Cesarean section and risk of childhood leukemia: a systematic review and meta-analysis

Background A large number of studies pointed that being delivered by cesarean section (CS) would affect the health outcomes of offspring, however, whether CS would affect the risk of childhood leukemia remained uncertain. This study conducted a meta-analysis to quantitatively evaluate whether being delivered by CS would influence the onset of childhood leukemia. Methods PubMed, Embase and Web of Science databases were searched from 3rd June, 1950 to 13th October, 2019 to identify the literature, which examined the relationship between CS and childhood leukemia. This study used Newcastle–Ottawa Scale to assess the quality of literature. Subgroup analyses were conducted on region, mode of delivery, design of the study and number of confounders adjusted. Egger’s test and Begg’s test were performed to evaluate possible publication bias. Results The pooled odds ratio (OR) estimates illustrated that children delivered by CS had a higher risk of developing leukemia [OR 1.10, 95% confidence interval (CI) 1.04–1.17, P = 0.002] and lymphoblastic leukemia (OR 1.12, 95% CI 1.03–1.23, P = 0.009), while a significant association for myeloid leukemia was not observed (OR 1.05, 95% CI 0.92–1.20, P = 0.451). Results of subgroup analyses indicated that elective CS would increase the risk of childhood lymphoblastic leukemia (OR 1.16, 95% CI 1.06–1.27, P = 0.002). However, a statistical relationship between emergency CS and lymphoblastic leukemia was not observed (OR 1.07, 95% CI 0.93–1.23, P = 0.364). Conclusions CS would increase the risk of childhood lymphoblastic leukemia. It is worth noting that subgroup analyses shows that elective CS rather than emergency CS increases the risk of lymphoblastic leukemia in offspring.