背景:随着癌症发病率和生存率的增加,孕产妇癌症的患病率及其对不良分娩结局的影响对产前护理和肿瘤学管理非常重要.然而,不同类型癌症在不同妊娠阶段的影响尚未得到广泛报道。
目的:描述妊娠相关癌症(妊娠期间和妊娠后一年)的流行病学特征,并评估不良分娩结局与母体癌症之间的关系。
方法:在983,162名儿童中,母亲的癌症史,包括孕前癌症,妊娠相关癌症和随后的癌症,使用健康信息网络在16475例病例中确定。采用泊松分布计算妊娠相关癌症的发病率和95%置信区间(CI)。使用多级对数二项模型估计不良出生结局与母体癌症之间的关联的调整风险比(RRadj)和95CI。
结果:共有38,295个后代出生在有癌症史的母亲身上。其中,2,583(6.75%)暴露于妊娠相关癌症,30,706(80.18%)随后被诊断为癌症,和5006(13.07%)暴露于孕前癌症。妊娠相关癌症的发病率为2.63/1000妊娠(95CI:2.53-2.73‰),甲状腺癌(1.15‰),乳房(0.25‰),女性生殖器官(0.23‰)是最常见的癌症类型。早产和低出生体重的风险增加与妊娠中期和中期诊断的癌症显着相关。而出生缺陷风险增加(RRadj=1.48,95CI:1.08-2.04)与妊娠早期诊断的癌症相关。早产风险增加(RRadj=1.16,95CI:1.02-1.32),低出生体重(RRadj=1.24,95CI:1.07-1.44),在甲状腺癌幸存者中观察到出生缺陷(RRadj=1.22,95CI:1.10-1.35).
结论:对于妊娠中期和晚期诊断为癌症的妇女,应仔细监测胎儿的生长情况。确保及时分娩并平衡新生儿健康和癌症治疗的益处。甲状腺癌幸存者中甲状腺癌的发病率较高,不良分娩结局的风险增加,这表明定期监测甲状腺功能和调节甲状腺激素水平对于维持妊娠和促进妊娠前和妊娠期间甲状腺癌幸存者的胎儿发育很重要。
With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and oncology management. However, the effects of different types of cancer at different gestational stages have not been widely reported.
This study aimed to describe the epidemiologic characteristics of pregnancy-associated cancers (during and 1 year after pregnancy) and evaluate the association between adverse birth outcomes and maternal cancers.
Of 983,162 cases, a history of maternal cancer, including pregestational cancer, pregnancy-associated cancer, and subsequent cancer, was identified in 16,475 cases using a health information network. The incidence and 95% confidence interval of pregnancy-associated cancer were calculated with the Poisson distribution. The adjusted risk ratio with 95% confidence interval of the association between adverse birth outcomes and maternal cancer were estimated using the multilevel log-binomial model.
A total of 38,295 offspring were born to mothers with a cancer history. Of these, 2583 (6.75%) were exposed to pregnancy-associated cancer, 30,706 (80.18%) had a subsequent cancer diagnosis, and 5006 (13.07%) were exposed to pregestational cancer. The incidence of pregnancy-associated cancer was 2.63 per 1000 pregnancies (95% confidence interval, 2.53‰-2.73‰), with cancer of the thyroid (1.15‰), breast (0.25‰), and female reproductive organs (0.23‰) being the most common cancer types. The increased risks of preterm birth and low birthweight were significantly associated with cancer diagnosed during the second and third trimester of pregnancy, whereas increased risks of birth defects (adjusted risk ratio, 1.48; 95% confidence interval, 1.08-2.04) were associated with cancer diagnosed in the first trimester. Increased risks of preterm birth (adjusted risk ratio, 1.16; 95% confidence interval, 1.02-1.32), low birthweight (adjusted risk ratio, 1.24; 95% confidence interval, 1.07-1.44), and birth defects (adjusted risk ratio, 1.22; 95% confidence interval, 1.10-1.35) were observed in thyroid cancer survivors.
Careful monitoring of fetal growth should be implemented for women diagnosed with cancer in the second and third trimester to ensure timely delivery and balance the benefits of neonatal health and cancer treatment. The higher incidence of thyroid cancer and increased risk of adverse birth outcomes among thyroid cancer survivors suggested that the regular thyroid function monitoring and regulation of thyroid hormone levels are important in maintaining pregnancy and promoting fetal development among thyroid cancer survivors before and during pregnancy.