妊娠期诊断出母亲癌症后的儿科结局。

Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy.

机构信息

From the Department of Gynecologic Oncology, University Hospitals Leuven and Department of Oncology, Katholieke Universiteit Leuven (F.A., T.V., M.V., S.H.), Departments of Cardiology (J.-U. V.), Pediatrics (G.N., L.V., L.L.), and Obstetrics (K.V.C.), University Hospitals Leuven, and the Department of Growth and Regeneration (G.N., L.L., K.V.C.) and the Faculty of Psychology and Educational Sciences (L.C.), Katholieke Universiteit Leuven, Leuven, and the Department of Obstetrics, Cliniques Universitaires St. Luc, Brussels (M.M.G.) - all in Belgium; Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Università degli Studi di Milano (M.F.) and Fertility and Reproduction Unit, European Institute of Oncology (F.P.) - both in Milan; the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic (M.J.H., L.R.); the Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam (I.B.), Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A., C.L.), and the Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht (P.W.) - all in the Netherlands; the Departments of Physics, Nuclear Physics, and Medical Physics, University of Oxford, Oxford, United Kingdom (F.V.H.); and the Department of Cardiology, Hospital for Sick Children, University of Toronto, Toronto (L.M.).

出版信息

N Engl J Med. 2015 Nov 5;373(19):1824-34. doi: 10.1056/NEJMoa1508913. Epub 2015 Sep 28.

DOI:10.1056/NEJMoa1508913

PMID:26415085

Abstract

BACKGROUND

Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking.

METHODS

In this multicenter case-control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months.

RESULTS

A total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P=0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P=0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings.

CONCLUSIONS

Prenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment. (Funded by Research Foundation-Flanders and others; ClinicalTrials.gov number, NCT00330447.).

摘要

背景

缺乏关于在妊娠期间母亲患有癌症且接受或未接受治疗的儿童的长期预后数据。

方法

在这项多中心病例对照研究中，我们比较了母亲在妊娠期间被诊断患有癌症的儿童与未被诊断患有癌症的妇女的儿童相匹配的儿童。我们使用健康问卷和医疗档案收集有关新生儿和一般健康的数据。所有儿童均在 18 个月、36 个月或两者时进行前瞻性评估（通过神经检查和贝利婴幼儿发育量表进行）。在 36 个月时进行心脏评估。

结果

共有 129 名儿童（中位数年龄为 22 个月；范围为 12 至 42 个月）被纳入母亲患有癌症（产前暴露组）的组中，对照组中有相应数量的儿童。在妊娠期间，96 名儿童（74.4％）接受了化疗（单独或联合其他治疗），11 名（8.5％）接受了放疗（单独或联合），13 名（10.1％）接受了手术治疗，2 名（1.6％）接受了其他药物治疗，14 名（10.9％）未接受治疗。在产前暴露组的 127 名儿童中，有 28 名（22.0％）的出生体重低于第 10 百分位，在对照组的 125 名儿童中，有 19 名（15.2％）的出生体重低于第 10 百分位（P=0.16）。根据贝利评分，两组在认知发育方面没有显著差异（P=0.08），也没有在亚组分析中发现差异。两组的胎龄与认知结局相关。在 47 名 36 个月大的儿童中进行的心脏评估显示心脏正常。