DOI QR코드

DOI QR Code

The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies

  • Ismail, Wan Rosmawati Wan (Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre) ;
  • Rahman, Raudah Abdul (Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre) ;
  • Rahman, Nur Ashiqin Abd (Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre) ;
  • Atil, Azman (Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre) ;
  • Nawi, Azmawati Mohammed (Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre)
  • Received : 2019.01.23
  • Accepted : 2019.06.13
  • Published : 2019.07.31

Abstract

Objectives: Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer. Methods: A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review. Results: Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19). Conclusions: Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.

Keywords

References

  1. Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol 2017;18(6):719-731. https://doi.org/10.1016/S1470-2045(17)30186-9
  2. Gupta S, Howard SC, Hunger SP, Antillon FG, Metzger ML, Israels T, et al. Treating childhood cancer in low- and middle-income countries. In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: disease control priorities. 3rd ed. Washington, DC: World Bank; 2015, chapter 7.
  3. Howard SC, Zaidi A, Cao X, Weil O, Bey P, Patte C, et al. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol 2018;19(5):e252-e266. https://doi.org/10.1016/S1470-2045(18)30123-2
  4. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
  5. Linet MS, Wacholder S, Zahm SH. Interpreting epidemiologic research: lessons from studies of childhood cancer. Pediatrics 2003;112(1 Pt 2):218-232.
  6. Gloeckler Ries LA, Reichman ME, Lewis DR, Hankey BF, Edwards BK. Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 2003;8(6):541-552. https://doi.org/10.1634/theoncologist.8-6-541
  7. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet 1991;338(8760):131-137. https://doi.org/10.1016/0140-6736(91)90133-A
  8. Botto LD, Moore CA, Khoury MJ, Erickson JD. Neural-tube defects. N Engl J Med 1999;341(20):1509-1519. https://doi.org/10.1056/NEJM199911113412006
  9. Shaw GM, O'Malley CD, Wasserman CR, Tolarova MM, Lammer EJ. Maternal periconceptional use of multivitamins and reduced risk for conotruncal heart defects and limb deficiencies among offspring. Am J Med Genet 1995;59(4):536-545. https://doi.org/10.1002/ajmg.1320590428
  10. Czeizel AE. Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Am J Med Genet 1996;62(2):179-183. https://doi.org/10.1002/(SICI)1096-8628(19960315)62:2<179::AID-AJMG12>3.0.CO;2-L
  11. Tolarova M, Harris J. Reduced recurrence of orofacial clefts after periconceptional supplementation with high-dose folic acid and multivitamins. Teratology 1995;51(2):71-78. https://doi.org/10.1002/tera.1420510205
  12. Werler MM, Hayes C, Louik C, Shapiro S, Mitchell AA. Multivitamin supplementation and risk of birth defects. Am J Epidemiol 1999;150(7):675-682. https://doi.org/10.1093/oxfordjournals.aje.a010070
  13. Li DK, Daling JR, Mueller BA, Hickok DE, Fantel AG, Weiss NS. Periconceptional multivitamin use in relation to the risk of congenital urinary tract anomalies. Epidemiology 1995;6(3):212-218. https://doi.org/10.1097/00001648-199505000-00004
  14. Yang Q, Khoury MJ, Olney RS, Mulinare J. Does periconceptional multivitamin use reduce the risk for limb deficiency in offspring? Epidemiology 1997;8(2):157-161. https://doi.org/10.1097/00001648-199703000-00006
  15. Kim YI. Will mandatory folic acid fortification prevent or promote cancer? Am J Clin Nutr 2004;80(5):1123-1128. https://doi.org/10.1093/ajcn/80.5.1123
  16. World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women; 2012 [cited 2019 Jan 23]. Available from: https://apps.who.int/iris/handle/10665/77770.
  17. Thompson JR, Gerald PF, Willoughby ML, Armstrong BK. Maternal folate supplementation in pregnancy and protection against acute lymphoblastic leukaemia in childhood: a casecontrol study. Lancet 2001;358(9297):1935-1940. https://doi.org/10.1016/S0140-6736(01)06959-8
