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Recent medication use of 3,394 members of the Group Health Cooperative of Puget Sound (GHC) diagnosed with an incident work-related injury was compared to that of two controls selected from the GHC membership and matched on age, gender, and Standard Industrial Classification Code of their employer. Medication use was determined from the GHC pharmacy data base. The injuries of the cases included 496 fractures or dislocations, 2,728 open wounds, crushing injuries, or superficial injuries, 176 burns, and 64 internal or intracranial injuries. The risk of injury was elevated among users of antihistamines [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1-1.9], antibiotics (OR = 1.2, 95% CI = 1.0-1.5), and diabetes medications (OR = 1.3, 95% CI = 0.9-1.9). The patterns of risk were similar for males and females, but varied by type of injury. No consistent associations between use of antidepressants, antianxiety medication, or narcotics and work-related injury were observed. The use of some medications, or conditions requiring medications, may contribute to the risk of a work-related injury.

We evaluated the accuracy of the field sobriety assessment of police officers following a motor vehicle crash. Using linked data from a statewide traffic crash database and the trauma center registry, the results of a field sobriety evaluation for each driver were compared with a blood alcohol concentration (BAC) drawn in the emergency department. BAC values served as the "gold standard" in which drivers with values over 0.1 mg/dl were classified as intoxicated. The subjects were drivers over age 15 years who were admitted or died at Level I trauma center as a results of motor vehicle crash injuries during 1986-1993. A total of 1336 subjects had both a recorded BAC and a police sobriety assessment. Seventy percent of subjects were male and 79% under the age of 35 years. Overall, 40% of all subjects were judged by police to have been impaired, based on the scene sobriety assessment. Among all drivers, the field assessment had a sensitivity of 91%, a specificity of 90% and a predictive value positive of 85%. After excluding the 419 drivers which had breath testing as part of their assessment, the field assessment had a sensitivity of 74% and a specificity of 97%. The sensitivity of the field assessment did not vary appreciably by gender but was lower among older drivers, and higher among severely injured drivers and those involved in weekend and nighttime crashes. Police officers in this sample appear to recognize drunk driving with a high degree of accuracy when investigating crashes in which the driver is transported to a trauma center.

To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies, we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants randomly selected from those without birth defects delivered during those years in five hospitals in King County, Washington. Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.2, 4.5). This risk was higher among light smokers (1-1000 cigarettes during the pregnancy) (OR = 3.7; 95% CI = 1.7, 8.6) than among heavy smokers (OR = 1.4; 95% CI = 0.6, 3.3). Our results corroborate previous findings and support the hypothesis of a causal relation.

To assess the relation between childhood brain tumor occurrence and exposure to potential sources of residential magnetic fields, a population-based case-control study of incident brain tumors was conducted in the Seattle, Washington, area at the Fred Hutchinson Cancer Research Center from 1989 to 1994 among children younger than age 20 years who were diagnosed from 1984 to 1990. The specific aims were to evaluate whether proximity to high-current residential power lines, as defined by the Wertheimer-Leeper code, or use of electric appliances or electric heating sources by the mother while pregnant or by the child before diagnosis were associated with increased risks of brain tumor occurrence. The mothers of 133 cases and 270 controls (recruited by random digit dialing) participated. Risk of brain tumor occurrence did not increase with increasing exposure, as indicated by the five-level Wertheimer-Leeper code. When exposure was dichotomized as high versus low, the odds ratio was 0.9 (95% confidence interval 0.5-1.5) and did not vary significantly by sex, age, or histology. No elevations in risk were found for ever versus never use of electric blankets, water beds, or electric heating sources. Odds ratios were slightly elevated for nine appliances and were at or below 1.0 for eight others. These data do not support the hypothesis that exposure to magnetic fields from high-current power lines, electric heating sources, or electric appliances is associated with the subsequent occurrence of brain tumors in children.

Summary. Prior studies suggest that diagnosis of gestational diabetes is associated with increased risk for development of gestational diabetes in future pregnancies, and with subsequent onset of established diabetes. The magnitudes of these risks have not been measured. Using linked birth certificate data from Washington State it is possible to identify all women with two or more births occurring during 1984-91. All women with gestational diabetes (n= 1375) or with established diabetes (n= 220), during their pregnancy for the second or greater birth were identified, and a control group consisting of women whose second or greater birth was not complicated by either condition was randomly selected (n = 6380). Data from the birth certificate, for the previous birth, were compared in order to estimate the risks of developing gestational or established diabetes in a subsequent pregnancy among women with prior gestational diabetes relative to women without gestational diabetes. The age-adjusted risk of developing gestational diabetes in the pregnancy for the subsequent birth associated with prior gestational diabetes was 23.2 (95% (confidence interval) CI = 17.2–31.2); the risk of having developed established diabetes by the time of the subsequent birth was 55.5 (95% CI = 34.4–89.4). Women who had a macrosomic infant (> 4000 gm) in the prior birth were also at increased risk for developing gestational diabetes (odds ratio OR = 3.3, 95% CI = 2.9-3.8) or established diabetes (OR = 5.8, 95% CI = 4.0–8.5). When data were restricted to patients with only one prior birth, to patients with early prenatal care, to delivery at facilities with long-established protocols for diagnosing gestational diabetes, or to more recent years, the risk estimates remained similarly elevated. The 23-fold increased risk of gestational diabetes associated with having gestational diabetes indicated on the birth certificate of a woman's previous baby, although not unexpected, is still remarkable and reinforces the importance of careful monitoring of women with this history. Although changes in how screening is conducted may account for some of the elevation in risk, our results stayed consistently elevated even when restrictions were made within the data to control for this. The fact that there was a 56-fold increased risk of having developed established diabetes by the time of the subsequent birth on record, associated with prior gestational diabetes, and a 6-fold increased risk associated with a macro-somic infant, supports the idea that these may be early steps in the development of established diabetes, and identifies a group that may benefit from close monitoring and possible intervention.

Background A recent meta-analysis suggested an association between exposure to paternal smoking during pregnancy and childhood brain tumor risk, but no studies have evaluated whether this association differs by polymorphisms in genes that metabolize tobacco-smoke chemicals. Methods We assessed 9 functional polymorphisms in 6 genes that affect the metabolism of polycyclic aromatic hydrocarbons (PAH) to evaluate potential interactions with parental smoking during pregnancy in a population-based case-control study of childhood brain tumors. Cases (N = 202) were ≤10 years old, diagnosed from 1984–1991 and identified in three Surveillance, Epidemiology, and End Results (SEER) registries in the western U.S. Controls in the same regions (N = 286) were frequency matched by age, sex, and study center. DNA for genotyping was obtained from archived newborn dried blood spots. Results We found positive interaction odds ratios (ORs) for both maternal and paternal smoking during pregnancy, EPHX1 H139R, and childhood brain tumors (Pinteraction = 0.02; 0.10), such that children with the high-risk (greater PAH activation) genotype were at a higher risk of brain tumors relative to children with the low-risk genotype when exposed to tobacco smoke during pregnancy. A dose-response pattern for paternal smoking was observed among children with the EPHX1 H139R high-risk genotype only (ORno exposure = 1.0; OR≤3 hours/day = 1.32, 95% CI: 0.52–3.34; OR>3hours/day = 3.18, 95% CI: 0.92–11.0; Ptrend = 0.07). Conclusion Parental smoking during pregnancy may be a risk factor for childhood brain tumors among genetically susceptible children who more rapidly activate PAH in tobacco smoke.

