Academic journal article Environmental Health Perspectives

In Utero Pesticide Exposure and Leukemia in Brazilian Children less than 2 Years of Age

Academic journal article Environmental Health Perspectives

In Utero Pesticide Exposure and Leukemia in Brazilian Children less than 2 Years of Age

Article excerpt

Pesticide exposure is a public health concern worldwide. In Brazil, a study conducted in two stages among small-scale fruit farmers revealed that 19% of them had reported at least one poisoning episode (4% in the year before interview). Even at this stage, 11% of all episodes were probable cases of acute poisoning according to World Health Organization criteria (Faria et al. 2009). Moreover, pesticide use also has been associated with chronic diseases such as cancer, including childhood leukemia, at 0-14 years of age (Bassil et al. 2007; Infante-Rivard and Weichenthal 2007; Turner et al. 2010; Zahm and Ward 1998).

Infant leukemias are rare acute leukemias diagnosed within the first 12 months of age, although some researchers include cases up to 18 months of age (Alexander et al. 2001; Pombo-de-Oliveira and Koifman 2006). DNA alterations during the periconceptional period or pregnancy, which may be caused by chemical substances and other environmental exposures, are potential risk factors for infant leukemias (Buffler et al. 2005; Lafiura et al. 2007).

However, few studies of pesticides and leukemia in very young children have been Previous studies have reported associations between childhood leukemia and maternal exposure to pesticides (Ma et al. 2002; Meinert et al. 2000; Menegaux et al. 2006; Monge et al. 2007; Rudant et al. 2007). However, few studies of pesticides and leukemia in very young children have been published. Additionally, most studies of association between childhood leukemias and pesticides have focused on parents' occupational exposures (Colt and Blair 1998; Monge et al. 2005; Perez-Saldivar et al. 2008; Rudant et al. 2007; Wigle et al. 2009), and a few have considered the use of household pesticides during the prenatal period (Lafiura et al. 2007; Meinert et al. 2000; Monge et al. 2007; Zahm and Ward 1998).

A case-control study of risk factors for leukemia in children < 2 years of age was conducted in Brazil, and an adjusted odds ratio (aOR) of 2.18 (95% CI: 1.53, 2.13) was reported in association with maternal exposure to pesticides (Pombo-de-Oliveira and Koifman 2006). In the present investigation, we aimed to extend these analyses of maternal pesticide exposure and leukemia in the offspring.

Methods

Study population. This investigation is part of a multicenter study, the Multi-institutional Study of Infant Leukemia: Contribution of Immunomolecular Markers in Distinguishing Different Etiopathogenic Factors, which focuses on the investigation of biomarkers of leukemia diagnosed in children < 2 years of age in Brazil. Participants (n = 675) were recruited from 13 states in all geographic areas in the country but the Amazon, including cities in the Southern Region, the Southeast, the Northeast, and the Middle West.

Study design. This is a hospital-based multi center case-control study in which controls were frequency matched with leukemia cases according to age (0-23 months) and enrolled from the same geographic areas where cases were diagnosed.

Data were obtained by in-person interviews carried out from 1999 through 2007 with mothers of newly diagnosed patients. These patients were recruited from the Brazilian National Health System centers that provide free oncologic care for pediatric patients and from general hospitals.

Cases (n = 252) were defined as children < 24 months of age with a conclusive diagnosis of acute lymphoid leukemia (ALL) (n = 193) or acute myeloid leukemia (AML) (n = 59) confirmed by morphology, immuno phenotype, and standard cytogeneticmolecular methods.

Controls (n = 423) were selected from among children < 24 months of age with nonmalignant diseases who were patients at the Brazilian National Health System centers where the cases were recruited or patients of general hospitals in the same cities. The hospitals from which controls were recruited had the same catchment areas of those of cases. …

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