  18. Amigou A, Rudant J, Orsi L, Goujon-Bellec S, Leverger G, Baruchel A, et al. Folic acid supplementation, MTHFR and MTRR polymorphisms, and the risk of childhood leukemia: the ESCALE study (SFCE). Cancer Causes Control 2012;23(8):1265-1277. https://doi.org/10.1007/s10552-012-0004-0
  19. Ford E, Catt S, Chalmers A, Fallowfield L. Systematic review of supportive care needs in patients with primary malignant brain tumors. Neuro Oncol 2012;14(4):392-404. https://doi.org/10.1093/neuonc/nor229
  20. Grupp SG, Greenberg ML, Ray JG, Busto U, Lanctot KL, Nulman I, et al. Pediatric cancer rates after universal folic acid flour fortification in Ontario. J Clin Pharmacol 2011;51(1):60-65. https://doi.org/10.1177/0091270010365553
  21. Sargeant JM, O'Connor AM. Conducting systematic reviews of intervention questions II: relevance screening, data extraction, assessing risk of bias, presenting the results and interpreting the findings. Zoonoses Public Health 2014;61 Suppl 1:39-51. https://doi.org/10.1111/zph.12124
  22. Cochrane Collaboration. RevMan information [cited 2019 Jan 23]. Available from: http://community.cochrane.org/help/tools-and-software/revman-web.
  23. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [cited 2019 Jan 20]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
  24. Egger M, Davey Smith G, Schneider M, Minder C. Bias in metaanalysis detected by a simple, graphical test. BMJ 1997;315(7109):629-634. https://doi.org/10.1136/bmj.315.7109.629
  25. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50(4):1088-1101. https://doi.org/10.2307/2533446
  26. Wen W, Shu XO, Potter JD, Severson RK, Buckley JD, Reaman GH, et al. Parental medication use and risk of childhood acute lymphoblastic leukemia. Cancer 2002;95(8):1786-1794. https://doi.org/10.1002/cncr.10859
  27. Shaw AK, Infante-Rivard C, Morrison HI. Use of medication during pregnancy and risk of childhood leukemia (Canada). Cancer Causes Control 2004;15(9):931-937. https://doi.org/10.1007/s10552-004-2230-6
  28. Milne E, Royle JA, Miller M, Bower C, de Klerk NH, Bailey HD, et al. Maternal folate and other vitamin supplementation during pregnancy and risk of acute lymphoblastic leukemia in the offspring. Int J Cancer 2010;126(11):2690-2699. https://doi.org/10.1002/ijc.24969
  29. Bailey HD, Miller M, Langridge A, de Klerk NH, van Bockxmeer FM, Attia J, et al. Maternal dietary intake of folate and vitamins B6 and B12 during pregnancy and the risk of childhood acute lymphoblastic leukemia. Nutr Cancer 2012;64(7):1122-1130. https://doi.org/10.1080/01635581.2012.707278
  30. Ross JA, Blair CK, Olshan AF, Robison LL, Smith FO, Heerema NA, et al. Periconceptional vitamin useand leukemia risk in children with Down syndrome: a Children's Oncology Group study. Cancer 2005;104(2):405-410. https://doi.org/10.1002/cncr.21171
  31. Linabery AM, Puumala SE, Hilden JM, Davies SM, Heerema NA, Roesler MA, et al. Maternal vitamin and iron supplementation and risk of infant leukaemia: a report from the Children's Oncology Group. Br J Cancer 2010;103(11):1724-1728. https://doi.org/10.1038/sj.bjc.6605957
  32. Ajrouche R, Rudant J, Orsi L, Petit A, Baruchel A, Nelken B, et al. Maternal reproductive history, fertility treatments and folic acid supplementation in the risk of childhood acute leukemia: the ESTELLE study. Cancer Causes Control 2014;25(10):1283-1293. https://doi.org/10.1007/s10552-014-0429-8
  33. Singer AW, Selvin S, Block G, Golden C, Carmichael SL, Metayer C. Maternal prenatal intake of one-carbon metabolism nutrients and risk of childhood leukemia. Cancer Causes Control 2016;27(7):929-940. https://doi.org/10.1007/s10552-016-0773-y
  34. Preston-Martin S, Pogoda JM, Mueller BA, Lubin F, Holly EA, Filippini G, et al. Prenatal vitamin supplementation and risk of childhood brain tumors. Int J Cancer Suppl 1998;11:17-22.
  35. Stalberg K, Haglund B, Stromberg B, Kieler H. Prenatal exposure to medicines and the risk of childhood brain tumor. Cancer Epidemiol 2010;34(4):400-404. https://doi.org/10.1016/j.canep.2010.04.018
  36. Ortega-Garcia JA, Ferris-Tortajada J, Claudio L, Soldin OP, Sanchez-Sauco MF, Fuster-Soler JL, et al. Case control study of periconceptional folic acid intake and nervous system tumors in children. Childs Nerv Syst 2010;26(12):1727-1733. https://doi.org/10.1007/s00381-010-1187-x