To study the relation of maternal periconceptional vitamin use to the risk of a congenital urinary tract anomaly (CUTA), we conducted a case-control study using the Washington State Birth Defect Registry. We identified CUTA cases with no known chromosomal abnormality in seven counties in western Washington State occurring between January 1, 1990, and December 31, 1991. We randomly selected a sample, as controls, of all infants delivered in five large hospitals in King County who did not have a birth defect and who were born in the same year as the cases. About 55% of all infants in King County and a smaller proportion of infants in the other six counties are delivered in these five hospitals. We interviewed mothers of 118 cases and 369 controls to obtain information about their vitamin use during the pregnancy and during the year before the conception. After adjustment for maternal race, family income, county of maternal residence, and birth year, we found that women who used multivitamins during the first trimester had only 15% the risk of bearing a child with a CUTA compared with women who did not take vitamins [odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.05-0.43]. The reduction was smaller for use restricted to the second or third trimesters (OR = 0.31; 95% CI = 0.09-1.02). Among women who used vitamins during the first trimester, vitamin use before conception was not associated with any further reduction in the risk, nor did there appear to be an association with the amount or brand of vitamin used.(ABSTRACT TRUNCATED AT 250 WORDS)

Several case-control studies have reported positive associations between childhood cancer and proximity to high-current residential power lines as defined by the Wertheimer-Leeper code. We conducted a study to evaluate whether or not differential nonparticipation of controls as a function of socioeconomic status is likely to account for the observed associations. We assessed the relation of annual family income to the Wertheimer-Leeper code in a sample of 392 households in western Washington state, and we evaluated the magnitude of bias that could occur from differential participation of low- and high-income eligible controls. Very-high-current configurations were most frequently located among households with self-reported family income of less than +15,000 per year, and very-low-current configurations were most frequently located among those with self-reported family income of more than +45,000 per year. In a hypothetical case-control study in which: (1) it was assumed that there is no true etiologic relation between power line configurations and cancer occurrence, and (2) controls with very low income were less likely to participate than others, observed (biased) odds ratios ranged from 1.03 to 1.24. If these results are applicable to other areas where case-control studies of cancer in relation to power lines have been conducted, they suggest that relatively lower participation among exposed controls (as a function of very low income) is not likely to account for the elevated risks of 1.5- to 3-fold that have been observed in these previous studies.

The purpose of this study was to evaluate the association between fetal development of congenital heart defects (CHD) and maternal prepregnancy body mass index (BMI, kg/m(2)) in the largest population-based case-control study to date.Mounting evidence implicates maternal obesity as a risk factor for birth defects. However, the association between maternal obesity and CHD in offspring has been less completely described.We conducted a study of CHD using linked birth-hospital discharge records for Washington State between 1992-2007. All infants with CHD (n = 14,142) were identified based on ICD9-CM discharge diagnosis codes. 141,420 controls, frequency matched on year of delivery, were selected at random from among infants without CHD. Maternal BMI was calculated from maternal prepregnancy data. Odds ratios (OR) and 95% confidence intervals (CI) for the association of CHD relative to maternal BMI were calculated, adjusted for gestational diabetes.Infants with CHD were more likely to have an obese mother (OR 1.22, 95% CI 1.15-1.30). The strength of association increased with increasing BMI (BMI 30-34.9: OR 1.16, 95% CI 1.07-1.25; BMI 35-39.9: OR 1.25, 95% CI 1.13-1.39; BMI= 40: OR 1.49, 95% CI 1.32-1.69). The association was greatest for left and right ventricular outflow tract defects (OR 1.27, 95% CI 1.02-1.59 and OR 1.43, 95% CI 1.20-1.69, respectively). Hypoplastic left heart syndrome was markedly associated (OR 1.86, 95% CI 1.13-3.05). There was no association with conotruncal defects (OR 1.04, 95% CI: 0.82-1.33).We confirmed the association between CHD and maternal obesity and observed increasing risk with increasing obesity. Outflow tract defects appear uniquely associated. A greater risk of CHD among offspring is an important outcome of maternal obesity, and suggests a need for targeted medical management strategies.

Objective To assess the relationship between selected maternal and infant characteristics and risk of type 1 diabetes mellitus, specifically characteristics identified from birth records that may pertain to the hygiene or overload hypotheses. Design Population-based case-control study. Setting Washington State from 1987 to 2005. Participants All children younger than 19 years hospitalized for type 1 diabetes ( International Classification of Diseases, Ninth Revision codes 250.x1 and 250.x3) identified (n = 1852) from hospital discharge data and linked with their birth certificates. Controls (n = 7408) were randomly selected from birth records, frequency matched on year of birth. Main Exposures Maternal factors included age, race, educational attainment, marital status, use of Medicaid insurance, body mass index, prepregnancy weight, prior births, timing and adequacy of prenatal care, and cesarean delivery. Infant factors included birth weight, size for gestational age, and gestational age. Main Outcome Measure The main outcome was first hospitalization for type 1 diabetes mellitus; adjusted odds ratios were estimated for the association of selected maternal and infant characteristics with type 1 diabetes. Results Consistent with the hygiene hypothesis, type 1 diabetes was negatively associated with having older siblings (for ≥3 siblings, odds ratio [OR], 0.56; 95% confidence interval [CI], 0.45-0.70) and with indicators of lower economic status or care access, such as an unmarried mother (OR, 0.79; 95% CI, 0.69-0.91), inadequate prenatal care (OR, 0.53; 95% CI, 0.40-0.71), or Medicaid insurance (OR, 0.67; 95% CI, 0.58-0.77). Related to the overload hypothesis, maternal body mass index of 30 or higher (OR, 1.29; 95% CI, 1.01-1.64) was associated with increased risk of diabetes. Conclusion Environmental factors related to decreased antigenic stimulation in early life and maternal obesity may be associated with type 1 diabetes.

Purpose To examine whether smoking during first pregnancy, a time of potential vulnerability to tobacco mutagens, is associated with breast cancer. Methods We conducted a nested case-control study within a cohort of Washington State residents with first deliveries during 1984–1999, identified in birth and fetal death records. Linkage to population-based cancer registry data identified 1,099 women in the cohort aged 65 years and younger diagnosed with breast cancer in 1985–2000. Controls (N=10,922) were matched by year and age of first delivery, race/ethnicity, and birth outcome. Maternal smoking and other variables characterizing the pregnancy were obtained from birth and fetal death records. Conditional logistic regression was used to analyze the data. Results The adjusted risk ratio for breast cancer was 0.8, 95% confidence interval 0.7–0.9, among women who smoked during their pregnancy compared with similar women who did not smoke. When the sample was restricted to known state residents at the time of the matched case's diagnosis, there was no association (risk ratio 1.0; 0.8–1.1). Conclusions Our results do not suggest that cigarette smoking during first pregnancy increases the risk of breast cancer.

Using the 1983 United States population of single live births, birthweight and gestational duration were compared for babies of these different parental racial groups: both parents White, mother White-father Black, mother Black-father White, both parents Black. The four groups differed significantly with respect to the usual sociodemographic variables. Mean birthweight and mean gestational duration decreased in that order from the White-White reference group, and conversely there were increasing trends for low birthweight and preterm delivery. Adjustment for the usual sociodemographic variables did not alter these trends appreciably. Group differences were more strongly related to the mother's race than to the father's, and the trends were related to the mother's race. Because the father's race was significant, genetic factors are probably of some importance. The evidence from this study, together with the often-demonstrated relationships between low birthweight and preterm delivery with sociodemographic variables, and the short-term downward secular trends in low birthweight, support the concept that non-genetic maternal factors are more important for these abnormal outcomes. But because neither the usually utilised sociodemographic variables nor genetic factors seem to explain much of the group differences, new approaches are necessary to understand why, irrespective of ethnic group, some women are at excess risk for suboptimal birth outcome.

