Sabeti Rad Zahra, Friberg Britt, Henic Emir, Rylander Lars, Ståhl Olof, Källén Bengt, Lingman Göran
Centre of Reproductive Medicine, Skåne University Hospital, Malmö, Sweden.
Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
J Obstet Gynaecol Can. 2016 Nov;38(11):1037-1044. doi: 10.1016/j.jogc.2016.07.001. Epub 2016 Aug 23.
To study the characteristics (except congenital malformations) of offspring born to women with a history of malignancy.
Data were obtained by linkage between four different Swedish national health registers. We compared the offspring born between 1994 and 2011 of women with a history of malignancy with all other infants. Survival of the infants was followed up through 2013. Adjusting for confounders was performed using Mantel-Haenszel methodology. We identified 7315 infants born to women with a history of a malignancy diagnosed at least 1 year before delivery. The total number of deliveries in Sweden in these years was 1 746 870, with 1 780 112 infants being born. We assessed rates of intrauterine death, preterm birth, low birth weight, and the nature of intrauterine growth. We also examined neonatal diagnoses (asphyxia, chronic respiratory condition, intracranial hemorrhage, jaundice, hypoglycemia, CNS symptoms) and infant death.
In women with a history of malignancy, we found no significantly increased risk for stillbirth or infant death. There were elevated rates of preterm birth (OR 1.50, 95% CI 1.37 to 1.64), very preterm birth (OR 1.89, 95% CI 1.54 to 2.32), and low birth weight (OR 1.50, 95% CI 1.34 to 1.68). There was a significantly increased risk of birth asphyxia, jaundice, hypoglycemia, and low Apgar score among infants born to women with a history of malignancy (OR 1.24, 95% CI 1.15 to 1.33), and this risk was maintained after excluding infants born after IVF.
We found an increased risk of preterm birth and low birth weight among infants of women with a history of malignancy, and as a result, found an increased risk of neonatal morbidity. No significant increase in risk of intrauterine or postnatal death was noted.
研究有恶性肿瘤病史的女性所生育后代（不包括先天性畸形）的特征。
通过链接瑞典四个不同的国家卫生登记系统获取数据。我们将1994年至2011年间有恶性肿瘤病史的女性所生育的后代与所有其他婴儿进行了比较。对婴儿的生存情况进行随访至2013年。使用Mantel-Haenszel方法对混杂因素进行了调整。我们确定了7315名由在分娩前至少1年被诊断为患有恶性肿瘤的女性所生育的婴儿。这些年瑞典的分娩总数为1746870例，出生婴儿1780112名。我们评估了宫内死亡、早产、低出生体重以及宫内生长情况。我们还检查了新生儿诊断（窒息、慢性呼吸疾病、颅内出血、黄疸、低血糖、中枢神经系统症状）和婴儿死亡情况。
在有恶性肿瘤病史的女性中，我们未发现死产或婴儿死亡风险显著增加。早产（比值比1.50，95%置信区间1.37至1.64）、极早产（比值比1.89，95%置信区间1.54至2.32）和低出生体重（比值比1.50，95%置信区间1.34至1.68）的发生率有所升高。有恶性肿瘤病史的女性所生育的婴儿中，出生窒息、黄疸、低血糖和阿氏评分低的风险显著增加（比值比1.24，95%置信区间1.15至1.33），并且在排除体外受精后出生的婴儿后，这种风险仍然存在。
我们发现有恶性肿瘤病史的女性所生育的婴儿早产和低出生体重风险增加，因此发现新生儿发病风险增加。未发现宫内或产后死亡风险显著增加。
