Article Text

Download PDFPDF
Tobacco, alcohol and illicit drugs during pregnancy and risk of neuroblastoma: systematic review
  1. Eloise Müller-Schulte1,
  2. Gerhard Kurlemann2,
  3. Anja Harder3,4
  1. 1 Institute of Medical Microbiology, Saarland University Medical Center, Homburg, Germany
  2. 2 Department of Pediatric Neurology, Children’s University Hospital, Münster, Germany
  3. 3 Institute of Pathology, Brandenburg Medical School, Brandenburg, Germany
  4. 4 Institute of Neuropathology, University Hospital, Münster, Germany
  1. Correspondence to Dr Anja Harder, Institute of Pathology, Health Care Center, Brandenburg Hospital, Brandenburg Medical School, Hochstr. 29, D-14770 Brandenburg, Germany; anja.harder{at}


Objective To determine whether prenatal and perinatal maternal consumption of alcohol, tobacco and/or illicit drugs is associated with risk of neuroblastoma.

Data sources Medline and Embase (both from inception to February 2017), and reference lists of included studies.

Study selection To be eligible, a study had to be an original report including data on intake of alcohol, tobacco smoking and/or consumption of illicit drugs during pregnancy and risk of neuroblastoma in the child.

Data extraction From eligible studies, data study characteristics as well as effect measures and confounders were extracted. We assessed unadjusted and confounder-adjusted estimates, performed risk of bias analysis, constructed random-effects models and assessed heterogeneity.

Results We identified 14 case–control studies (1987–2016) involving a total of 3114 children with neuroblastoma. Meta-analysis of unadjusted estimates showed an association between alcohol (OR 1.26; 95% CI 1.07 to 1.49), tobacco (OR 1.22; 95% CI 1.04 to 1.44) and illicit drug consumption during pregnancy and risk of neuroblastoma during childhood, with illicit drug consumption showing the strongest association (OR 3.26; 95% CI 1.36 to 7.86). However, adjusted estimates were highly heterogeneous.

Limitations All studies were at high risk of bias.

Conclusions Smoking, alcohol or illicit drugs during pregnancy might play a role in the development of neuroblastoma. However, well-designed studies are needed to assess whether these exposures are causal and whether time period during pregnancy, dose or co-consumption of substances is critical.

Trial registration number Registration number CRD42016036165.

  • oncology
  • epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AH conceptualised and designed the study, drafted the initial manuscript and approved the final manuscript as submitted. EM-S collected the data, coordinated the analyses and carried out the study, reviewed and revised the manuscript, and approved the final manuscript as submitted. GK critically reviewed and revised the manuscript and approved the final manuscript as submitted.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.