Brain tumor research is unlike some other areas of cancer research, in which definite causes have been identified and prevention and treatment strategies may be developed. Primary brain tumors are heterogeneous with respect to several characteristics, and brain tumor research is hampered by this fact, as well as by the small numbers of cases, by the lack of a clearly established and consistently applied histopathologic classification scheme, and by geographical variations in diagnostic capabilities and mechanisms for case reporting. The current movement toward molecular epidemiology has resulted in several changes in the ways we will be able to investigate cancer etiologies in the future, and promises to be especially fruitful in the area of brain tumor research. The search is under way for biologic markers of risk exposures for various cancers, and for laboratory methods to identify those individuals who, because of their genetic qualities, are most likely to have brain tumors. There are probably multiple causes for brain tumors, incorporating both genetic and environmental pathways. Prior research has consistently identified few risk factors for brain tumors, such as ionizing radiation. Thus, collaborative efforts among clinicians, laboratory scientists, and epidemiologists, which make use of molecular epidemiologic methods, are perhaps of greater importance in this field than for cancers arising at other sites.

Children born with a facial cleft are not thought to be at a greater risk for infant mortality than are those without congenital anomalies. The purpose of this study was to investigate whether the presence of a facial cleft alone or its coexistence with other anomalies increases a child's risk for dying. Birth and death certificate data from Washington State for the years 1984 to 1988 were linked for infants who died before 1 year of age. Mortality rates for different types of facial clefts and for births without noted abnormalities were compared. Relative to infants with no diagnosed abnormalities noted in the birth certificate, infants with facial clefts without other abnormalities have a 3.7 fold increased odds for dying during their first year of life. This elevated risk for dying was fairly consistent during the first year of life. When facial clefts are associated with other abnormalities there is an 82.3 fold increase in odds for mortality during the first year of life. This elevated risk is highest during the neonatal period; 77% of all deaths occurred during the first 27 days. It is concluded that infants with facial clefts with or without associated anomalies have a significantly increased mortality risk when compared to infants without any diagnosed abnormalities at birth.

In order to explore possible etiologic differences between tubal infertility in women who had been physician-diagnosed as having pelvic inflammatory disease ("overt" PID) and in women who had not ("silent" pelvic inflammatory disease), we made use of self-reported data from a large, population-based, case-control study of infertility in King County, Washington. Responses from 33 infertile women with no history of physician-reported PID and 129 infertile women with such a history were compared to those of 501 fertile women. No cultures or blood for antibody titers were obtained. Logistic regression was used to compute the relative risks for silent and overt PID-related tubal dysfunction associated with various lifestyle and contraceptive habits in an effort to identify practices that potentially affect these outcomes. In general, practices associated with an increased risk of overt tubal disease, such as use of Dalkon Shield and other types of intrauterine devices, were also associated with an increased risk of silent tubal disease, but to a lesser extent. Women who used oral contraceptives for longer than three years had a decreased risk for silent disease (relative risk = 0.5, 95% confidence interval = 0.3-0.8), but their risk for overt disease did not decrease to the same extent (relative risk = 0.9, 95% confidence interval = 0.3-2.5). These results suggest that silent and overt tubal disease share many common lifestyle risk factors.

Objective To compare birth outcomes among female survivors of childhood and adolescent cancer who subsequently bear children, relative to those of women without a history of cancer. Design Retrospective cohort study. Setting Four US regions. Participants Cancer registries identified girls younger than 20 years who were diagnosed as having cancer from 1973 through 2000. Linked birth records identified the first live births after diagnosis (n = 1898). Comparison subjects were selected from birth records (n = 14 278). Survivors of genital tract carcinomas underwent separate analysis. Main Exposure Cancer diagnosis at younger than 20 years. Main Outcome Measures Infant low birth weight, preterm delivery, sex ratio, malformations, mortality, and delivery method, and maternal diabetes, anemia, and preeclampsia. Results Infants born to childhood cancer survivors were more likely to be preterm (relative risk [RR], 1.54; 95% confidence interval [CI], 1.30-1.83) and to weigh less than 2500 g (1.31; 1.10-1.57). For the offspring of genital tract carcinoma survivors, RRs were 1.33 (95% CI, 1.13-1.56) and 1.29 (1.10-1.53), respectively. There were no increased risks of malformations, infant death, or altered sex ratio, suggesting no increased germ cell mutagenicity. In exploratory analysis, bone cancer survivors had an increased risk of diabetes (RR, 4.92; 95% CI, 1.60-15.13), and anemia was more common among brain tumor survivors (3.05; 1.16-7.98) and childhood cancer survivors whose initial treatment was chemotherapy only (2.45; 1.16-5.17). Conclusions Infants born to female survivors of childhood and adolescent cancer were not at increased risk of malformations or death. Increased occurrence of preterm delivery and low birth weight suggest that close monitoring is warranted. Increased diabetes and anemia among subgroups have not been reported, suggesting areas for study.

Insecticides that target the nervous system may play a role in the development of childhood brain tumors (CBTs). Constitutive genetic variation affects metabolism of these chemicals.We analyzed population-based case-control data to examine whether CBT is associated with the functional genetic polymorphisms PON1C-108T, PON1Q192R, PON1L55M, BCHEA539T, FMO1C-9536A, FMO3E158K, ALDH3A1S134A, and GSTT1 (null). DNA was obtained from newborn screening archives for 201 cases and 285 controls,or= 10 years of age, and born in California or Washington State between 1978 and 1990. Conception-to-diagnosis home insecticide treatment history was ascertained by interview.We observed no biologically plausible main effects for any of the metabolic polymorphisms with CBT risk. However, we observed strong interactions between genotype and insecticide exposure during childhood. Among exposed children, CBT risk increased per PON1-108T allele [odds ratio (OR) = 1.8; 95% confidence interval (CI), 1.1-3.0] and FMO1-9536A (*6) allele (OR = 2.7; 95% CI, 1.2-5.9), whereas among children never exposed, CBT risk was not increased (PON1: OR = 0.7; 95% CI, 0.5-1.0, interaction p = 0.005; FMO1: OR = 1.0; 95% CI, 0.6-1.6, interaction p = 0.009). We observed a similar but statistically nonsignificant interaction between childhood exposure and BCHEA539T (interaction p = 0.08). These interactions were present among both Hispanic and non-Hispanic white children.Based on known effects of these variants, these results suggest that exposure in childhood to organophosphorus and perhaps to carbamate insecticides in combination with a reduced ability to detoxify them may be associated with CBT. Confirmation in other studies is required.

Few risk factors for childhood cancer are well-established. We investigated whether advancing parental age increases childhood cancer risk.We assessed the relationship between parental age and childhood cancer in a case-control study using pooled population-based data. Our pooling was based on linked cancer and birth registry records from New York, Washington, Minnesota, Texas, and California. Subjects included 17,672 cancer cases diagnosed at ages 0-14 years during 1980-2004 and 57,966 controls born during 1970-2004. Individuals with Down syndrome were excluded. Odds ratios and 95% confidence intervals were calculated by logistic regression for the association between parental age and childhood cancer after adjustment for sex, birth weight, gestational age, birth order, plurality, maternal race, birth year, and state.Positive linear trends per 5-year maternal age increase were observed for childhood cancers overall (odds ratio = 1.08 [95% confidence interval = 1.06-1.10]) and 7 of the 10 most frequent diagnostic groups: leukemia (1.08 [1.05-1.11]), lymphoma (1.06 [1.01-1.12]), central nervous system tumors (1.07 [1.03-1.10]), neuroblastoma (1.09 [1.04-1.15]), Wilms' tumor (1.16 [1.09-1.22]), bone tumors (1.10 [1.00-1.20]), and soft tissue sarcomas (1.10 [1.04-1.17]). No maternal age effect was noted for retinoblastoma, germ cell tumors, or hepatoblastoma. Paternal age was not independently associated with most childhood cancers after adjustment for maternal age.Our results suggest that older maternal age increases risk for most common childhood cancers. Investigation into possible mechanisms for this association is warranted.

