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Multicenter Study
. 2014 Nov;25(6):811-22.
doi: 10.1097/EDE.0000000000000141.

Maternal supplementation with folic acid and other vitamins and risk of leukemia in offspring: a Childhood Leukemia International Consortium study

Catherine Metayer  1 , Elizabeth Milne, John D Dockerty, Jacqueline Clavel, Maria S Pombo-de-Oliveira, Catharina Wesseling, Logan G Spector, Joachim Schüz, Eleni Petridou, Sameera Ezzat, Bruce K Armstrong, Jérémie Rudant, Sergio Koifman, Peter Kaatsch, Maria Moschovi, Wafaa M Rashed, Steve Selvin, Kathryn McCauley, Rayjean J Hung, Alice Y Kang, Claire Infante-Rivard
Affiliations
Multicenter Study

Maternal supplementation with folic acid and other vitamins and risk of leukemia in offspring: a Childhood Leukemia International Consortium study

Catherine Metayer et al. Epidemiology. 2014 Nov.

Abstract

Background: Maternal prenatal supplementation with folic acid and other vitamins has been inconsistently associated with a reduced risk of childhood acute lymphoblastic leukemia (ALL). Little is known regarding the association with acute myeloid leukemia (AML), a rarer subtype.

Methods: We obtained original data on prenatal use of folic acid and vitamins from 12 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2012), including 6,963 cases of ALL, 585 cases of AML, and 11,635 controls. Logistic regression was used to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for child's age, sex, ethnicity, parental education, and study center.

Results: Maternal supplements taken any time before conception or during pregnancy were associated with a reduced risk of childhood ALL; odds ratios were 0.85 (95% CI = 0.78-0.92) for vitamin use and 0.80 (0.71-0.89) for folic acid use. The reduced risk was more pronounced in children whose parents' education was below the highest category. The analyses for AML led to somewhat unstable estimates; ORs were 0.92 (0.75-1.14) and 0.68 (0.48-0.96) for prenatal vitamins and folic acid, respectively. There was no strong evidence that risks of either types of leukemia varied by period of supplementation (preconception, pregnancy, or trimester).

Conclusions: Our results, based on the largest number of childhood leukemia cases to date, suggest that maternal prenatal use of vitamins and folic acid reduces the risk of both ALL and AML and that the observed association with ALL varied by parental education, a surrogate for lifestyle and sociodemographic characteristics.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Maternal vitamin supplementation preconception and during pregnancy, by study. For data from Germany, data for vitamin use were collected for preconception and/or pregnancy period. CCG indicates Children's Cancer Group; NCCLS, Northern California Childhood Leukemia Study.
Figure 2
Figure 2
Maternal folic acid supplementation preconception and during pregnancy, by study. NCCLS indicates Northern California Childhood Leukemia Study.
See this image and copyright information in PMC

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