Melin Johanna, Heinävaara Sirpa, Malila Nea, Tiitinen Aila, Gissler Mika, Madanat-Harjuoja Laura
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, the Departments of Obstetrics and Gynecology and Pediatrics, University of Helsinki and Helsinki University Hospital, and the National Institute for Health and Welfare, Helsinki, and the Department of Obstetrics and Gynecology, Kymenlaakso Central Hospital, Kotka, and the School of Health Sciences, University of Tampere, Tampere, Finland.
Obstet Gynecol. 2015 Oct;126(4):803-810. doi: 10.1097/AOG.0000000000001035.
To evaluate risk of adverse obstetric outcomes and operative deliveries in female cancer survivors (diagnosed younger than 35 years of age) compared with female siblings of survivors.
Nationwide cancer and birth registries were merged to identify 1,800 first postdiagnosis deliveries of female cancer survivors and 7,137 first deliveries of female siblings between January 1987 and December 2013. Multiple unconditional logistic regression models were used to estimate the risk for adverse obstetric outcomes and operative deliveries adjusting for maternal age, year of delivery, gestational age, and smoking.
We found a significantly elevated risk for induction of labor, 19.1% in survivors and 15.6% in siblings (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.35) and cesarean delivery, 23.6% in survivors and 18.6% in siblings (OR 1.15, 95% CI 1.01-1.31) among cancer survivors compared with female siblings. The risks of instrumental vaginal delivery, malpresentation, placental pathologies, and postpartum hemorrhage were not, however, elevated among cancer survivors. The highest risks of adverse obstetric outcomes were seen among women treated in their childhood (aged 0-14 years).
Cancer survivors have a small but statistically increased risk for induction of labor and cesarean delivery compared with siblings without a history of cancer. Our findings indicate that pregnancies in cancer survivors are typically uncomplicated and cancer survivors should not be discouraged to have children after their cancer is cured.
II.
评估与癌症幸存者的女性同胞相比，女性癌症幸存者（诊断时年龄小于35岁）发生不良产科结局及手术分娩的风险。
合并全国癌症登记处和出生登记处的数据，以确定1987年1月至2013年12月期间女性癌症幸存者1800例诊断后的首次分娩以及女性同胞7137例首次分娩情况。采用多个非条件逻辑回归模型，对产妇年龄、分娩年份、孕周和吸烟情况进行校正，以估计不良产科结局及手术分娩的风险。
我们发现，与女性同胞相比，癌症幸存者引产风险显著升高，幸存者为19.1%，同胞为15.6%（优势比[OR]为1.17，95%置信区间[CI]为1.02 - 1.35）；剖宫产风险也显著升高，幸存者为23.6%，同胞为18.6%（OR为1.15，95%CI为1.01 - 1.31）。然而，癌症幸存者器械助产、胎位异常、胎盘病变及产后出血的风险并未升高。不良产科结局风险最高的是儿童期（0 - 14岁）接受治疗的女性。
与无癌症病史的同胞相比，癌症幸存者引产和剖宫产的风险虽小但在统计学上有所增加。我们的研究结果表明，癌症幸存者的妊娠通常无并发症，不应因癌症病史而劝阻癌症幸存者在治愈后生育。
II级。
