562, Greece
- Postgraduate Diabetes Education, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
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Abstract
Pregnant women are particularly vulnerable to iron deficiency and related adverse pregnancy outcomes and, as such, are routinely recommended for iron supplementation. Emerging evidence from both animal and population-based studies, however, has raised potential concerns because significant associations have been observed between greater iron stores and disturbances in glucose metabolism, including increased risk of type 2 diabetes among nonpregnant individuals. Yet, the evidence is uncertain regarding the role of iron in the development of gestational diabetes mellitus (GDM), a common pregnancy complication which has short-term and long-term adverse health ramifications for both women and their children. In this review, we critically and systematically evaluate available data examining the risk of GDM associated with dietary iron, iron supplementation, and iron status as measured by blood concentrations of several indicators. We also discuss major methodologic concerns regarding the available epidemiologic studies on iron and GDM.
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Affiliation(s)
- Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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Eades CE, Cameron DM, Evans JMM. Prevalence of gestational diabetes mellitus in Europe: A meta-analysis. Diabetes Res Clin Pract 2017; 129:173-181. [PMID: 28531829 DOI: 10.1016/j.diabres.2017.03.030] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/28/2017] [Indexed: 11/29/2022]
Abstract
AIMS Estimates of the prevalence of gestational diabetes vary widely. It is important to have a clear understanding of the prevalence of this condition to be able to plan interventions and health care provision. This paper describes a meta-analysis of primary research data reporting the prevalence of gestational diabetes mellitus in the general pregnant population of developed countries in Europe. METHODS Four electronic databases were systematically searched in May 2016. English language articles reporting gestational diabetes mellitus prevalence using universal screening in general pregnant population samples from developed countries in Europe were included. All papers identified by the search were screened by one author, and then half screened independently by a second author and half by a third author. Data were extracted by one author. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out. RESULTS A total of 3258 abstracts were screened, with 40 studies included in the review. Overall prevalence of gestational diabetes mellitus was 5.4% (3.8-7.8). Maternal age, year of data collection, country, area of Europe, week of gestation at testing, and diagnostic criteria were found to have a significant univariate effect on GDM prevalence, and area, week of gestation at testing and year of data collection remained statistically significant in multivariate analysis. Quality category was significant in multivariate but not univariate analysis. CONCLUSIONS This meta-analysis shows prevalence of GDM that is at the upper end of previous estimates in Europe.
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Affiliation(s)
- Claire E Eades
- Faculty of Health Sciences and Sport, University of Stirling, United Kingdom.
| | - Dawn M Cameron
- Faculty of Health Sciences and Sport, University of Stirling, United Kingdom
| | - Josie M M Evans
- Faculty of Health Sciences and Sport, University of Stirling, United Kingdom
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AISF position paper on liver disease and pregnancy. Dig Liver Dis 2016; 48:120-37. [PMID: 26747754 DOI: 10.1016/j.dld.2015.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/29/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
Abstract
The relationship between liver disease and pregnancy is of great clinical impact. Severe liver disease in pregnancy is rare; however, pregnancy-related liver disease is the most frequent cause of liver dysfunction during pregnancy and represents a severe threat to foetal and maternal survival. A rapid differential diagnosis between liver disease related or unrelated to pregnancy is required in women who present with liver dysfunction during pregnancy. This report summarizes the recommendation of an expert panel established by the Italian Association for the Study of the Liver (AISF) on the management of liver disease during pregnancy. The article provides an overview of liver disease occurring in pregnancy, an update on the key mechanisms involved in its pathogenesis, and an assessment of the available treatment options. The report contains in three sections: (1) specific liver diseases of pregnancy; (2) liver disease occurring during pregnancy; and (3) pregnancy in patients with pre-existing chronic liver disease. Each topic is discussed considering the most relevant data available in literature; the final statements are formulated according to both scientific evidence and clinical expertise of the involved physicians, and the AISF expert panel recommendations are reported.
