Evidence map›Paper›PMID 27063976›Full record

ArticleThe Lancet. Haematology2016

Caesarean delivery and risk of childhood leukaemia: a pooled analysis from the Childhood Leukemia International Consortium (CLIC).

Erin L Marcotte, Thomas P Thomopoulos, Claire Infante-Rivard, Jacqueline Clavel, Eleni Th Petridou, Joachim Schüz, Sameera Ezzat, John D Dockerty, Catherine Metayer, Corrado Magnani and 11 more

Erratum issuedOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Haematology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 67 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 7 pooled it
8.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 7 syntheses or guidelines pooled it, 111 citations in OpenAlex.

  1. Pooled it
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  12. BMJ open · 2026
    Article
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  20. Childhood B cell leukemia: Intercepting the paths to progression.BioEssays : news and reviews in molecular, cellular and developmental biology · 2024
    Review

7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 16 institutions in 9 countries.

Erin L MarcotteDepartment of Pediatrics, University of Minnesota, MN, USA. Electronic address: marcotte@umn.edu.
Thomas P ThomopoulosDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Claire Infante-RivardDepartment of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Jacqueline ClavelINSERM Unit 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France; Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France.
Eleni Th PetridouDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Joachim SchüzInternational Agency for Research on Cancer, Section of Environment and Radiation, Lyon, France.
Sameera EzzatNational Liver Institute, Menoufia University, Menoufia, Egypt.
John D DockertyDean's Department and Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Catherine MetayerUniversity of California, School of Public Health, Berkeley, CA, USA.
Corrado MagnaniDipartimento di Medicina Traslazionale, Università del Piemonte Orientale, SCDU Epidemiologia dei Tumori, Novara, Italy.
Michael E ScheurerBaylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX, USA; Texas Children's Cancer Center, Houston, TX, USA.
Beth A MuellerEpidemiology Department, University of Washington School of Public Health, Seattle, WA, USA; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Ana M MoraCentral American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica; Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
Catharina WesselingCentral American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica.
Alkistis SkalkidouDepartment of Women's and Children's Health, Obstetrics and Gynecology, Akademiska Sjukhuset, Uppsala, Sweden.
Wafaa M RashedResearch Department, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
Stephen S FrancisUniversity of California, School of Public Health, Berkeley, CA, USA; University of California, San Francisco, Neuro and Molecular Epidemiology Laboratory, San Francisco, CA, USA.
Roula AjroucheINSERM Unit 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France; Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France.
Friederike ErdmannInternational Agency for Research on Cancer, Section of Environment and Radiation, Lyon, France.
Laurent OrsiINSERM Unit 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France; Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France.
Logan G SpectorDepartment of Pediatrics, University of Minnesota, MN, USA.
Centre International de Recherche sur le Cancer · FRNational and Kapodistrian University of Athens · GRUniversidad Nacional · CRUniversity of Minnesota · USChildren Cancer Hospital · EGChildren's Cancer Center · USFred Hutch Cancer Center · USInserm · FRMcGill University · CAMenoufia University · EGSorbonne Paris Cité · FRUniversità degli Studi del Piemonte Orientale “Amedeo Avogadro” · ITUniversité Paris Cité · FRUniversity of California, San Francisco · USUniversity of Otago · NZUppsala University Hospital · SE

Funding

Environmental and Molecular Epidemiology of Childhood LeukemiaR01ES009137 · NIEHS · UNIVERSITY OF CALIFORNIA BERKELEY · PI METAYER, CATHERINE · 1999 to 2013
$21.1M
Training Program in Translational Brain Tumor ResearchT32CA151022 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Joseph F Costello · 2010 to 2026
$6.6M
Translational Pediatric Cancer Epidemiology Research Training GrantT32CA099936 · NCI · UNIVERSITY OF MINNESOTA TWIN CITIES · PI Logan G. Spector · 2004 to 2026
$5.1M
Project 3: Prenatal Exposure, DNA Methylation & Childhood LeukemiaP01ES018172 · NIEHS · UNIVERSITY OF CALIFORNIA BERKELEY · PI METAYER, CATHERINE · 2009 to 2013
$3.7M
Childhood Leukemia International Consortium (CLIC)R03CA132172 · NCI · UNIVERSITY OF CALIFORNIA BERKELEY · PI BUFFLER, PATRICIA A · 2007 to 2008
$125k
2012 Annual Scientific Meeting of the International Childhood Leukemia ConsortiumR13ES022868 · NIEHS · UNIVERSITY OF CALIFORNIA BERKELEY · PI METAYER, CATHERINE · 2012 to 2012
$18k
2014 Childhood Leukemia International Consortium Annual Scientific MeetingR13ES024632 · NIEHS · UNIVERSITY OF CALIFORNIA BERKELEY · PI METAYER, CATHERINE · 2014 to 2014
$10k
2011 Annual Scientific Meeting of the International Childhood Leukemia ConsortiumR13ES021145 · NIEHS · UNIVERSITY OF CALIFORNIA BERKELEY · PI BUFFLER, PATRICIA A · 2011 to 2011
$10k
NCI NIH HHS R03 CA132172NCI NIH HHS T32 CA099936NCI NIH HHS T32 CA151022NIEHS NIH HHS P01 ES018172NIEHS NIH HHS R01 ES009137NIEHS NIH HHS R13 ES021145NIEHS NIH HHS R13 ES021145-01NIEHS NIH HHS R13 ES022868NIEHS NIH HHS R13 ES024632World Health Organization 001
6 · The paper itself

Abstract

backgroundResults from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery.

methodsWe pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis.

findingsThe studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]).

interpretationOur results suggest an increased risk of childhood ALL after prelabour caesarean delivery. If this association is causal, maladaptive immune activation due to an absence of stress response before birth in children born by prelabour caesarean delivery could be considered as a potential mechanism.

fundingNational Cancer Institute.

Indexed as

AdolescentCanadaCesarean SectionChildChild, PreschoolCosta RicaEgyptFemaleFranceGermanyGreeceHumansInfantInfant, NewbornItalyLeukemia, Myeloid, Acute

Identifiers

PMID27063976
PMCPMC5283076
OpenAlexW2286860957

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.