Cancer Causes & Control

, Volume 26, Issue 7, pp 1003–1017 | Cite as

Parental smoking, maternal alcohol, coffee and tea consumption during pregnancy, and childhood acute leukemia: the ESTELLE study

  • L. Orsi
  • J. Rudant
  • R. Ajrouche
  • G. Leverger
  • A. Baruchel
  • B. Nelken
  • M. Pasquet
  • G. Michel
  • Y. Bertrand
  • S. Ducassou
  • V. Gandemer
  • P. Lutz
  • L. Saumet
  • P. Moreau
  • D. Hemon
  • J. Clavel
Original Paper



To investigate the role of parental smoking during pre-conception and pregnancy, maternal beverage consumption (alcohol, coffee and tea) during pregnancy and their possible interactions, in the etiology of childhood acute leukemia (CL).


The ESTELLE study included 747 cases of CL [636 cases of acute lymphoblastic leukemia (ALL) and 100 cases of acute myeloblastic leukemia (AML)] diagnosed in France in 2010–2011 and 1,421 population controls frequency-matched with the cases on age and gender. Data were obtained from structured telephone questionnaires administered to the mothers. The odds ratios (OR) and their 95 % confidence intervals were estimated using unconditional logistic regression models adjusted for potential confounders.


AML, but not ALL, was non-significantly associated with alcohol drinking during pregnancy [OR = 1.3 (0.8–2.0)] with a significant positive dose–response trend (p-trend = 0.02). Pre-conception paternal smoking was significantly associated with ALL [OR = 1.2 (1.1–1.5)] and AML [OR = 1.5 (1.0–2.3)]. CL was not associated with maternal smoking [OR = 1.0 (0.8–1.2)], or maternal coffee [OR = 0.9 (0.8–1.1)] or tea drinking [OR = 0.9 (0.8–1.1)] during pregnancy. However, a high consumption of coffee (>2 cups/day) was significantly associated with ALL [OR = 1.3 (1.0–1.8)].


The findings constitute additional evidence that maternal alcohol drinking during pregnancy may be involved in AML, and that paternal smoking before pregnancy may be a risk factor for CL. The role of maternal coffee drinking in CL remains unclear and should be investigated further in consortium analyses and in large birth cohort studies with exposure assessment more contemporaneous with the exposure, before the occurrence of the disease.


Childhood acute leukemia Parental smoking Coffee Alcohol 



Acute lymphoblastic leukemia


Acute myeloblastic leukemia


B cell precursor acute lymphoblastic leukemia


Childhood acute leukemia


National registry of childhood hematopoietic malignancies



The authors are grateful to: Noureddine Balegroune, Sofiène Ben Salha and the team of clinical research associates who contributed to the recruitment of the cases; Laure Faure and the staff of the French National Registry of Childhood Hematopoietic Malignancies, who contributed to case detection and verification; Christophe David and the team of interviewers (Institut IPSOS), who recruited the controls and interviewed the cases and controls and Elsa Charles for her technical assistance The authors would like to thank all of the Société Française de lutte contre les Cancers de l’Enfant et de l’Adolescent (SFCE) principal investigators: André Baruchel (Hôpital Saint-Louis/Hôpital Robert Debré, Paris), Claire Berger (Centre Hospitalier Universitaire, Saint-Etienne), Christophe Bergeron (Centre Léon Bérard, Lyon), Gérard Michel (Hôpital La Timone, Marseille), Yves Bertrand (Institut d’Hématologie et d’Oncologie Pédiatrique, Lyon), Pascal Chastagner (Centre Hospitalier Universitaire, Nancy), Patrick Boutard (Centre Hospitalier Régional Universitaire, Caen), Gérard Couillault (Hôpital d’Enfants, Dijon), Christophe Piguet (Centre Hospitalier Régional Universitaire, Limoges), Anne-Sophie Defachelles (Centre Oscar Lambret, Lille), François Demeocq (Hôpital Hôtel-Dieu, Clermont-Ferrand), Alain Fischer (Hôpital des Enfants Malades, Paris), Virginie Gandemer (Centre Hospitalier Universitaire– Hôpital Sud, Rennes), Dominique Valteau-Couanet (Institut Gustave Roussy, Villejuif), Philippe Colombat (Centre Gatien de Clocheville, Tours), Frederic Millot (Centre Hospitalier Universitaire Jean Bernard, Poitiers), Guy Leverger (Hôpital Armand-Trousseau, Paris), Patrick Lutz (Hôpital de Hautepierre, Strasbourg), Nicolas Sirvent (Hôpital Arnaud de Villeneuve, Montpellier), Xavier Rialland (Hôpital Mère et Enfants, Nantes), Martine Münzer (American Memorial Hospital, Reims), Brigitte Nelken (Hôpital Jeanne de Flandre, Lille), François Doz (Institut Curie, Paris), Brigitte Pautard (Centre Hospitalier Universitaire, Amiens), Yves Perel (Hôpital Pellegrin Tripode, Bordeaux), Alain Pierre-Kahn (Hôpital Enfants Malades, Paris), Emmanuel Plouvier (Centre Hospitalier Régional, Besançon), Xavier Rialland (Centre Hospitalier Universitaire, Angers), Alain Robert (Hôpital des Enfants, Toulouse), Hervé Rubie (Hôpital des Enfants, Toulouse), Nicolas Sirvent (L’Archet, Nice), Marilyne Poiree (Fondation Lenval, Nice), Jean-Pierre Vannier (Hôpital Charles Nicolle, Rouen), Dominique Plantaz (Centre Hospitalier Universitaire, Grenoble), Philippe Lemoine (Hôpital Morvan, Brest) and Christian Sainte Rose (Centre Hospitalier Universitaire Necker, Paris).


