Background Previous epidemiological studies have found positive associations between maternal infections and childhood leukaemia; however, evidence from prospective cohort studies is scarce. We aimed to examine the associations using large-scale prospective data. Methods Data were pooled from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA (recruitment 1950s-2000s). Primary outcomes were any childhood leukaemia and acute lymphoblastic leukaemia (ALL); secondary outcomes were acute myeloid leukaemia (AML) and any childhood cancer. Exposures included maternal self-reported infections [influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections and urinary tract infection (including cystitis)] and infection-associated symptoms (fever and diarrhoea) during pregnancy. Covariate-adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated using multilevel Cox models. Results Among 312 879 children with a median follow-up of 13.6 years, 167 leukaemias, including 129 ALL and 33 AML, were identified. Maternal urinary tract infection was associated with increased risk of any leukaemia [HR (95% CI) 1.68 (1.10–2.58)] and subtypes ALL [1.49 (0.87–2.56)] and AML [2.70 ([0.93–7.86)], but not with any cancer [1.13 (0.85–1.51)]. Respiratory tract infection was associated with increased risk of any leukaemia [1.57 (1.06–2.34)], ALL [1.43 (0.94–2.19)], AML [2.37 (1.10–5.12)] and any cancer [1.33 (1.09–1.63)]; influenza-like illness showed a similar pattern but with less precise estimates. There was no evidence of a link between other infections and any outcomes. Conclusions Urinary tract and respiratory tract infections during pregnancy may be associated with childhood leukaemia, but the absolute risk is small given the rarity of the outcome.

中文翻译：

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孕期常见母体感染和后代儿童白血病：来自六个国际出生队列的研究结果

背景 先前的流行病学研究发现母体感染与儿童白血病之间存在正相关关系；然而，来自前瞻性队列研究的证据很少。我们的目的是使用大规模前瞻性数据来检查这些关联。方法 数据来自澳大利亚、丹麦、以色列、挪威、英国和美国的六个基于人口的出生队列（1950 年代至 2000 年代招募）。主要结局是任何儿童白血病和急性淋巴细胞白血病 (ALL)；次要结果是急性髓性白血病 (AML) 和任何儿童癌症。暴露包括产妇自我报告的感染[流感样疾病、普通感冒、任何呼吸道感染、阴道鹅口疮、阴道感染和尿路感染（包括膀胱炎）]和怀孕期间的感染相关症状（发烧和腹泻）。使用多级 Cox 模型估计协变量调整后的风险比 (HR) 和 95% 置信区间 (CI)。结果 在中位随访时间为 13.6 年的 312 879 名儿童中，确定了 167 例白血病，包括 129 例 ALL 和 33 例 AML。母体尿路感染与任何白血病 [HR (95% CI) 1.68 (1.10–2.58)] 和亚型 ALL [1.49 (0.87–2.56)] 和 AML [2.70 ([0.93–7.86)] 的风险增加有关，但没有任何癌症 [1.13 (0.85–1.51)]。呼吸道感染与任何白血病 [1.57 (1.06–2.34)]、ALL [1.43 (0.94–2.19)]、AML [2.37 (1.10–5.12)] 和任何癌症 [1.33 (1.09–1.63)] 的风险增加有关; 流感样疾病表现出类似的模式，但估计不太准确。没有证据表明其他感染与任何结果之间存在联系。结论 妊娠期泌尿道和呼吸道感染可能与儿童白血病有关，但鉴于这种结果的罕见性，绝对风险很小。