极低出生体重儿的分娩与母亲患癌及死亡风险增加：一项长达16年随访的人群研究。

Delivery of a very low birth weight infant and increased maternal risk of cancer and death: a population study with 16 years of follow-up.

作者信息

Grisaru-Granovsky Sorina, Gordon Ethel Sherry, Haklai Ziona, Schimmel Michael S, Drukker Lior, Samueloff Arnon, Keinan-Boker Lital

机构信息

Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, 12 Bayit Street, 91031, Jerusalem, Israel.

Department of Health Information and Computer Services, Ministry of Health, Jerusalem, Israel.

出版信息

Cancer Causes Control. 2015 Nov;26(11):1593-601. doi: 10.1007/s10552-015-0653-x. Epub 2015 Aug 28.

DOI:10.1007/s10552-015-0653-x

PMID:26316180

Abstract

BACKGROUND

Pregnancy complications represent sentinel events for women's future health. We investigated whether delivery of a very low birth weight (VLBW) infant is associated with increased maternal risk for future incidence of maternal cancer and death.

METHODS

This is a population-based cohort study of linked Israeli Ministry of Health datasets between 1995 and 2011. Women delivering a live singleton <1,500 g infant (VLBW group) were compared with women delivering a live singleton, 3,000-3,500 g (control). The first pregnancy eligible for entry into the study, the "index pregnancy," reflected exposure status for each participant. Primary outcomes were maternal cancer and death. Cancer diagnoses were further classified by primary site. Cox regression models adjusted for follow-up period and maternal characteristics at index pregnancy: Age at delivery, ethnicity, years of education, marital status, and previous cancer afforded calculation of hazard ratios (HR) and 95% confidence intervals (CI).

FINDINGS

During the study period, 982,091 mothers with 2,243,736 live births were identified; of these, 13,773 births were VLBW eligible for inclusion in the study and 448,743 births were controls. Groups differed significantly by average follow-up and all maternal characteristics evaluated. Overall rate of cancers and death was significantly increased for VLBW women compared to controls: 18.4 versus 15.7% and 7.3 versus 3.2%, both p < 0.0001. The Cox model adjusted for maternal characteristics showed significantly increased risk of cancer (all sites) in the VLBW women: HR 1.18 (95% CI 1.02-1.37) and for death: HR 2.13 (95% CI 1.68-2.71), and an increased combined risk of both outcomes: HR 1.4 (95% CI 1.23-1.59).

INTERPRETATION

The delivery of a VLBW newborn is an independent lifetime risk factor for subsequent maternal cancers and death. These women may benefit from targeted cancer screening and counseling.

摘要

背景

妊娠并发症是女性未来健康的标志性事件。我们调查了极低出生体重（VLBW）婴儿的分娩是否与母亲未来患癌和死亡风险的增加有关。

方法

这是一项基于人群的队列研究，关联了1995年至2011年以色列卫生部的数据集。将分娩体重<1500g活产单胎婴儿的女性（VLBW组）与分娩体重3000 - 3500g活产单胎婴儿的女性（对照组）进行比较。符合纳入研究条件的首次妊娠，即“索引妊娠”，反映了每位参与者的暴露状态。主要结局是母亲患癌和死亡。癌症诊断进一步按原发部位分类。Cox回归模型对随访期和索引妊娠时的母亲特征进行了调整：分娩年龄、种族、受教育年限、婚姻状况以及既往癌症史，据此计算风险比（HR）和95%置信区间（CI）。

结果

在研究期间，共识别出982,091名母亲的2,243,736次活产；其中，13,773例分娩符合纳入VLBW研究的条件，448,743例分娩为对照组。两组在平均随访时间和所有评估的母亲特征方面存在显著差异。与对照组相比，VLBW组女性的总体癌症和死亡率显著升高：分别为18.4%对15.7%以及7.3%对3.2%，两者p<0.0001。经母亲特征调整的Cox模型显示，VLBW组女性患癌（所有部位）的风险显著增加：HR为1.18（95%CI 1.02 - 1.37），死亡风险：HR为2.13（95%CI 1.68 - 2.71），两种结局的综合风险增加：HR为1.4（95%CI 1.23 - 1.59）。