OBJECTIVE: The risk of hepatoblastoma is strongly increased among children with very low birth weight ( METHODS: We combined case-control data sets created by linking the cancer and birth registries of California, Minnesota, New York, Texas, and Washington states, which included 17672 children diagnosed as having cancer at 0 to 14 years of age and 57966 randomly selected control subjects. Unconditional logistic regression analysis was used to examine the association of cancer with very low birth weight and moderately low birth weight (1500–1999 g and 2000–2499 g, respectively), compared with moderate/high birth weight (≥2500 g), with adjustment for gender, gestational age, birth order, plurality, maternal age, maternal race, state, and year of birth. RESULTS: Most childhood cancers were not associated with low birth weights. However, retinoblastomas and gliomas other than astrocytomas and ependymomas were possibly associated with very low birth weight. The risk of other gliomas was also increased among children weighing 1500 to 1999 g at birth. CONCLUSIONS: These data suggested no association between most cancers and very low birth weight, with the exception of the known association of hepatoblastoma and possibly moderately increased risks of other gliomas and retinoblastoma, which may warrant confirmation.

To determine whether maternal infertility treatment is associated with adverse outcomes.Population-based cohort study using linked birth certificate-hospital discharge data.Washington State.Live-born singleton infants conceived with infertility treatment between 2003 and 2006 (n = 2,182) and a random sample of live-born singleton infants conceived spontaneously, frequency matched by birth year (n = 10,989).None.Mantel-Haenszel adjusted relative risks (RRs) and 95% confidence intervals (CIs) were computed for low birth weight, delivery at37 weeks, small for gestational age infants, any malformation, placenta previa, and placenta abruptio.Women with infertility treatment were at increased risk of placental abnormalities, including placenta abruptio (RR, 1.6; 95% CI, 1.1-2.5) and placenta previa (RR, 3.0; 95% CI, 2.0-4.7). Their infants were more likely to be delivered at37 weeks (RR, 1.7; 95% CI, 1.4-1.9) or weigh2500 g (RR, 1.4; 95% CI, 1.1-1.7); however, they were not at increased risk of being small for gestational age. An increased risk of malformations was observed in infants born to older women with infertility treatment, but not to younger women.Women using infertility treatment are at increased risk for delivering preterm, placenta previa, and placenta abruptio. Studies with measurement of specific infertility treatments will help identify the mechanisms.

Maternal dietary data from an international collaborative case-control study on childhood brain tumors were used to evaluate associations between histology-specific risk and consumption of specific food groups during pregnancy.Nine study centers from seven countries contributed 1218 cases and 2223 controls. Most cases were diagnosed between 1982 and 1992 and ranged in age from 0 to 19 years. Dietary consumption was measured as average grams per day.Foods generally associated with increased risk were cured meats, eggs/dairy, and oil products; foods generally associated with decreased risk were yellow-orange vegetables, fresh fish, and grains. The cured meat association was specific to astrocytomas (odds ratio [OR] range=1.8-2.5 across astrocytoma subtypes for 4th vs. 1st quartile of consumption, p trendsor= 0.03) and ependymomas (OR, 2.0; 95% confidence interval (CI), 0.4-2.9 for 4th vs. 1(st) quartile; p trend=0.03) and was similar in magnitude to previously reported ORs relating maternal cured meat consumption to increased astroglial risk. Other histology-specific associations were decreased risk of anaplastic astrocytomas from cruciferous vegetables (OR, 0.4; 95% CI, 0.3-0.7 for 4th vs. 1st quartile; p trend0.0001), decreased risk of astroglial tumors from fresh fish (OR, 0.6; 95% CI, 0.5-0.9 for 4th vs. 1st quartile; p trend=0.008), and increased risk of medulloblastoma from oil products (OR, 1.5; 95% CI, 1.0-2.2 for 4th vs. 1(st) quartile; p trend=0.005).These results suggest the need for dietary analysis not only by brain tumor histology, but also by specific foods within a broad food group.

BACKGROUND:: The extent to which helmet use reduces the risk of injury in ski- and snowboard-related accidents is unclear. We studied the association of helmet use with injuries of the head, face, and neck among skiers and snowboarders involved in falls and collisions. METHODS:: We conducted a case-control study, using ski patrol injury reports for the years 2000-2005 from 3 ski resorts in the western United States. We identified all skiers and snowboarders involved in falls or collisions who received care from the ski patrol. Helmet use among persons with injuries of the head (n = 2537), face (n = 1122), or neck (n = 565) was compared with helmet use among those involved in falls and collisions who received care for injuries below the neck (n = 17,674). We calculated odds ratios for head, face, and neck injury among helmeted compared with unhelmeted persons. RESULTS:: The adjusted odds ratios were 0.85 for head injury (95% confidence interval = 0.76-0.95), 0.93 for facial injury (0.79-1.09), and 0.91 for neck injury (0.72-1.14). CONCLUSIONS:: Helmets may provide some protection from head injury among skiers and snowboarders involved in falls or collisions. Language: en

Recreational drug (marijuana, lysergic acid diethylamide or LSD, speed, cocaine, and "other") exposures of women with primary infertility were compared with those of a matched control group of women with proven fertility. Women who reported smoking marijuana had a slightly elevated risk for infertility due to an ovulatory abnormality (RR = 1.7, 95% CI = 1.0 to 3.0). The risk was greatest among women who had used marijuana within one year of trying to become pregnant (RR = 2.1, 95% CI = 1.1 to 4.0). No consistent frequency or duration of use effects could be demonstrated, and the risk was confined to low-frequency users. Risks associated with the use of other drugs were not elevated. The risk of infertility from a tubal abnormality associated with cocaine use was greatly increased (RR = 11.1, 95% CI = 1.7 to 70.8). Our results are consistent with animal studies suggesting that smoking marijuana may cause a transient disruption of ovulatory function. The possibility that cocaine exposure influences the development of tubal infertility needs further investigation.

BACKGROUND. Neuroblastoma is the most common malignancy among infants, but risk factors remain poorly understood. Because most patients present in the first few years of life, it has been hypothesized that prenatal and perinatal exposures may contribute to the pathogenesis of neuroblastoma. METHODS. A population-based case-control study was conducted by using linked birth and cancer registry records from 1980 to 2004 in Washington State. Maternal and infant characteristics from birth and hospital discharge records for 240 cases of neuroblastoma and 2400 controls were compared. RESULTS. Neuroblastoma was associated with the presence of major congenital abnormalities (odds ratio [OR], 6.86; [95% CI], 2.92–16.08), particularly with cardiac abnormalities (OR, 5.84; 95% CI, 1.93–17.66), even after excluding abnormalities near the primary tumor. A borderline association was observed with maternal gestational diabetes (OR, 1.84; 95% CI, 0.98–3.47). The magnitude of both associations was greater when the analysis was limited to children who were diagnosed at age

