INTRODUCTION

Childhood cancer has been increasing in

Scotland. A published report estimates that

its incidence has risen from an age standardised rate of 120 cases per million population in the time period 1983–1987 to 161

cases per million in the period 2003–2007.1

The reason for this increasing trend remains

unexplained as the aetiopathogenesis of

childhood cancer is poorly understood. As

most of the children present with cancer in

the first few years of life, epidemiologists

hypothesise that prenatal and perinatal exposures may have a part to play in its pathogenesis. The evidence surrounding this is,

however, conflicting. While some researchers

have found associations of younger maternal

age at delivery2 maternal anaemia,3 4 history

of miscarriage,256 maternal overweight7 and

smoking8 with some childhood cancers,

others have found no such associations.9–11

Fetal growth is perhaps the most investigated

perinatal risk factor for childhood

cancer7 12 13; but the authors report conflicting results. While specific central nervous

system tumours have been found to be associated with intrauterine growth restriction

(IUGR), the overall risk was small.12

Therefore, apart from the associations with

Down’s syndrome and in utero exposure to

radiation, research into the maternal and

perinatal risk factors has remained inconsistent, the results limited by small sample sizes

and recall or reporting bias.

Our objective was, therefore, to investigate

the maternal and perinatal risk factors for

childhood cancer, specifically to examine the

effects of IUGR, preterm birth and birth

asphyxia on the development of childhoodcancer in the offspring, taking advantage of the opportunities offered by record linkage of a cancer registry

with a local birth register.

odel.

Conclusions: Younger maternal age, maternal

smoking, delivery by caesarean section and low Apgar

score at 5 min were independently associated with

increased risk of childhood cancer. These general

findings should be interpreted with caution as this

study did not have the power to detect any association

with individual diagnostic categories of childhood

cancer.