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Fu S, Li F, Zhou J, Liu Z. The Relationship Between Body Iron Status, Iron Intake And Gestational Diabetes: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e2383. [PMID: 26765415 PMCID: PMC4718241 DOI: 10.1097/md.0000000000002383] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Biological and epidemiological evidence have found that gestational diabetes mellitus (GDM) may be correlated with body iron status and dietary iron intake. Therefore, we investigated the relationship between dietary iron intake and body iron status and GDM risk.We conducted a systematic search in Embase, PubMed, Web of Science, and Cochrane Library up to April 2015. Prospective cohort studies or case-control studies which appraised the relationship between body iron status, dietary iron intake, and GDM risk were included. Relative risks (RRs), standard mean difference (SMD), and 95% confidence intervals [CIs] were used to measure the pooled data.A total of 8 prospective cohort studies and 7 case-control studies were in accordance with inclusive criteria, and 14 studies were included in meta-analysis. The overall RR comparing the highest and lowest levels of serum ferritin was 3.22 (95% CI: 1.73-6.00) for prospective cohort studies. Serum ferritin of GDM group is markedly higher than that of control (0.88 ng/mL; 95% CI: 0.40-1.35 ng/mL) for case-control studies. The comparison between the highest and the lowest serum ferritin levels and dietary total iron levels revealed pooled RRs of 1.53 (95% CI: 1.17-2.00) and 1.01 (95% CI: 1.00-1.01) for prospective cohort studies, respectively. The combined SMD comparing serum transferrin levels of cases and controls was -0.02 μmol/L (95% CI: -0.22 to 0.19 μmol/L) for case-control studies.Increased higher ferritin levels were significantly correlated with higher risk of GDM, and higher heme iron levels may be correlated with higher risk of GDM; however, the present conclusion did not constitute definitive proof that dietary total iron or serum transferrin have relation to GDM.
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Affiliation(s)
- Shimin Fu
- From the Department of Endocrinology (SF, FL, ZL), The First Affiliated Hospital of Chongqing Medical University, Chongqing; and Department of Oncology (JZ), Affiliated Hospital of Zunyi Medical University, Guizhou, China
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Zein S, Rachidi S, Awada S, Osman M, Al-Hajje A, Shami N, Sharara I, Cheikh-Ali K, Salameh P, Hininger-Favier I. High iron level in early pregnancy increased glucose intolerance. J Trace Elem Med Biol 2015; 30:220-5. [PMID: 25441227 DOI: 10.1016/j.jtemb.2014.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/14/2014] [Accepted: 09/03/2014] [Indexed: 12/11/2022]
Abstract
High iron stores in pregnancy are essential in preventing negative outcomes for both infants and mothers; however the risk of gestational diabetes mellitus (GDM) might also be increased. We intend to study the relationship between increased iron stores in early pregnancy and the risk of glucose intolerance and GDM. This prospective, observational, single-hospital study involved 104 non-anemic pregnant women, divided into 4 groups based on the quartile values for ferritin at the first trimester of pregnancy. All participants were screened for GDM with 75-g oral glucose tolerance test (OGTT) at 24-28 weeks' gestation. We observed that ferritin levels at early pregnancy were significantly correlated to glucose level after OGTT at 1-h and 2-h (rho=0.21, p<0.05; rho=0.43, p<0.001 respectively). Furthermore, in the higher quartile for ferritin (>38.8μg/L) glycemia at 2-h OGTT was significantly higher than in the others quartiles (p=0.002). In multivariate regression analysis, serum ferritin was a significant determinant of glycemia at 2-h OGTT. Although we did not find a significant association in the incidence of GDM in women with higher serum ferritin levels, probably in reason to the limit power of our study, our data demonstrated that the role of iron excess is tightly involved in the pathogenesis of glucose intolerance. We report for the first time that high ferritin values in early pregnancy are predictors of impaired glucose tolerance in non-anemic women. Individual iron supplementation should be evaluated in order to minimize glucose impairment risk in women with high risk of diabetes.
