Evaluation of maternal health and labor and delivery conditions as risk factors for childhood leukemias in children with Down syndrome

- Children with Down syndrome have a high risk of childhood leukemia but the mechanisms for this relationship are not well understood.
- This study of maternal health and labor/delivery conditions found no association between most factors evaluated and leukemia in children with DS.
- A pattern of increased leukemia risk was seen with co-occurring heart anomalies in children with DS.
- Investigation of specific co-occurring heart defects may provide insights into the development of leukemia among this high risk population.

Children with Down syndrome (DS) have a remarkably high risk of developing leukemia during childhood; the mechanisms driving that risk are not well understood, and no clear prevention strategies exist. We conducted a nested case-control study in a Texas DS birth cohort to investigate possible links between maternal health, labor/delivery conditions, and leukemia risk. For most of the factors studied there was no evidence of an increased risk of total leukemias, or the subtypes acute lymphoid or acute myeloid leukemia. Ultrasound use showed an almost 2-fold increased odds of leukemia, but this result is likely an example of confounding by indication. There was a pattern of increased risk seen for presence of co-occurring heart anomalies, including tetralogy of Fallot, ventricular septal defects, atrial septal defects, and patent ductus arteriosus. Further investigation of the links between co-occurring heart defects in children with DS and development of leukemia may provide new understanding of cancer mechanisms, and ultimately lead to prevention opportunities for this high-risk population.