Mueller Beth A, Chow Eric J, Kamineni Aruna, Daling Janet R, Fraser Alison, Wiggins Charles L, Mineau Geraldine P, Hamre Merlin R, Severson Richard K, Drews-Botsch Carolyn
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Arch Pediatr Adolesc Med. 2009 Oct;163(10):879-86. doi: 10.1001/archpediatrics.2009.112.
To compare birth outcomes among female survivors of childhood and adolescent cancer who subsequently bear children, relative to those of women without a history of cancer.
Retrospective cohort study.
Four US regions.
Cancer registries identified girls younger than 20 years who were diagnosed as having cancer from 1973 through 2000. Linked birth records identified the first live births after diagnosis (n = 1898). Comparison subjects were selected from birth records (n = 14 278). Survivors of genital tract carcinomas underwent separate analysis.
Cancer diagnosis at younger than 20 years.
Infant low birth weight, preterm delivery, sex ratio, malformations, mortality, and delivery method, and maternal diabetes, anemia, and preeclampsia.
Infants born to childhood cancer survivors were more likely to be preterm (relative risk [RR], 1.54; 95% confidence interval [CI], 1.30-1.83) and to weigh less than 2500 g (1.31; 1.10-1.57). For the offspring of genital tract carcinoma survivors, RRs were 1.33 (95% CI, 1.13-1.56) and 1.29 (1.10-1.53), respectively. There were no increased risks of malformations, infant death, or altered sex ratio, suggesting no increased germ cell mutagenicity. In exploratory analysis, bone cancer survivors had an increased risk of diabetes (RR, 4.92; 95% CI, 1.60-15.13), and anemia was more common among brain tumor survivors (3.05; 1.16-7.98) and childhood cancer survivors whose initial treatment was chemotherapy only (2.45; 1.16-5.17).
Infants born to female survivors of childhood and adolescent cancer were not at increased risk of malformations or death. Increased occurrence of preterm delivery and low birth weight suggest that close monitoring is warranted. Increased diabetes and anemia among subgroups have not been reported, suggesting areas for study.
比较童年期和青春期癌症女性幸存者生育子女后的出生结局与无癌症病史女性的出生结局。
回顾性队列研究。
美国四个地区。
癌症登记处识别出1973年至2000年期间被诊断患有癌症的20岁以下女孩。关联的出生记录识别出诊断后的首次活产（n = 1898）。对照对象从出生记录中选取（n = 14278）。生殖道癌幸存者进行单独分析。
20岁之前的癌症诊断。
婴儿低出生体重、早产、性别比、畸形、死亡率和分娩方式，以及母亲患糖尿病、贫血和先兆子痫的情况。
童年癌症幸存者所生婴儿更易早产（相对风险[RR]，1.54；95%置信区间[CI]，1.30 - 1.83）且体重低于2500克（1.31；1.10 - 1.57）。对于生殖道癌幸存者的后代，RR分别为1.33（95%CI，1.13 - 1.56）和1.29（1.10 - 1.53）。畸形、婴儿死亡或性别比改变的风险未增加，表明生殖细胞致突变性未增加。在探索性分析中，骨癌幸存者患糖尿病的风险增加（RR，4.92；95%CI，1.60 - 15.13），贫血在脑肿瘤幸存者（3.05；1.16 - 7.98）以及仅接受化疗作为初始治疗的童年癌症幸存者中更常见（2.45；1.16 - 5.17）。
童年期和青春期癌症女性幸存者所生婴儿出现畸形或死亡的风险未增加。早产和低出生体重发生率增加表明有必要进行密切监测。亚组中糖尿病和贫血增加的情况此前未被报道，提示有待研究的领域。
