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NOCs are carcinogenic in animal systems. However, the relationship between nitrosatable drug exposure in pregnancy and childhood cancer risk remains inconclusive. Using the Taiwan Maternal and Child Health Database (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u20092,090,806), we conducted a population\u2010based cohort study of mother\u2013child pairs with children born 2004\u20132015, to investigate the link between exposure to nitrosatable drugs in pregnancy and childhood cancer risk among offspring. Prescriptions of nitrosatable drugs were obtained from the National Health Insurance Program, and cancer cases were ascertained through linkage to the Cancer Registry. Cox proportional hazards regression models were applied to estimate both crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Among 3203 cancer cases, nitrosatable drug exposure was associated with higher risks of neuroblastoma (aHR\u2009=\u20091.27, 95% CI: 0.95\u20131.73) and hepatoblastoma (aHR\u2009=\u20091.49, 95% CI: 0.97\u20132.28). Neuroblastoma (aHR\u2009=\u20091.32, 95% CI: 0.96\u20131.82) and osteosarcoma (aHR\u2009=\u20092.05, 95% CI: 1.07\u20133.89) were most strongly associated with amides, while the risk of hepatoblastoma was highest among offspring of tertiary amine users (aHR\u2009=\u20091.57, 95% CI: 1.00\u20132.46), compared to other functional groups. Some results may need to be interpreted with caution due to the wide confidence intervals. Our findings highlight the need for future research into the biological mechanisms between NOCs and childhood cancer.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70240","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T04:04:30Z","timestamp":1762574670000},"page":"2092-2101","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to nitrosatable drugs during pregnancy and childhood cancer: A cohort study in Taiwan"],"prefix":"10.1002","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7069-4237","authenticated-orcid":false,"given":"Chuanjie","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health University of California, Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya\u2010Hui","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anupong","family":"Sirirungreung","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health University of California, Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenia Yupei","family":"Chock","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeyan","family":"Liew","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences Yale School of Public Health  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beate","family":"Ritz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health University of California, Los Angeles  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7813-0823","authenticated-orcid":false,"given":"Pei\u2010Chen","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8713-8413","authenticated-orcid":false,"given":"Julia E.","family":"Heck","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health University of California, Los Angeles  Los Angeles California USA"},{"name":"College of Health and Public Service University of North Texas  Denton Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010022\u201004442\u20103"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102022\u2010067585"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2981"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34744"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000759"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmaa042"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20808"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mrrev.2006.09.003"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114513003462"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753\u20104887.1998.tb01721.x"},{"key":"e_1_2_11_12_1","first-page":"1","article-title":"IARC monographs on the evaluation of carcinogenic risks to humans. 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