This work was supported by grants from the Ligue Nationale Contre le Cancer (LNCC), the Agence Nationale de Sécurité Sanitaire de l’alimentation, de l’Environnement et du Travail (PNREST Anses, Cancer TMOI AVIESAN, 2013/1/248), the Institut National du Cancer (INCa), the association Enfants et Santé and the Agence Nationale de la Recherche (ANR-10-COHO-0009).

Ethical Standards

The study protocol complied with the French regulations relating to databases and ethics and the pertinent approvals (CNIL, French Data Protection Authority, no. 90828 and CPP Idf IV, Comitee for Personal Protection, no. 2008/12NICB, respectively) were obtained.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 84 kb)
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Supplementary material 2 (DOCX 13 kb)
10552_2015_593_MOESM3_ESM.docx (18 kb)
Supplementary material 3 (DOCX 17 kb)
10552_2015_593_MOESM4_ESM.docx (14 kb)
Supplementary material 4 (DOCX 14 kb)


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • L. Orsi
    • 1
    • 2
  • J. Rudant
    • 1
    • 2
    • 3
  • R. Ajrouche
    • 1
    • 2
  • G. Leverger
    • 4
    • 5
  • A. Baruchel
    • 6
    • 7
  • B. Nelken
    • 8
  • M. Pasquet
    • 9
  • G. Michel
    • 10
  • Y. Bertrand
    • 11
  • S. Ducassou
    • 12
  • V. Gandemer
    • 13
  • P. Lutz
    • 14
  • L. Saumet
    • 15
  • P. Moreau
    • 16
  • D. Hemon
    • 1
    • 2
  • J. Clavel
    • 1
    • 2
    • 3
  1. 1.INSERM U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA)VillejuifFrance
  2. 2.Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS)ParisFrance
  3. 3.RNHE - National Registry of Childhood Hematopoietic MalignanciesVillejuifFrance
  4. 4.AP-HP, Hôpital Armand TrousseauParisFrance
  5. 5.Université Paris 6 Pierre et Marie CurieParisFrance
  6. 6.AP-HP, Hôpital Robert DebréParisFrance
  7. 7.Université Paris 7ParisFrance
  8. 8.CHRUHôpital Jeanne de FlandreLilleFrance
  9. 9.Hôpital des EnfantsToulouseFrance
  10. 10.AP-HM, Hôpital la TimoneMarseilleFrance
  11. 11.Institut d’Hématologie et d’Oncologie PédiatriqueLyonFrance
  12. 12.Hôpital Pellegrin TripodeBordeauxFrance
  13. 13.CHU Hôpital SudRennesFrance
  14. 14.Hôpital de HautepierreStrasbourgFrance
  15. 15.Hôpital Arnaud de VilleneuveMontpellierFrance
  16. 16.Hôpital Mère-EnfantCHU-NantesNantesFrance

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