Abstract 6371: Prenatal exposure to medication and risk of childhood cancer - A systematic review and meta-analysis
Authors: Lübtow Alicia , Marron Manuela , Nagrani Rajini , Ahrens Wolfgang , Brackmann Lara Kim 
Published: March 2024

Abstract
The use of medication during pregnancy carries a potential health risk for the unborn child. However, the majority of drugs examined in previous observational studies have shown inconsistent results with the risk of childhood cancer, and these findings have not been consolidated in drug-specific meta-analyses. To address this gap, a systematic search was conducted in the databases PubMed and Science Citation Index for studies on medication use during pregnancy and the risk of childhood cancer. Studies with exposure to diethylstilbestrol as a known teratogen were excluded. Meta-analyses with estimates for random effects models with 95% confidence intervals were conducted, if at least three studies on the same research question were available. The I² statistic was calculated to quantify between-study heterogeneity. Statistical significance of I2 was analyzed with the Q statistic (P value for heterogeneity (P)). Study quality was summarized based on a self-developed scoring system with five items. The systematic literature search yielded 2,373 studies, of which 62 were included in the systematic review. We conducted a total of 37 analyses including exposure to 12 different types of medications during pregnancy and 13 different outcomes of childhood cancer. Pooled odds ratios (OR) showed an increased risk of acute leukemia (AL) and its subtype acute lymphoblastic leukemia (ALL) after prenatal exposure to antiemetics (AL: OR= 1.47 (95 % confidence interval 1.02; 2.14) I²= 0.0 % P= 0.44; ALL: OR= 1.27 (1.01;1.59) I²= 0.0 % P= 0.93) and any kind of antibiotics (AL: OR= 1.13 (1.01; 1.27) I²= 0.0 % P= 0.53; ALL: OR= 1.12 (1.01; 1.24) I²= 19.7 % P= 0.26). In addition, an increased risk of childhood cancer in general was observed when mothers took nitrosatable antibiotics (OR= 1.32 (1.14; 1.53) I²= 0.0 % P= 0.97). Finally, the use of analgesics (OR= 1.40 (1.00; 1.95) I²= 43.8 % P= 0.15) during pregnancy was associated with an increased risk of neuroblastoma in the offspring. All these analyses did not reveal any indications of heterogeneity between the analyzed studies. The remaining 31 analyses showed no association. Our results suggest that the use of nitrosatable antibiotics during pregnancy may be associated with an increased risk of childhood cancer. Maternal intake of antibiotics and antiemetics may increase the risk of AL and ALL in their children. An increased risk of childhood neuroblastoma could be associated with prenatal exposure to analgesics. However, the underlying disease of the mother, which is treated with the investigated medication, could be the actual reason for the development of childhood cancer in the offspring.
Citation Format: Alicia Lübtow, Manuela Marron, Rajini Nagrani, Wolfgang Ahrens, Lara Kim Brackmann. Prenatal exposure to medication and risk of childhood cancer - A systematic review and meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6371.