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Affiliation(s)
- Salam Zein
- Clinical Pharmacy Department, Faculty of Pharmacy, Lebanese University, Campus Rafic Hariri, Hadath, Lebanon.
| | - Samar Rachidi
- Clinical Pharmacy Department, Faculty of Pharmacy, Lebanese University, Campus Rafic Hariri, Hadath, Lebanon
| | - Sanaa Awada
- Clinical Pharmacy Department, Faculty of Pharmacy, Lebanese University, Campus Rafic Hariri, Hadath, Lebanon
| | - Mireille Osman
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, INSERM U1055, Grenoble Cedex 09 F-38041, France
| | - Amal Al-Hajje
- Clinical Pharmacy Department, Faculty of Pharmacy, Lebanese University, Campus Rafic Hariri, Hadath, Lebanon
| | - Nadine Shami
- Department of Gynecology and Obstetrics, Bahman Hospital, Beirut, Lebanon
| | - Iman Sharara
- Department of Gynecology and Obstetrics, Bahman Hospital, Beirut, Lebanon
| | - Khawla Cheikh-Ali
- Department of Gynecology and Obstetrics, Bahman Hospital, Beirut, Lebanon
| | - Pascale Salameh
- Clinical Pharmacy Department, Faculty of Pharmacy, Lebanese University, Campus Rafic Hariri, Hadath, Lebanon
| | - Isabelle Hininger-Favier
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, INSERM U1055, Grenoble Cedex 09 F-38041, France.
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Zhuang T, Han H, Yang Z. Iron, oxidative stress and gestational diabetes. Nutrients 2014; 6:3968-80. [PMID: 25255832 PMCID: PMC4179198 DOI: 10.3390/nu6093968] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/27/2014] [Accepted: 09/09/2014] [Indexed: 01/01/2023] Open
Abstract
Both iron deficiency and hyperglycemia are highly prevalent globally for pregnant women. Iron supplementation is recommended during pregnancy to control iron deficiency. The purposes of the review are to assess the oxidative effects of iron supplementation and the potential relationship between iron nutrition and gestational diabetes. High doses of iron (~relative to 60 mg or more daily for adult humans) can induce lipid peroxidation in vitro and in animal studies. Pharmaceutical doses of iron supplements (e.g., 10× RDA or more for oral supplements or direct iron supplementation via injection or addition to the cell culture medium) for a short or long duration will induce DNA damage. Higher heme-iron intake or iron status measured by various biomarkers, especially serum ferritin, might contribute to greater risk of gestational diabetes, which may be mediated by iron oxidative stress though lipid oxidation and/or DNA damage. However, information is lacking about the effect of low dose iron supplementation (≤60 mg daily) on lipid peroxidation, DNA damage and gestational diabetes. Randomized trials of low-dose iron supplementation (≤60 mg daily) for pregnant women are warranted to test the relationship between iron oxidative stress and insulin resistance/gestational diabetes, especially for iron-replete women.
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Affiliation(s)
- Taifeng Zhuang
- Department of Neonatal Intensive Care Unit (NICU), Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
| | - Huijun Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.
| | - Zhenyu Yang
- Key Laboratory of Trace Element Nutrition of the Ministry of Health, National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China.
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Sivitskaya L, Danilenko N, Zabarouskaya Z, Davydenko O. HFE Gene Mutation Associated with the Severity of Gestational Diabetes Mellitus in Belarusian Women. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojemd.2013.31002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sharifi F, Ziaee A, Feizi A, Mousavinasab N, Anjomshoaa A, Mokhtari P. Serum ferritin concentration in gestational diabetes mellitus and risk of subsequent development of early postpartum diabetes mellitus. Diabetes Metab Syndr Obes 2010; 3:413-9. [PMID: 21437111 PMCID: PMC3047976 DOI: 10.2147/dmsott.s15049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the serum ferritin concentrations of normal pregnant women with those having gestational diabetes mellitus (GDM) and to determine the possible role of ferritin in predicting pregnancy outcome and early development of postpartum glucose intolerance and diabetes mellitus. METHOD This case-control study consisted of 128 pregnant women (64 women with GDM and 64 age-matched healthy pregnant women) seen at a university hospital in Zanjan, Iran. Anthropometric measurements were determined, and serum ferritin, C-reactive protein, insulin, glycosylated hemoglobin (HbA(1c)), and hemoglobin levels were measured. Pregnancy outcomes were recorded in all subjects. In the women with GDM, a diagnostic oral glucose tolerance test was performed eight weeks after delivery. RESULTS Women with GDM had a higher concentration of serum ferritin (112 ± 28.4 pmol/L in GDM versus 65 ± 16.9 pmol/L in controls, P < 0.001). A positive correlation was found between serum ferritin level and mid-pregnancy fasting plasma glucose and HbA(lc) levels. Although women in the highest quartile of serum ferritin had a greater than two-fold increased risk of GDM, no significant correlation was found between ferritin levels and early postpartum oral glucose tolerance test results. CONCLUSIONS Elevated serum ferritin concentrations in mid-pregnancy are associated with an increased risk of GDM independent of C-reactive protein and body mass index. Ferritin levels in GDM cannot be used as an indicator to predict subsequent glucose concentration in early postpartum oral glucose tolerance test.