Background: Although a few genetic syndromes are known to increase cancer risk in children, the presence of a structural birth defect in the absence of these syndromes is increasingly being recognized as a risk factor for childhood cancer. To better understand associations of specific defects and cancer types, we conducted a population-based assessment to avoid biases often present in studies relying on single clinics, referral centers, or treatment networks. Methods: Records of those diagnosed with cancer Results: Having any birth defect was associated with a 50% increased risk of childhood cancer overall (OR 1.5, 95% CI 1.2-1.8), and specifically for leukemia (OR = 1.7, 95% CI 1.2-2.4); neuroblastoma (OR = 1.9, 95% CI 1.0-3.5); soft tissue sarcoma (OR = 2.0, 95% CI 1.2-3.5); and germ cell tumors (OR = 3.0, 95% CI 1.6-5.5). Some specific defects were associated with specific cancer types: central nervous system (CNS) tumors with CNS defects (OR>4.0); leukemia, neuroblastoma, renal tumors, and soft tissue sarcoma with gastrointestinal anomalies (ORs>9.0); renal tumors and urogenital anomalies (OR>4.0); and soft tissue sarcoma with adactyly, polydactyly, or syndactyly (OR>8.0). Conclusions: Consistent with prior studies, structural birth defects were associated with increased cancer risk. Pooling similar data from many regions will increase power to identify specific associations in order to inform molecular studies examining possible common developmental pathways in the etiologies of birth defects and cancer, and will provide information that can be translated into screening strategies for children at high risk of developing cancer. Funding: Cancer Prevention Research Institute of Texas RP140258 and Alex's Lemonade Stand Foundation Citation Format: Philip J. Lupo, Michael E. Scheurer, Sharon E. Plon, Logan E. Spector, Beth A. Mueller. The risk of cancer among children with birth defects. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2741. doi:10.1158/1538-7445.AM2015-2741

To evaluate the risk of self-reported temporomandibular disorder (TMD) pain among adolescents in relation to previous head and/or neck injury.3,101 enrollees (11 to 17 years of age) of a nonprofit integrated health-care system were interviewed by telephone. Two hundred four cases with self-reported TMD pain and 194 controls without self-reported TMD pain frequency-matched to the cases by age and gender completed standardized in-person interviews and physical examinations in which reports of previous head/neck injuries were recorded. Odds ratio (OR) estimates and 95% confidence intervals (CIs) of the relative risks of TMD pain associated with prior head and/or neck injuries were calculated using logistic regression.A greater proportion of subjects reporting TMD pain (36%) than controls (25%) had a history of head and/or neck injuries (OR = 1.8, 95% CI, 1.1-2.8). In a separate analysis, the presence of TMD based upon the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was assessed in relation to prior head and/or neck injury. Cases reporting TMD pain and meeting the RDC/TMD criteria for myofascial pain and/or arthralgia or arthritis were 2.0 (CI, 1.0-3.8) times more likely to have had a prior head injury than were controls with neither self-reported nor RDC/TMD pain diagnoses.The results suggest a modest association of prior head injuries with both self-reported and clinically diagnosed TMD pain in adolescents.

We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately. Additional population-based studies are needed to identify strategies to improve fetal death certificate data.

Data from 1218 cases of childhood brain tumors (CBT) diagnosed between 1976 and 1994 and 2223 matched controls from the general population were included in an analysis of maternal beauty product exposure and beauty-related employment in 9 centers in 7 countries. A 50% increased odds ratio (OR) [95% confidence interval (CI) = 1.0–2.1] for CBT was observed among children of mothers who were exposed via personal use of and/or possible ambient contact with beauty products during the 5 years preceding the index child’s birth compared with children of mothers never exposed to beauty products during this time period. Overall maternal personal use of hair-coloring agents in the month before or during the pregnancy of the index child’s birth was not associated with CBT (OR = 1.0, CI = 0.83–1.3) or with astroglial (OR = 1.1, CI = 0.85–1.4), PNET (OR = 1.0, CI = 0.71–1.5) and other glial subtypes (OR = 1.0, CI = 0.62–1.0). Similarly, no statistically increased ORs or discernable pattern of risk estimates were observed for period of use or for number of applications per year for maternal personal use of hair-coloring agents overall or by histologic type. Among children born on or after 1980, increased ORs for CBT were associated with maternal non-work-related exposure to any beauty products (OR = 2.6, CI = 1.2–5.9), hair-dyes (OR = 11, CI = 1.2–90), and hair sprays (OR = 3.4, CI = 1.0–11). No overall increased OR for CBT was observed among children of mothers employed in beauty-related jobs during the 5 years preceding the index child’s birth compared with those who reported no beauty-related employment. In general, other specific beauty product-related exposures were not associated with increased ORs for CBT. Data from our study provide little evidence of an increased risk for CBT with mothers’ exposures to beauty products.

Objective. Maternal risk factors for hypospadias are poorly defined, and there is debate about temporal trends in hypospadias prevalence. We examined select maternal characteristics as possible risk factors for hypospadias among male offspring and evaluated yearly prevalence rates in Washington State. Methods. We performed a population-based, case-control study using linked birth-hospital discharge data from Washington State for 1987–1997 and prevalence data for 1987–2002. All cases of hypospadias were identified on the basis of International Classification of Diseases, Ninth Revision, codes from the birth hospitalization (N = 2155). Five control subjects were randomly selected for each case subject from the remaining singleton births, frequency matched according to year of birth (N = 10775). Maternal and infant characteristics were ascertained from the birth certificate. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Yearly prevalence was determined by dividing the total number of hypospadias cases by the number of male singleton live births for each year. Results. The risk of delivering an affected male infant increased with advancing maternal age; relative to women 40 years of age were at greatest risk (OR: 1.70; 95% CI: 1.17–2.48). Infants of nonwhite women were generally at decreased risk. Infants born to women with preexisting diabetes mellitus were at greater risk than those born to women without diabetes (OR: 2.18; 95% CI: 1.03–4.60); however, this was not observed for infants born to women with gestational diabetes. The birth prevalence of hypospadias in 2002 was 5.0 cases per 1000 male births, not significantly different from that in 1987. Conclusion. Older maternal age, white race, and preexisting diabetes were associated with increased risk of hypospadias among male offspring. The prevalence of hypospadias in Washington State did not increase significantly between 1987 and 2002.

ContextHousehold firearms are associated with an elevated risk of firearm death to occupants in the home. Many organizations and health authorities advocate locking firearms and ammunition to prevent access to guns by children and adolescents. The association of these firearm storage practices with the reduction of firearm injury risk is unclear.ObjectiveTo measure the association of specific household firearm storage practices (locking guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and self-inflicted firearm injuries.Design and SettingCase-control study of firearms in events identified by medical examiner and coroner offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo.Cases and ControlsCase firearms were identified by involvement in an incident in which a child or adolescent younger than 20 years gained access to a firearm and shot himself/herself intentionally or unintentionally or shot another individual unintentionally. Firearm assaults and homicides were excluded. We used records from hospitals and medical examiners to ascertain these incidents. Using random-digit dial telephone sampling, control firearms were identified by identification of eligible households with at least 1 firearm and children living or visiting in the home. Controls were frequency matched by age group and county.Main Exposure MeasuresThe key exposures of interest in this study were: (1) whether the subject firearm was stored in a locked location or with an extrinsic lock; (2) whether the firearm was stored unloaded; (3) whether the firearm was stored both unloaded in a locked location; (4) whether the ammunition for the firearm was stored separately; and (5) whether the ammunition was stored in a locked location. Data regarding the storage status of case and control guns were collected by interview with respondents from the households of case and control firearms.ResultsWe interviewed 106 respondents with case firearms and 480 with control firearms. Of the shootings associated with the case firearms, 81 were suicide attempts (95% fatal) and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding variables, guns from case households were less likely to be stored unloaded than control guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly, case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were consistent for both handguns and long guns and were also similar for both suicide attempts and unintentional injuries.ConclusionsThe 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.

As part of a study on childbearing and survival, we linked records of young women with invasive breast cancer identified through three population-based cancer registries, to state birth certificate records. In Michigan prior to 1989, only maternal social security number (SSN) was available for matching; other data became available in 1989 including name, birth date, address, and infant's surname. To examine the quality of the linkage using SSN as the sole matching criterion, we conducted two procedures using data for 1989-1994 to compare linkages identified by SSN, to linkages identified using other available variables. Linkage was conducted using a deterministic approach based on seven variables and 14 steps. In each step a string of relevant variables was created and in successive phases selected variables were substituted or removed with decreasingly stringent requirements. A manual review was done to check for accuracy. Utilizing all available variables, the linkage process yielded 793 matches (live births) among 4496 patients, 780 [98%] of which would have been identified using SSN alone. Five of seven matches identified by SSN were not confirmed by manual review. SSN appears to be fairly accurate for linkage and can be valuable for linking cancer registries to other data sources.

