European Journal of Epidemiology

, Volume 30, Issue 12, pp 1277–1285

Perinatal risk factors for acute myeloid leukemia

  • Casey Crump
  • Jan Sundquist
  • Weiva Sieh
  • Marilyn A. Winkleby
  • Kristina Sundquist

DOI: 10.1007/s10654-015-0063-0

Cite this article as:
Crump, C., Sundquist, J., Sieh, W. et al. Eur J Epidemiol (2015) 30: 1277. doi:10.1007/s10654-015-0063-0


Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973–2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June–August), incidence rate ratios for AML were 1.72 (95 % CI 1.25–2.38; P = 0.001) for winter (December–February), 1.37 (95 % CI 0.99–1.90; P = 0.06) for spring (March–May), and 1.27 (95 % CI 0.90–1.80; P = 0.17) for fall (September–November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.


Cohort studies Fetal development Gestational age Leukemia Risk factors Seasons 



Acute lymphoblastic leukemia


Acute myeloid leukemia


Confidence interval


Date of birth


International classification of diseases


Incidence rate ratio


Standard deviation

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Casey Crump
    • 1
  • Jan Sundquist
    • 2
  • Weiva Sieh
    • 3
  • Marilyn A. Winkleby
    • 4
  • Kristina Sundquist
    • 2
  1. 1.Department of MedicineStanford UniversityStanfordUSA
  2. 2.Center for Primary Health Care Research, Clinical Research Centre (CRC)Lund UniversityMalmöSweden
  3. 3.Department of Health Research and PolicyStanford UniversityStanfordUSA
  4. 4.Stanford Prevention Research CenterStanford UniversityStanfordUSA

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