妊娠剧吐与后代癌症风险：一项斯堪的纳维亚基于登记的巢式病例对照研究。
Hyperemesis gravidarum and risk of cancer in offspring, a Scandinavian registry-based nested case-control study.
机构信息
Department of Genes and Environment, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, PO box 4950, Nydalen, Oslo, Norway.
出版信息
BMC Cancer. 2015 May 13;15:398. doi: 10.1186/s12885-015-1425-4.
BACKGROUND
Hyperemesis gravidarum is a serious condition affecting 0.8-2.3% of pregnant women and can be regarded as a restricted period of famine. Research concerning potential long-term consequences of the condition for the offspring, is limited, but lack of nutrition in-utero has been associated with chronic disease in adulthood, including some cancers. There is growing evidence that several forms of cancer may originate during fetal life. We conducted a large study linking the high-quality population-based medical birth- and cancer registries in Norway, Sweden and Denmark, to explore whether hyperemesis is associated with increased cancer risk in offspring.
METHODS
A registry-based nested case-control study. Twelve types of childhood cancer were selected; leukemia, lymphoma, cancer of the central nervous system, testis, bone, ovary, breast, adrenal and thyroid gland, nephroblastoma, hepatoblastoma and retinoblastoma. Conditional logistic regression models were applied to study associations between hyperemesis and risk of childhood cancer, both all types combined and separately. Cancer types with five or more exposed cases were stratified by age at diagnosis. All analysis were adjusted for maternal age, ethnicity and smoking, in addition to the offspring's Apgar score, placental weight and birth weight. Relative risks with 95% confidence intervals were calculated.
RESULTS
In total 14,805 cases and approximately ten controls matched on time, country of birth, sex and year of birth per case (147,709) were identified. None of the cancer types, analyzed combined or separately, revealed significant association with hyperemesis. When stratified according to age at diagnosis, we observed a RR 2.13 for lymphoma among adolescents aged 11-20 years ((95% CI 1.14-3.99), after adjustment for maternal ethnicity and maternal age, RR 2.08 (95% CI 1.11-3.90)). The finding was not apparent when a stricter level of statistical significance was applied.
CONCLUSIONS
The main finding of this paper is that hyperemesis does not seem to increase cancer risk in offspring. The positive association to lymphoma may be by chance and needs confirmation.
背景
妊娠剧吐是一种严重的病症，影响了 0.8-2.3%的孕妇，可被视为一段限制时期的饥荒。对于该病症对后代的潜在长期后果的研究有限，但子宫内缺乏营养与成年后慢性疾病有关，包括某些癌症。越来越多的证据表明，某些类型的癌症可能起源于胎儿期。我们进行了一项大型研究，将挪威、瑞典和丹麦高质量的基于人群的出生和癌症登记处联系起来，以探讨妊娠剧吐是否与后代癌症风险增加有关。
方法
一项基于登记的巢式病例对照研究。选择了 12 种儿童癌症；白血病、淋巴瘤、中枢神经系统癌症、睾丸、骨、卵巢、乳房、肾上腺和甲状腺癌、肾母细胞瘤、肝母细胞瘤和视网膜母细胞瘤。应用条件逻辑回归模型研究了妊娠剧吐与儿童癌症风险之间的关系，包括所有类型的癌症以及分别研究。对于诊断时年龄为 5 岁或以上的癌症类型，按年龄分层。所有分析均调整了母亲年龄、种族和吸烟情况，以及子女的阿普加评分、胎盘重量和出生体重。计算了相对风险及其 95%置信区间。
结果
共确定了 14805 例病例和大约 10 例对照，按时间、出生地、性别和病例出生年份匹配（147709 例）。分析时并未发现任何癌症类型（包括综合分析和分别分析）与妊娠剧吐有显著关联。按诊断时年龄分层，我们观察到青少年（11-20 岁）的淋巴瘤风险为 2.13（95%CI 1.14-3.99），在调整母亲种族和母亲年龄后，风险为 2.08（95%CI 1.11-3.90）。当应用更严格的统计学显著性水平时，该发现并不明显。
结论
本文的主要发现是妊娠剧吐似乎不会增加后代的癌症风险。与淋巴瘤的阳性关联可能是偶然的，需要进一步证实。
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