Background The period in utero is a time of increased vulnerability. Offspring of pregnant women exposed to carcinogenic substances in drinking water may be more likely to develop cancer. We examined whether household water source and the presence of nitrates or nitrites in residential water were associated with increased risks of childhood brain tumours (CBT). Methods We used data from a multicentre, case-control study with maternal information on residential water source, and nitrate/nitrite levels of tap water measured by dipstick. Subjects included 836 CBT cases and 1485 controls from five countries. Results The risks of CBT associated with reliance on well water (versus public water) during pregnancy varied widely, with significantly increased risks noted in two (of seven) regions and a decreased risk observed in one region. CBT risk did not increase with increasing nitrate levels. However, our results based on tap water tested in the pregnancy residences suggest the risk of astrocytoma may be associated with increasing levels of nitrite (odds ratio [OR] = 4.3, 95% CI: 1.4, 12.6 for nitrite levels of 1

BACKGROUND Obesity is an established risk factor for gestational diabetes. It is not known whether this risk might be reduced through weight loss between pregnancies. We sought to determine whether weight loss between pregnancies reduced the risk of gestational diabetes among obese women. METHODS We conducted a population-based cohort study of 4102 women with 2 or more singleton live births in Washington State between 1992 and 1998. All subjects were nondiabetic and obese (at least 200 lbs) at their first birth during these years. Weight change was calculated as the difference between prepregnancy weight for the 2 pregnancies. We estimated relative risks of gestational diabetes at the subsequent delivery through stratified analyses and Mantel-Haenszel estimates. RESULTS Thirty-two percent of women lost weight between pregnancies, with a mean weight loss of 23 lbs. Women who lost at least 10 lbs between pregnancies had a decreased risk of gestational diabetes relative to women whose weight changed by less than 10 lbs (relative risk = 0.63; 95% confidence interval = 0.38-1.02, adjusted for age and weight gain during each pregnancy). Of the 61% of women who gained weight between pregnancies, the mean weight gain was 22 lbs. Women who gained at least 10 lbs had an increased risk of gestational diabetes (1.47; 1.05-2.04). CONCLUSIONS Even moderate changes in prepregnancy weight can apparently affect the risk of gestational diabetes among obese women. This may offer further motivation for interventions aimed at reducing obesity among women of reproductive age.

BACKGROUND Many young patients with breast carcinoma have not started, or completed, their desired families. How childbearing after a diagnosis of breast carcinoma affects survival is of importance to these women and their families. The authors measured relative mortality among young patients with breast carcinoma with and without births occurring after diagnosis. METHODS The authors conducted a cohort study using data from three population-based cancer registries in the U.S. (Seattle, Detroit, and Los Angeles), linked to birth certificate data in each state. Four hundred thirty-eight women younger than 45 years of age with primary invasive breast carcinoma were identified as having births after diagnosis. In addition, 2775 comparison women, matched on the basis of age at the time of diagnosis, race/ethnicity, diagnosis year, disease stage, and presence of previous nonbreast primary tumors, were identified among those with breast carcinoma without births after diagnosis. Relative mortality was assessed using multivariable statistical methods. RESULTS After adjustment for stage of disease, age at diagnosis, study region, diagnosis year, and race/ethnicity, women with births occurring 10 months or more after diagnosis had a significantly decreased risk of dying (relative Risk [RR] = 0.54, 95% confidence interval [CI], 0.41–0.71) compared to women without subsequent births. Women pregnant at the time of diagnosis had a mortality rate similar to those who did not give birth (RR = 1.10, 95% CI, 0.80–1.60). CONCLUSIONS The results of the current study, in light of growing evidence from other studies using various methods, may provide some reassurance to young women with breast carcinoma that subsequent childbearing is unlikely to increase their risk of mortality. Cancer 2003;98:1131–40. © 2003 American Cancer Society. DOI 10.1002/cncr.11634

A compelling hypothesis was proposed that childhood brain tumours are associated with maternal exposure to N-nitroso compounds during the prenatal period. Many common drugs, such as antihistamines, aspirin, and antibiotics, are nitrosatable and depending upon the product, potentially carcinogenic. We hypothesized that maternal ingestion of certain subgroups of nitrosatable drug products during pregnancy increases the risk of brain tumour development in offspring.Data were collected as part of a population-based case-control study of childhood brain tumours and mothers' self-reported exposure to therapeutic drugs and dietary nitrites. Cases were enrolled from three US West Coast SEER tumour registries: Seattle-Puget sound, Los Angeles County, and the San Francisco-Oakland Bay Area. Tumours were grouped into three major histological tumour subtypes: astroglial, primitive neural ectodermal tumours, and all remaining glial tumours ('other glial'). Therapeutic drugs reported by mothers were translated into active chemical compounds and classified as secondary amines, tertiary amines, amides, or none of the three. Risk estimates were computed according to classes of nitrosatability, potential carcinogenicity, teratogenicity, and predicted end product.We found no significant association between maternal use of nitrosatable drugs, either overall or within any of the nitrosatable drug classifications, and subsequent development of brain tumours in children. Nitrite consumption from cured meats was not an effect modifier. However, exposure to nitrosoephedrine during pregnancy was associated with significantly increased risk of 'other glial' tumours (OR = 3.1; 95% CI: 1.1-9.2).These findings do not support an association between maternal use of nitrosatable drugs during pregnancy and brain tumour risk in offspring. While exposure to the nitrosation end product nitrosoephedrine was associated with increased risk for other glial tumours, the finding was not specific to any one type of tumour.

A total of 1218 cases of childhood brain tumours (CBT) and 2223 control subjects from the general population were included in a population-based case-control study conducted in nine centres in seven countries. Mothers were asked about farm- or agriculture-related exposures. Significantly elevated odds ratios (OR) for CBT were associated with children's personal and maternal prenatal exposure while living on a farm with pigs (child OR = 1.7, mother OR = 2.3), horses (child OR = 1.6, mother OR = 1.8), dogs (child OR = 1.5, mother OR = 1.5) and cats (child OR = 1.5, mother OR = 1.7). Children who were exposed to pigs, horses and cats combined, while living on a farm, had a threefold elevated OR for CBT. Increased ORs for primitive neuroectodermal tumours (PNET) were associated with children's farm exposure to dogs (OR = 1.9) and cats (OR = 2.2), and maternal farm exposure to pigs (OR = 4.2). The OR for CBT was elevated (OR = 2.3) for children of mothers who had preconception/prenatal farm- or agriculture-related employment involving potential contact with animals, relative to no farm- or agriculture-related employment. In particular, increased ORs for CBT were observed for children of mothers who were employed as general farmers (OR = 4.1) or general farm workers (OR = 3.8). During the 5 years preceding the index child's birth, maternal exposures were related to CBT, relative to no maternal exposure to agricultural chemicals or animal products: fertilisers (OR = 1.8), pesticides (OR = 2.0), animal manure (OR = 2.0) and unprocessed wool (OR = 3.0). Our findings suggest that various farm-related exposures are positively associated with CBT and warrant further investigation into the public health importance of these associations.

