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More Evidence Links Season of Birth and Risk for MS


A new study of more than 21,000 patients with multiple sclerosis (MS) in the United Kingdom (UK) provides further evidence that season of birth can influence the risk for MS and that this association cannot be explained away by "background patterns."

In the study, MS risk was 24% higher for those born in April vs those born in November, even after adjustment for multiple variables, including geographic and timing variations. In addition, there were 15.7% fewer MS births than expected in November compared with general population data.

"We wanted to adjust our data to avoid potential biases, which have been noted lately," said lead author Pedro María Rodríguez Cruz, MD, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.

Although more studies now need to be conducted, "I think clinicians should keep this information in mind," added Dr Cruz about the results.

The findings were published online June 27 in JAMA Neurology.

The investigators note that although previous research in the UK has shown that spring births convey higher risk for MS than fall births, they have been underpowered or "lacked appropriate controls to reliably quantify regional and latitudinal effects."

The new study, which was conducted between January 2014 and September 2015, included 21,138 participants with MS. The group included patients from eight MS-specialized centers in the UK, those who participated in the population-based UK Risk Sharing Scheme study, and those from the Borders and Lothian regions of Scotland who had participated in incidence and prevalence studies. The researchers also examined the UK Office of National Statistics for general population/control group data.

Potential temporal and regional effects were assessed by measuring deviances in monthly live birth rates over time between 1938 and 2000, by using the Walter and Elwood test, and by live-birth data from government sources for 1965 to 1999.

Significant Seasonal Effects

After adjustments, the 1938 to 1980 MS cohort had a significant seasonal effect compared with the general population during the same time period (P < .001). April was the peak month for MS births, with 6.8% more than expected.

November was the "trough month," with 9.0% fewer than expected MS births. The adjusted odds ratio (OR) for "peak-trough amplitude" for MS was 1.17 vs the control group (95% confidence interval [CI], 1.09 - 1.25).

A significant seasonal effect was also found in the 1965 to 1980 "regional MS cohort" compared with the control group, even after adjustment for region (P < .001), with the OR for peak-trough amplitude at 1.24 (95% CI, 1.10 - 1.41).

The adjusted OR was only 0.84 (95% CI, 0.76 - 0.92) for MS births in November compared with the controls.

"The findings…appear to confirm that, after making the appropriate corrections for regional origin and year of birth, the month of birth effect in development of MS in the United Kingdom remains significant," write the investigators.

However, because region and birth year can influence birth rates, "these confounders should be considered when studying the seasonality of diseases."

They note that more research is now needed to determine the mechanism for the link between month of birth and MS found in the UK. "The symmetrical deviations could imply a natural cycle; therefore, studying factors such as the variation in sunlight hours across regions…would be of great interest."

A Role for Birthdates?

"Establishing that there are gestation-related risk factors for multiple sclerosis…significantly impacts our understanding of the timing of environmental risk in MS and ultimately would have a critical influence on prevention strategies," writes Jennifer S. Graves, MD, PhD, Adult and Pediatric Multiple Sclerosis Centers, University of California, San Francisco, in an accompanying editorial.

She reiterates that although month or season of birth has been associated before with risk for MS and other diseases, recent studies have questioned these links because of possible birth pattern biases.

Dr Cruz and colleagues "confirm regional and temporal effects of seasonal variation on birth rate in the controls. Nonetheless, a season effect on month of birth in individuals with MS remained significant" after adjustment for these effects, Dr Graves writes.

She notes that although causes for this association are unknown, possibilities include lower vitamin D levels in the winter, seasonal conditions in the mother (such as influenza), mother's diet or activity levels, perinatal complications, and variants in ultraviolet light.

Determining the mechanism, she said, would lend "critical support" to the season of birth effect.

Story Source: The above story is based on materials provided by MEDSCAPE
Note: Materials may be edited for content and length

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