Maternal and perinatal exposures are associated with risk for pediatric-onset multiple sclerosis

Network of Pediatric Multiple Sclerosis Centers

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children. METHODS: This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status. RESULTS: Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20-4.21, P=.01) and cesarean delivery with 60% reduction (95% CI 0.20-0.82, P=.01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardeningrelated occupation (odds ratio [OR] 2.18, 95% CI 1.14-4.16, P=.02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06-2.81, P=.03) were both associated with increased odds to have pediatric MS. CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.

Original languageEnglish (US)
Article numbere20162838
JournalPediatrics
Volume139
Issue number4
DOIs
StatePublished - Apr 1 2017

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Maternal Exposure
Multiple Sclerosis
Pediatrics
Confidence Intervals
Pregnancy
Pesticides
Social Class
Odds Ratio
Environmental Exposure
Maternal Age
Breast Feeding
Occupations
Smoke
Fathers
Postpartum Period
Tobacco
Case-Control Studies
Parents
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Maternal and perinatal exposures are associated with risk for pediatric-onset multiple sclerosis. / Network of Pediatric Multiple Sclerosis Centers.

In: Pediatrics, Vol. 139, No. 4, e20162838, 01.04.2017.

Research output: Contribution to journalArticle

Network of Pediatric Multiple Sclerosis Centers. / Maternal and perinatal exposures are associated with risk for pediatric-onset multiple sclerosis. In: Pediatrics. 2017 ; Vol. 139, No. 4.
@article{4aeb830b5171466ba2596e551012f7d0,
title = "Maternal and perinatal exposures are associated with risk for pediatric-onset multiple sclerosis",
abstract = "OBJECTIVE: To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children. METHODS: This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status. RESULTS: Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62{\%} girls) and 412 healthy controls (median age 14.6, 54{\%} girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95{\%} confidence interval [CI] 1.20-4.21, P=.01) and cesarean delivery with 60{\%} reduction (95{\%} CI 0.20-0.82, P=.01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardeningrelated occupation (odds ratio [OR] 2.18, 95{\%} CI 1.14-4.16, P=.02) or any use in household of pesticide-related products (OR 1.73, 95{\%} CI 1.06-2.81, P=.03) were both associated with increased odds to have pediatric MS. CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.",
author = "{Network of Pediatric Multiple Sclerosis Centers} and Graves, {Jennifer S.} and Tanuja Chitnis and Bianca Weinstock-Guttman and Jennifer Rubin and Zelikovitch, {Aaron S.} and Bardia Nourbakhsh and Timothy Simmons and Michael Waltz and Casper, {T. Charles} and Emmanuelle Waubant and Gregory Aaen and Anita Belman and Leslie Benson and Candee Meghan and Mark Gorman and Manu Goyal and Benjamin Greenberg and Yolanda Harris and Ilana Kahn and Timothy Lotze and Mar Soe and Manikum Moodley and Jayne Ness and Mary Rensel and Shelly Roalstad and Moses Rodriguez and John Rose and Teri Schreiner and Tillema, {Jan Mendelt} and Amy Waldman",
year = "2017",
month = "4",
day = "1",
doi = "10.1542/peds.2016-2838",
language = "English (US)",
volume = "139",
journal = "Pediatrics",
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publisher = "American Academy of Pediatrics",
number = "4",

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T1 - Maternal and perinatal exposures are associated with risk for pediatric-onset multiple sclerosis

AU - Network of Pediatric Multiple Sclerosis Centers

AU - Graves, Jennifer S.

AU - Chitnis, Tanuja

AU - Weinstock-Guttman, Bianca

AU - Rubin, Jennifer

AU - Zelikovitch, Aaron S.

AU - Nourbakhsh, Bardia

AU - Simmons, Timothy

AU - Waltz, Michael

AU - Casper, T. Charles

AU - Waubant, Emmanuelle

AU - Aaen, Gregory

AU - Belman, Anita

AU - Benson, Leslie

AU - Meghan, Candee

AU - Gorman, Mark

AU - Goyal, Manu

AU - Greenberg, Benjamin

AU - Harris, Yolanda

AU - Kahn, Ilana

AU - Lotze, Timothy

AU - Soe, Mar

AU - Moodley, Manikum

AU - Ness, Jayne

AU - Rensel, Mary

AU - Roalstad, Shelly

AU - Rodriguez, Moses

AU - Rose, John

AU - Schreiner, Teri

AU - Tillema, Jan Mendelt

AU - Waldman, Amy

PY - 2017/4/1

Y1 - 2017/4/1

N2 - OBJECTIVE: To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children. METHODS: This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status. RESULTS: Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20-4.21, P=.01) and cesarean delivery with 60% reduction (95% CI 0.20-0.82, P=.01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardeningrelated occupation (odds ratio [OR] 2.18, 95% CI 1.14-4.16, P=.02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06-2.81, P=.03) were both associated with increased odds to have pediatric MS. CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.

AB - OBJECTIVE: To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children. METHODS: This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status. RESULTS: Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20-4.21, P=.01) and cesarean delivery with 60% reduction (95% CI 0.20-0.82, P=.01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardeningrelated occupation (odds ratio [OR] 2.18, 95% CI 1.14-4.16, P=.02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06-2.81, P=.03) were both associated with increased odds to have pediatric MS. CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.

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