Bannister-Tyrrell Melanie, Roberts Christine L, Hasovits Csilla, Nippita Tanya, Ford Jane B
Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2015 Apr;55(2):116-22. doi: 10.1111/ajo.12279. Epub 2014 Oct 28.
There is controversy about the interaction between melanoma and pregnancy. There is a lack of Australian data on pregnancy outcomes associated with melanoma in pregnancy, despite Australia having the highest incidence of melanoma in the world.
Describe trends, maternal characteristics and pregnancy outcomes associated with pregnancy-associated melanoma in New South Wales.
Population-based cohort study of all births (n = 1 309 501) of at least 20-week gestation or 400 g birthweight in New South Wales, 1994-2008. Logistic regression was used to analyse the association between melanoma in pregnancy and adverse birth outcomes.
577 pregnancy-associated melanomas were identified, including 195 diagnosed during pregnancy and 382 diagnosed within 12 months postpartum. The crude incidence of pregnancy-associated melanoma increased from 37.1 per 100 000 maternities in 1994 to 51.84 per 100 000 maternities in 2008. Adjusting for maternal age accounted for the trend in pregnancy-associated melanoma. Melanomas diagnosed in pregnancy were thicker (median = 0.75 mm) than melanomas diagnosed postpartum (median = 0.60 mm) (P = 0.002). Pregnancy-associated melanoma was associated with the increased risk of large-for-gestational-age infant but not preterm birth, planned birth, caesarean section or stillbirth. Parity was inversely associated with pregnancy-associated melanoma, as women with three or more previous pregnancies had 0.59 times the odds of pregnancy-associated melanoma compared to nulliparous women (95% CI 0.42-0.84, P = 0.003).
The incidence of pregnancy-associated melanoma has increased with increasing maternal age. The observation of thicker melanomas in pregnancy and increased risk of large-for-gestational-age infants may suggest a role for growth-related pregnancy factors in pregnancy-associated melanoma.
黑色素瘤与妊娠之间的相互作用存在争议。尽管澳大利亚是世界上黑色素瘤发病率最高的国家，但缺乏关于妊娠合并黑色素瘤的妊娠结局的澳大利亚数据。
描述新南威尔士州妊娠相关黑色素瘤的趋势、产妇特征和妊娠结局。
对1994 - 2008年新南威尔士州所有妊娠至少20周或出生体重至少400克的分娩（n = 1309501例）进行基于人群的队列研究。采用逻辑回归分析妊娠合并黑色素瘤与不良分娩结局之间的关联。
共识别出577例妊娠相关黑色素瘤，其中195例在孕期诊断，382例在产后12个月内诊断。妊娠相关黑色素瘤的粗发病率从1994年的每10万例产妇37.1例增至2008年的每10万例产妇51.84例。调整产妇年龄后，妊娠相关黑色素瘤的趋势得以解释。孕期诊断的黑色素瘤比产后诊断的黑色素瘤更厚（中位数分别为0.75毫米和0.60毫米）（P = 0.002）。妊娠相关黑色素瘤与大于胎龄儿风险增加相关，但与早产、计划分娩、剖宫产或死产无关。产次与妊娠相关黑色素瘤呈负相关，因为有三次或更多次既往妊娠的女性发生妊娠相关黑色素瘤的几率是未生育女性的0.59倍（95%可信区间0.42 - 0.84，P = 0.003）。
妊娠相关黑色素瘤的发病率随产妇年龄增加而上升。孕期黑色素瘤更厚以及大于胎龄儿风险增加的观察结果可能提示与生长相关的妊娠因素在妊娠相关黑色素瘤中起作用。