The immature nervous system of the fetus is characterised by rapid cell growth and division and is particularly vulnerable to carcinogens and mutagens. Several epidemiological studies have reported an increased risk for childhood brain tumours (CBT) associated with exposure to N-nitroso compounds (NOC). Hair-colouring products (hair "dyes") that contain NOC-related aromatic amines have shown mutagenicity in vitro and carcinogenic properties in vivo. The potential public health impact of the relationship between hair dye use and carcinogenesis has prompted epidemiological research, given that a large proportion of American women have used hair dyes. A large population-based case-control study was conducted on the west coast of the USA to investigate risk factors for CBT including exposure to NOC. Eligible CBT patients (

The etiology of childhood brain tumors (CBTs) remains unknown. Tobacco smoke contains several known carcinogens and can induce DNA adducts in human placenta and hemoglobin adducts in fetuses. We present the results of an international case-control study to evaluate the association between CBTs and exposure of parents and children to cigarette smoke. The study was undertaken as part of the SEARCH program of the IARC. Nine centers in 7 countries were involved. The studies mainly covered the 1980s and early 1990s. Cases (1,218, ages 0-19 years) were children newly diagnosed with a primary brain tumor; there were 2,223 population-based controls. Most mothers who agreed to participate were interviewed in person at home. Odds ratios (ORs) were calculated by unconditional logistic regression, adjusted for age, sex and center, for all types of CBT combined, 4 CBT histotypes, 5 age groups and each center. There was no association between the risk of brain tumors in the child and parental smoking prior to pregnancy, maternal smoking or regular exposure to others' cigarette smoke during pregnancy at home or at work, or passive smoking by the child during the first year of life. These results did not change considering the child's age at diagnosis, the histologic type of tumor or center.

OBJECTIVE: The purpose of this study was to determine whether women with multiple sclerosis who deliver singleton infants are more likely to have pregnancy or delivery complications or to have infants with low birth weight, preterm gestation, or malformations than women without multiple sclerosis and to compare their need for rehospitalization during the 2 years after delivery. Study Design: This was a population-based cohort study that used Washington State linked birth certificate-hospital discharge records for singleton births from 1987 through 1996. Pregnancy course, birth outcomes, and need for rehospitalization within 2 years after delivery were compared for 198 women with multiple sclerosis and a comparison group of 1584 women. RESULTS: With the exception of maternal anemia, women with multiple sclerosis were no more likely to have pregnancy or delivery complications, nor were their infants more likely to be low birth weight or preterm or to have malformations. Affected women were, however, twice as likely to be rehospitalized during the 3 months after delivery. CONCLUSION: The increased risk of rehospitalization emphasizes a need for strong support systems and close monitoring during the 3 months after delivery. (Am J Obstet Gynecol 2002;186:446-52.)

BACKGROUND: Hematopoietic cell transplantation (HCT) survivors have high risks of mortality and late complications compared with the general population. Few analyses have compared the magnitude of these risks against those experienced by a matched non-HCT cancer population where the primary difference may be exposure to HCT. METHODS: The Fred Hutchinson Cancer Research Center (FHCRC) performs most of the HCTs in Washington State (WA), including all allogeneic HCTs. We linked medical records of all 2+ year HCT survivors who were WA residents treated at FHCRC from 1992-2009 (n=1,929; 53.3% allogeneic; 83.8% hematologic malignancies) to the state’s hospital discharge and death registries. Individuals randomly selected from the state’s cancer registry (n=5,806) and the driver’s license files (n=16,340) who also survived 2+ years formed 2 comparison groups, frequency-matched by age, sex, year of HCT, and underlying diagnosis (HCT and cancer registry subjects only). Based on hospital and death registry coding (per International Classification of Diseases [ICD-9 and 10]), the cumulative incidence and the relative hazards (HR; Cox models) of experiencing specific organ-based complications (time to first event) were estimated for each group. Subanalyses involving HCT survivors alone examined the relationship between adverse outcomes occurring 2+ years after HCT and any chronic graft versus host disease (cGVHD) and/or original disease relapse prior to 2 years. RESULTS: With a median age at HCT of 43 years (range 0-79), HCT recipients experienced 3,011 hospitalizations and 399 deaths over a median follow-up time of 6.3 years (range 2.0-20.0) following HCT. Compared with non-HCT cancer survivors, HCT survivors had markedly higher rates of hospitalizations or deaths related to infections (10-year cumulative incidence 30.5 vs. 21.5%; HR 1.6, 95% CI 1.4-1.7), in particular respiratory infections (17.7 vs. 11.4%; HR 1.8, 95% CI 1.5-2.0). Among 688 hospitalizations with a primary infection code (ICD9 codes 1-139), a bacterial source was identified in 63% (gram-negative species 16%; staphylococcus 14%; clostridium difficile 7%), virus in 31% (herpes zoster 8%), and fungus in 24% (aspergillus 8%). Among hospitalizations for a respiratory infection (n=511), bacterial pneumonia was common (21%), followed by viral (8%) and fungal (7%) pneumonias; most pneumonias had no pathogen coded (n=228 of 511; 45%). HCT survivors also had greater 10-year cumulative incidence rates for circulatory (25.5 vs. 22.8%), gastrointestinal (19.2 vs. 16.4%), genitourinary (18.1 vs. 15.5%), nervous system (13.5 vs. 11.6%), musculoskeletal (16.9 vs. 13.3%), dermatologic (7.2 vs. 5.6%), and non-infectious respiratory (15.5 vs. 11.8%) complications, with HRs 1.2-1.4 and p10 percentage points lower in the general population. Among HCT recipients, history of chronic graft versus host disease (cGVHD) and relapse of one’s original disease were risk factors for most outcomes. Risks among allogeneic and autologous HCT recipients otherwise were similar. Adjustment for cGVHD status attenuated the risks between HCT and non-HCT cancer survivors, but HCT status remained a significant risk factor for many outcomes including infections and respiratory disease. CONCLUSIONS: Compared with similar non-HCT cancer survivors, 2+ year HCT survivors were at greater risk of multiple adverse late complications, in particular late respiratory infections. Greater awareness and earlier intervention, along with improvements in cGVHD treatment, may reduce some of these disparities. Disclosures No relevant conflicts of interest to declare.

Objective To determine the risk of hospitalization associated with prenatal care use and indicators of socioeconomic status and social support among infants of teenage mothers. Design Population-based case-control study. Setting Nonfederal hospitals in Washington State. Participants Infants born from 1987 to 1995 to mothers younger than 20 years were identified using linked birth certificate–state hospital discharge data. Cases consisted of 8052 infants who were hospitalized during the first year of life at least 2 days after birth hospitalization discharge. An equal number of controls, frequency matched on birth year and maternal age group, were randomly sampled from among nonhospitalized infants. Main Outcome Measure Hospitalization in the first year of life. Results Infants with a father listed on the birth certificate or whose mothers had commercial health insurance had a decreased risk of hospitalization (adjusted odds ratios, 0.91 and 0.78, respectively; 95% confidence intervals, 0.83-0.99 and 0.71-0.85, respectively). Participation in state-funded pregnancy programs, adequacy of prenatal care, or marital status did not affect the risk of hospitalization, except among infants whose mothers received more than adequate prenatal care (adjusted odds ratio, 1.15; 95% confidence interval, 1.03-1.29). Conclusion Our results suggest that teenaged mothers who list a father on the birth certificate or who have insurance, indicative of higher socioeconomic status, may have a reduced risk of hospitalization for their infants. Teenaged mothers who receive more than adequate prenatal care may have pregnancy complications that place their infants at increased risk of hospitalization. The effect of these protective factors should be clarified in future studies.

A large case-control study of children was used to test mothers' reporting of information on fathers' background, lifestyle and occupational factors. For a subset (104) of 1341 enrolled families, both parents were interviewed about fathers' characteristics. Reliability of reporting was determined for fathers' race, education, smoking status, non-recent job history and use of occupational agents. The ability of mothers to report fathers' race, education and smoking status was high (kappa > 0.70). Mothers were generally able to report jobs held by the fathers in the 5 years preceding the birth of the child, but reliability was higher for jobs held for longer (kappa typically above 0.70), rather than shorter periods (kappa above 0.40). The finding that mothers' reporting on fathers' background, lifestyle and non-recent job history was reliable is encouraging, because many studies on childhood health rely exclusively on information from interviews with mothers. However, mothers were not reliably able to describe exposure to specific occupational agents.