  37. Milne E, Greenop KR, Bower C, Miller M, van Bockxmeer FM, Scott RJ, et al. Maternal use of folic acid and other supplements and risk of childhood brain tumors. Cancer Epidemiol Biomarkers Prev 2012;21(11):1933-1941. https://doi.org/10.1158/1055-9965.EPI-12-0803
  38. Bailey HD, Rios P, Lacour B, Guerrini-Rousseau L, Bertozzi AI, Leblond P, et al. Factors related to pregnancy and birth and the risk of childhood brain tumours: the ESTELLE and ESCALE studies (SFCE, France). Int J Cancer 2017;140(8):1757-1769. https://doi.org/10.1002/ijc.30597
  39. Amitay EL, Dubnov Raz G, Keinan-Boker L. Breastfeeding, other early life exposures and childhood leukemia and lymphoma. Nutr Cancer 2016;68(6):968-977. https://doi.org/10.1080/01635581.2016.1190020
  40. Johnson KJ, Poynter JN, Ross JA, Robison LL, Shu XO. Pediatric germ cell tumors and maternal vitamin supplementation: a Children's Oncology Group study. Cancer Epidemiol Biomarkers Prev 2009;18(10):2661-2664. https://doi.org/10.1158/1055-9965.EPI-09-0462
  41. Schuz J, Weihkopf T, Kaatsch P. Medication use during pregnancy and the risk of childhood cancer in the offspring. Eur J Pediatr 2007;166(5):433-441. https://doi.org/10.1007/s00431-006-0401-z
  42. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab 2012;97(4):1153-1158. https://doi.org/10.1210/jc.2011-2601
  43. Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of pediatric cancers: a meta-analysis. Clin Pharmacol Ther 2007;81(5):685-691. https://doi.org/10.1038/sj.clpt.6100100
  44. Metayer C, Milne E, Dockerty JD, Clavel J, Pombo-de-Oliveira MS, Wesseling C, et al. Maternal supplementation with folic acid and other vitamins and risk of leukemia in offspring: a Childhood Leukemia International Consortium study. Epidemiology 2014;25(6):811-822. https://doi.org/10.1097/EDE.0000000000000141
  45. Lachin JM. Introduction to sample size determination and power analysis for clinical trials. Control Clin Trials 1981;2(2):93-113. https://doi.org/10.1016/0197-2456(81)90001-5
  46. Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci 2013;14(5):365-376. https://doi.org/10.1038/nrn3475
  47. Deschler B, Lubbert M. Acute myeloid leukemia: epidemiology and etiology. Cancer 2006;107(9):2099-2107. https://doi.org/10.1002/cncr.22233
  48. Chiavarini M, Naldini G, Fabiani R. Maternal folate intake and risk of childhood brain and spinal cord tumors: a systematic review and meta-analysis. Neuroepidemiology 2018;51(1-2):82-95. https://doi.org/10.1159/000490249
  49. Vollset SE, Clarke R, Lewington S, Ebbing M, Halsey J, Lonn E, et al. Effects of folic acid supplementation on overall and sitespecific cancer incidence during the randomised trials: metaanalyses of data on 50,000 individuals. Lancet 2013;381(9871):1029-1036. https://doi.org/10.1016/S0140-6736(12)62001-7
  50. Barua S, Kuizon S, Junaid MA. Folic acid supplementation in pregnancy and implications in health and disease. J Biomed Sci 2014;21:77. https://doi.org/10.1186/s12929-014-0077-z
  51. Ames BN. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutat Res 2001;475(1-2):7-20. https://doi.org/10.1016/S0027-5107(01)00070-7
  52. Caruana EJ, Roman M, Hernandez-Sanchez J, Solli P. Longitudinal studies. J Thorac Dis 2015;7(11):E537-E540.
  53. Song JW, Chung KC. Observational studies: cohort and casecontrol studies. Plast Reconstr Surg 2010;126(6):2234-2242. https://doi.org/10.1097/PRS.0b013e3181f44abc

Cited by

  1. Risk Factors for Childhood Leukemia: Radiation and Beyond vol.9, 2019, https://doi.org/10.3389/fpubh.2021.805757
  2. Is Supplementation with Micronutrients Still Necessary during Pregnancy? A Review vol.13, pp.9, 2019, https://doi.org/10.3390/nu13093134
  3. Association of MTHFR 677C &gt; T, 1298A &gt; C and MTR 2756A &gt; G Polymorphisms with Susceptibility to Childhood Retinoblastoma: A Systematic Review and Met-Analysis vol.40, pp.6, 2019, https://doi.org/10.1080/15513815.2020.1721738
  4. Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects vol.24, 2021, https://doi.org/10.1016/j.pmedr.2021.101617