Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe S B, Koren G
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Arch Intern Med. 1992 Mar;152(3):573-6.
Cancer is the second leading cause of death of women during the reproductive years, and its occurrence in pregnancy is between 0.07% and 0.1%.
To analyze the effect of cancer on pregnancy, we compared 21 pregnancies occurring during 30 years in women who received chemotherapy for their cancer with a control group matched for maternal age and composed of women not exposed to known teratogens or reproductive risks during pregnancy.
Of 13 women exposed to chemotherapy during the first trimester, two of five whose pregnancies continued to term had major malformations in their infants, four had spontaneous abortions, and four had therapeutic abortions. Of four women with second-trimester exposure to chemotherapy, two had normal live births, one had a stillbirth, and one had a therapeutic abortion. All four pregnancies exposed to chemotherapy during the third trimester resulted in healthy live births. Infants exposed to chemotherapy had statistically significantly lower birth weights than their matched controls (2227 +/- 558 g vs 3519 +/- 272 g, P less than .001), due to both significantly lower gestational age and substantial intrauterine growth retardation (P less than .01). The trend for higher rate of stillbirth (1/11) agrees well with 10 stillbirths among all women with cancer in pregnancy without and with chemotherapy who gave birth (n = 223), when compared with the population of Ontario (P less than .0005).
This study confirms the increased likelihood of spontaneous abortions and major birth defects when chemotherapy is used during embryogenesis, whereas such a risk is not apparent beyond the first trimester. Because of the higher risk of stillbirth and intrauterine growth retardation, women with cancer should be monitored closely by a high-risk obstetric unit to define the optimal time of delivery.
癌症是育龄期女性的第二大死因，其在孕期的发生率为0.07%至0.1%。
为分析癌症对妊娠的影响，我们将30年间接受癌症化疗的女性所发生的21次妊娠与一个按母亲年龄匹配的对照组进行比较，该对照组由孕期未接触已知致畸物或生殖风险的女性组成。
在孕早期接触化疗的13名女性中，5名妊娠至足月的女性中有2名婴儿有严重畸形，4名自然流产，4名进行了治疗性流产。在孕中期接触化疗的4名女性中，2名正常活产，1名死产，1名进行了治疗性流产。在孕晚期接触化疗的所有4次妊娠均分娩出健康活婴。接触化疗的婴儿出生体重在统计学上显著低于其匹配的对照组（2227±558克对3519±272克，P<0.001），这是由于孕周显著缩短和严重的宫内生长受限（P<0.01）。死产率较高的趋势（1/11）与安大略省人群相比，在所有妊娠合并癌症且分娩的女性（无论是否接受化疗，n = 223）中有10例死产的情况相符（P<0.0005）。
本研究证实，在胚胎发育期间使用化疗时，自然流产和严重出生缺陷的可能性增加，而这种风险在孕早期之后并不明显。由于死产和宫内生长受限的风险较高，癌症女性应由高危产科单位密切监测，以确定最佳分娩时间。
