PLOS ONE ( IF 2.9 ) Pub Date : 2020-03-30 , DOI: 10.1371/journal.pone.0230721 Mi Ah Han 1 , Dawid Storman 2 , Husam Al-Rammahy 3 , Shaowen Tang 4 , Qiukui Hao 5 , Gareth Leung 6 , Maryam Kandi 7 , Romina Moradi 7 , Jessica J Bartoszko 7 , Callum Arnold 8 , Nadia Rehman 9 , Gordon Guyatt 7
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Background
A number of studies have reported on associations between reproductive factors, such as delivery methods, number of birth and breastfeeding, and incidence of cancer in children, but systematic reviews addressing this issue to date have important limitations, and no reviews have addressed the impact of reproductive factors on cancer over the full life course of offspring.
Methods
We performed a comprehensive search in MEDLINE, and Embase up to January 2020 and Web of Science up to 2018 July, including cohort studies reporting the association between maternal reproductive factors of age at birth, birth order, number of births, delivery methods, and breastfeeding duration and cancer in children. Teams of two reviewers independently extracted data and assessed risk of bias. We conducted random effects meta-analyses to estimate summary relative estimates, calculated absolute differences between those with and without risk factors, and used the GRADE approach to evaluate the certainty of evidence.
Results
For most exposures and most cancers, we found no suggestion of a causal relation. We found low to very low certainty evidence of the following very small possible impact: higher maternal age at birth with adult multiple myeloma and lifetime uterine cervix cancer incidence; lower maternal age at birth with childhood overall cancer mortality (RR = 1.15, 95% CI = 1.01–1.30; AR/10,000 = 1, 95% CI = 0 to 2), adult leukemia and lifetime uterine cervix cancer incidence; higher birth order with adult melanoma, cervix uteri, corpus uteri, thyroid cancer incidence, lifetime lung, corpus uteri, prostate, testis, sarcoma, thyroid cancer incidence; larger number of birth with childhood brain (RR = 1.27, 95% CI = 1.06–1.52; AR/10,000 = 1, 95% CI = 0 to 2), leukemia (RR = 2.11, 95% CI = 1.62–2.75; AR/10,000 = 9, 95% CI = 5 to 14), lymphoma (RR = 4.66, 95% CI = 1.40–15.57; AR/10,000 = 11, 95% CI = 1 to 44) incidence, adult stomach, corpus uteri cancer incidence and lung cancer mortality, lifetime stomach, lung, uterine cervix, uterine corpus, multiple myeloma, testis cancer incidence; Caesarean delivery with childhood kidney cancer incidence (RR = 1.25, 95% CI = 1.01–1.55; AR/10,000 = 0, 95% CI = 0 to 1); and breastfeeding with adult colorectal cancer incidence.
Conclusion
Very small impacts existed between a number of reproductive factors and cancer incidence and mortality in children and the certainty of evidence was low to very low primarily due to observational design.
中文翻译：
孕产妇生殖因素对后代癌症风险的影响：队列研究的系统评价和荟萃分析。
背景
许多研究报告了生殖因素之间的关联，例如分娩方法，出生和母乳喂养的次数以及儿童患癌症的发生率，但是迄今为止，针对该问题的系统评价存在重要局限性，而没有任何评论涉及到儿童的影响。子代一生中癌症的生殖因子。
方法
我们在MEDLINE中进行了全面的搜索，截至2020年1月的Embase以及截至2018年7月的Web of Science，包括队列研究，报告了出生时的年龄，出生顺序，出生数量，分娩方式和母乳喂养的母亲生殖因素之间的关系。持续时间和儿童癌症。由两名审稿人组成的团队独立提取数据并评估偏见风险。我们进行了随机效应荟萃分析，以估算汇总相对估算值，计算有无风险因素之间的绝对差异，并使用GRADE方法评估证据的确定性。
结果
对于大多数暴露和大多数癌症，我们没有发现因果关系的暗示。我们发现从低到非常低的确定性证据表明，可能产生的影响很小：出生时较高的母亲年龄，成人多发性骨髓瘤和终生宫颈癌的发病率；较低的产妇出生年龄和儿童总体癌症死亡率（RR = 1.15，95％CI = 1.01-1.30； AR / 10,000 = 1，95％CI = 0至2），成人白血病和终生宫颈癌的发病率；成人黑素瘤，子宫颈，子宫体，甲状腺癌的发病率较高，一生中肺，子宫体，前列腺，睾丸，肉瘤，甲状腺癌的发病率较高；有大量儿童脑的出生（RR = 1.27，95％CI = 1.06-1.52; AR / 10,000 = 1，95％CI = 0至2），白血病（RR = 2.11，95％CI = 1.62-2.75; AR / 10,000 = 9，95％CI = 5至14），淋巴瘤（RR = 4.66，95％CI = 1）。40–15.57；AR / 10,000 = 11，95％CI = 1至44）发病率，成年胃，子宫体子宫癌的发病率和肺癌死亡率，一生的胃，肺，子宫子宫颈，子宫体，多发性骨髓瘤，睾丸癌的发病率；剖宫产与儿童肾癌的发生率相关（RR = 1.25，95％CI = 1.01-1.55； AR / 10,000 = 0，95％CI = 0至1）；和母乳喂养与成人大肠癌的发病率有关。
结论
许多生殖因素与儿童的癌症发病率和死亡率之间存在很小的影响，主要是由于观察设计，证据的确定性从低到非常低。
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