No significant association between maternal hormonal contraception use and central nervous system tumors in children

1. There was no statistically significant association between any maternal hormonal contraception use and increased risk for central nervous system tumors in a cohort of Danish children.

2. Further research on the tumorigenic properties of certain hormonal contraceptives and their effect on the proliferation of neural stem cells and progenitors may help explain the mechanism by which maternal hormonal exposure may increase childhood cancer risk.

Evidence Rating Level: 2 (Good)

Study Rundown: Despite an increase in the incidence of central nervous system (CNS) tumors in children, few risk factors have been identified. Some have postulated if an association with maternal hormonal contraception use exists given that sex hormones are considered potent human carcinogens at certain levels and hormonal exposure in utero has been associated with other forms of childhood cancers in exposed offspring. This registry-based cohort study assessed the association between maternal hormonal contraception use and the risk of childhood CNS tumors (age 0-19 years) in Danish children between 1996 and 2014. The main outcomes were hazard ratio (HR) and incidence rate difference (IRD) of CNS tumors. Among 1,185,063 Danish children, the adjusted incidence of CNS tumors in children born to mothers with recent hormonal contraceptive use vs mothers without any contraceptive use was 5.0 vs 5.3 per 100,000 person-years, a statistically nonsignificant difference. Thus, there was no statistically significant association between any maternal hormonal contraception use and increased risk for CNS tumors in a cohort of Danish children. A limitation of this study was that few subgroup analyses were performed due to the overall low prevalence of CNS tumors in children, reducing the statistical precision of some estimates.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Hormonal contraceptive use and risk of glioma among younger women: a nationwide case-control study

In-Depth [prospective cohort]: This Danish cohort study included 1,185,063 children with a diagnosis of a CNS tumor between January 1996 and December 2014, with follow-up through to December 2018 (mean follow-up, 12.9 years). Maternal hormonal contraception use was grouped according to any use, regimen (combined/progestin only), and route of administration (oral/nonoral), categorized as recent use (≤3 months before start and during pregnancy), previous use (>3 months before start of pregnancy), and no use. In total, 725 children (mean age, 7 years; 342 [47.2%] female) were diagnosed with a CNS tumor, where the adjusted incidence of CNS tumors per 100,000 person-years was 5.0 for children born to mothers with recent contraceptive use (n = 136,022), 4.5 for mothers with previous use (n = 778,843), and 5.3 for mothers with no use (n = 270,198). The corresponding HRs were 0.95 ([95%CI, 0.74-1.23]; 84 children with CNS tumors; IRD, −0.3 [95%CI, −1.6 to 1.0]) for recent use and 0.86 ([95%CI, 0.72-1.02]; 421 children with CNS tumors; IRD, −0.8 [95%CI, −1.7 to 0.0]) for previous use, compared with no use. No statistically significant associations were found according to usage, regimen, or route of administration.

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