We examined adverse birth outcomes among Mexican-Americans to determine the effect of country of maternal birth, a measure of acculturation.We conducted a retrospective cohort analysis of birth outcomes among 4800 Mexico-born and 4800 US-born Mexican-American women using Washington State birth certificate data from 1989 to 1994. Length of residence at current address was used to help refine our measure of acculturation.US-born women had a slightly increased risk of preterm birth relative to Mexico-born women [relative risk (RR) 1.18, 95% confidence interval (CI) 1.04-1.33]. Among Mexico-born women, the risk of preterm birth increased with greater duration of current residence.US-born Mexican-American women had a slightly increased risk of preterm birth despite having more adequate prenatal care, more education, and higher socioeconomic indicators. This may be due to acculturation factors, such as earlier pregnancy, loss of social support systems, and increased smoking or alcohol use. Reducing this risk depends on recognition among health care workers and policy-makers of the potential influence of acculturation on health in this population.

A series of co-ordinated population-based case-control studies of childhood brain tumours (CBT) was undertaken under the auspices of the Surveillance of Environmental Aspects Related to Cancer in Humans (SEARCH) programme of the International Agency for Research on Cancer (IARC) to evaluate, inter alia, the risk in relation to characteristics of the index pregnancy and birth, and maternal reproductive history. Subjects comprised 1218 cases aged 0-19 years and 2223 controls. Risk estimates were calculated by unconditional logistic regression, adjusted for age, sex, centre and mother's years of schooling, for all types of CBT combined as well as for four groups defined by histopathology (astrologlial tumours, primitive neuroectodermal tumours of the brain, 'other glial' tumours and 'other histological types') and for five age groups (0-1, 0-4, 5-9, 10-14, 15-19 years). Use of anaesthetic 'gas' was associated with an increased risk of CBT (OR = 1.5, 95% CI [1.1, 2.0]), apparent in children aged 0-4 years (OR = 2.4, 95% CI [1.4, 4.1]) and for astroglial tumours (OR = 1.6, 95% CI [1.1, 2.2]) with non-significantly increased relative risks for each of the other histological groups. However, not all centre-specific relative risks were elevated. No other aspect of the index pregnancy, delivery and early neonatal period or of the mother's previous reproductive history was associated with risk for CBT.

Objective: To determine whether individuals with a traumatic brain injury (TBI) or stroke (cerebrovascular accident [Cva]) have an increased risk of subsequent motor vehicle crash or moving violation. Design: A retrospective study comparing the driving records of four cohorts hospitalized with TBI, CVA, isolated extremity fractures (FX), and appendicitis (APPY) with the records of four age-matched, gender-matched, and zip code-matched nonhospitalized cohorts. Setting: Eligible drivers in the state of Washington, 1991 to 1993. Participants/Methods: Four cohorts hospitalized in 1992 with TBI, CVA, FX, or APPY were identified from Washington state hospital discharge data. The state driver's license database identified patients with driver's licenses. Each hospitalized cohort was compared with its own age-matched, gender-matched, and zip code-matched nonhospitalized cohort. Main Outcome Measures: Crashes and citations for moving violations 12 months after hospitalization adjusted for age, gender, and prior driving record. Results: The relative risks (RRs) of any subsequent crash or receipt of citation were not greater for those with either CVA or TBI than for nonhospitalized individuals, nor were the risks of experiencing two or more of these events in the 12 months after hospitalization significantly elevated. After adjustment for prior driving record, modest elevations were observed only for the risks of subsequent driving violation among those with TBI (RR = 1.3, 1.0–1.7) and among patients with FX (RR = 1.2, 1.1–1.4). Conclusions: The results do not support the hypothesis that individuals who have sustained a brain injury are at increased risk of motor vehicle crashes. Although patients with TBI were more likely to subsequently receive citations than nonhospitalized individuals, a similar increase was observed among patients without brain injury who had FX, suggesting an inability to completely control for driver characteristics that may be related to risk-taking behavior and that are also associated with an increased risk of driving violation.

Background Acute leukemia is extremely rare in the first year of life: about 150 cases are diagnosed each year in the United States. Clinical and molecular studies of infant acute leukemia (IAL) suggest a distinct etiology and provide strong evidence of an in utero origin. Little is known about IAL etiology; however, advanced maternal age (adjusted for paternal age) has been associated with an increased risk of childhood cancers diagnosed between 0-14 years of age including leukemia (both acute lymphoblastic (ALL) and acute myeloid leukemia (AML)), lymphoma, central nervous system tumors, neuroblastoma, Wilms’ tumor, bone tumors and soft tissue sarcoma, while associations with paternal age after adjusting for maternal age are less striking. Methods Linked birth and cancer registry data for the period 1980-2004 were pooled from five states (NY, WA, MN, TX and CA) to evaluate associations between birth characteristics and IAL. The pooled data contained information for 351 infants diagnosed with acute leukemia (220 ALL, 131 AML) in the first year of life and 57,966 infant controls born in the same years. Children with Down syndrome documented at birth were excluded. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results Overall, males had a slightly decreased risk of developing IAL (OR=0.8, CI 0.7, 1.0), but there was little evidence of association with plurality, birth weight or maternal race. After adjusting for paternal age, infants with mothers ≥40 years of age had a significantly increased risk of developing IAL (OR=2.9, CI 1.4, 5.9), which was confined to the AML subtype (OR=5.5, 95% CI 2.1-14.6). In contrast, young paternal age Discussion Ours is the first study to demonstrate a strong significant association of paternal young age with infant ALL. Since this study ascertained case and control status by record linkage, selection bias-- where cases or controls determine extent of participation-- is of little concern. Recall bias is also unlikely, as parental age was recorded prior to cancer diagnosis. These intriguing associations provide further evidence of differences in underlying etiology for IAL. Of note, approximately 80% of infants with ALL and 60% of infants with AML have a rearrangement involving the MLL gene in their leukemia cells, which has been shown to arise in utero. Given our findings, parental age associations with MLL rearrangements in IAL need to be investigated. Further, while epidemiological studies of IAL have primarily focused on maternal factors that may increase risk, our data suggest that paternal factors also need to be considered. Future IAL research to help elucidate the biological basis should include collection of detailed epidemiological data and biospecimens from both parents and infants to determine whether parent-of-origin de novo mutations and/or carcinogenic exposures are involved. Disclosures: No relevant conflicts of interest to declare.

Self-reported reproductive histories of male employees of a lead-zinc smelter were related to pre-conception measures of lead exposure to examine associations between paternal occupational lead exposure and adverse pregnancy outcome. The participants reported 2,021 pregnancies which resulted in 1,684 normal live births, 12 stillbirths, 30 birth defects, 203 spontaneous abortions, and 92 "other" outcomes. Birth defects and stillbirths were combined for the analysis. The risk of a stillbirth or birth defect was elevated for pre-conception employment in a high-lead-exposure compared with a low-lead-exposure job (odds ratio = 2.7, 95% confidence interval = 0.7, 9.6). A similar risk was found for pre-conception blood lead levels of 25-39 µg/dL and/= 40 µg/dL when compared with blood lead levels of25 µg/dL (OR = 2.9, 95% CI = 0.6, 13.3, and OR = 2.5, 95% CI = 0.5, 11.6, respectively). No association was found between pre-conception lead exposure and spontaneous abortion. A relatively low response rate to the questionnaire and potentially erroneous reporting of reproductive outcomes by male workers are limitations of the study.