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Affiliation(s)
| | - Amir Ziaee
- Qazvin Metabolic Diseases Research Center, Qazvin
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Abstract
Iron overload in humans is associated with a variety of genetic and acquired conditions. Of these, HFE hemochromatosis (HFE-HC) is by far the most frequent and most well-defined inherited cause when considering epidemiological aspects and risks for iron-related morbidity and mortality. The majority of patients with HFE-HC are homozygotes for the C282Y polymorphism [1]. Without therapeutic intervention, there is a risk that iron overload will occur, with the potential for tissue damage and disease. While a specific genetic test now allows for the diagnosis of HFE-HC, the uncertainty in defining cases and disease burden, as well as the low phenotypic penetrance of C282Y homozygosity poses a number of clinical problems in the management of patients with HC. This Clinical Practice Guideline will therefore, focus on HFE-HC, while rarer forms of genetic iron overload recently attributed to pathogenic mutations of transferrin receptor 2, (TFR2), hepcidin (HAMP), hemojuvelin (HJV), or to a sub-type of ferroportin (FPN) mutations, on which limited and sparse clinical and epidemiologic data are available, will not be discussed. We have developed recommendations for the screening, diagnosis, and management of HFE-HC.
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PRATAP U, QUINN S, BLIZZARD LB, REID DW. Population-based study of cystic fibrosis disease severity and haemochromatosis gene mutations. Respirology 2010; 15:141-9. [DOI: 10.1111/j.1440-1843.2009.01649.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weinberg E. Are iron supplements appropriate for iron replete pregnant women? Med Hypotheses 2009; 73:714-5. [DOI: 10.1016/j.mehy.2009.04.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 04/21/2009] [Accepted: 04/25/2009] [Indexed: 12/13/2022]
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Dorak MT, Pearce MS, Hammal DM, McNally RJQ, Parker L. Examination of gender effect in birth weight and miscarriage associations with childhood cancer (United Kingdom). Cancer Causes Control 2007; 18:219-28. [PMID: 17206531 DOI: 10.1007/s10552-006-0093-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Higher birth weight and maternal history of miscarriage has been associated with an increased risk of childhood leukemia. The possibility that this association may be sex-specific has not been explored in detail in previous studies. METHODS In a retrospective case-control study, 732 childhood (< or =14 years) cancer cases from a population-based Registry in Northern England whose hospital birth records could be accessed and 3,723 controls matched for date and hospital of birth to the cases were compared. We examined birth weight for sex-specific associations with childhood cancer. Conditional logistic regression analysis was used for statistical evaluation of associations. RESULTS In acute lymphoblastic leukemia (ALL) (225 cases and 1,163 matched controls), birth weight and sex showed a strong interaction (P = 0.003). In boys with ALL, but not in girls, there was a nonlinear association with birth weight (P for trend = 0.008; OR = 3.05 for the highest quintile compared to the second lowest quintile, 95% CI = 1.40-6.64; P = 0.005). When birth weights were adjusted using UK standards for gestational age and sex, the risk associations were similar in statistical significance and magnitude. Maternal history of miscarriage showed an association with all cancers and individually with ALL. The miscarriage association with ALL was statistically significant in boys only (OR = 1.91, 95% CI = 1.07-3.42; P = 0.03). A multivariable model for ALL containing other examined maternal and reproductive variables confirmed the independence of the birth weight and miscarriage associations. There was no birth weight or miscarriage associations in other cancers. CONCLUSIONS This study confirmed the risk associations with birth weight and miscarriages in childhood ALL. Statistically significant association of size at birth suggested marked differences in etiology between girls and boys.
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Affiliation(s)
- M Tevfik Dorak
- Paediatric and Lifecourse Epidemiology Research Group, Sir James Spence Institute, School of Clinical Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.
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