BMJ  2005;330:120 (15 January), doi:10.1136/bmj.38301.686030.63 (published 7 December 2004)

Paper

Timing of birth and risk of multiple sclerosis: population based study

Cristen J Willer, postdoctoral fellow1, David A Dyment, doctoral student2, A Dessa Sadovnick, professor3, Peter M Rothwell, professor4, T Jock Murray, professor of medicine5, George C Ebers, action research professor4, for the Canadian Collaborative Study Group

1 Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA, 2 Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, 3 Department of Medical Genetics and Faculty of Medicine (Division of Neurology), University of British Columbia, Vancouver, BC, Canada V6T 2B5, 4 Department of Clinical Neurology, Radcliffe Infirmary, University of Oxford, OX2 6HE, 5 Dalhousie University, Halifax, NS, Canada B3H 4R2

Correspondence to: G C Ebers george.ebers{at}clneuro.ox.ac.uk

Objectives To determine if risk of multiple sclerosis (MS) is associated with month of birth in countries in the northern hemisphere and if factors related to month of birth interact with genetic risk.

Design Population based study with population and family based controls and a retrospective cohort identified from death certificates. A post hoc pooled analysis was carried out for large northern datasets including Sweden and Denmark.

Setting 19 MS clinics in major cities across Canada (Canadian collaborative project on the genetic susceptibility to multiple sclerosis); incident cases of MS from a population based study in the Lothian and Border regions of Scotland; and death records from the UK Registrar General.

Populations 17 874 Canadian patients and 11 502 British patients with multiple sclerosis.

Main outcome measure Diagnosis of multiple sclerosis.

Results In Canada (n = 17 874) significantly fewer patients with MS were born in November compared with controls from the population census and unaffected siblings. These observations were confirmed in a dataset of British patients (n = 11 502), in which there was also an increase in the number of births in May. A pooled analysis of datasets from Canada, Great Britain, Denmark, and Sweden (n = 42 045) showed that significantly fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. For recent incident data, the effect of month of birth was most evident in Scotland, where MS prevalence is the highest.

Conclusions Month of birth and risk of MS are associated, more so in familial cases, implying interactions between genes and environment that are related to climate. Such interactions may act during gestation or shortly after birth in individuals born in the northern countries studied.


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