Department of Epidemiology, University of North Carolina, Chapel Hill.
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill.
JAMA Oncol. 2017 Aug 1;3(8):1078-1084. doi: 10.1001/jamaoncol.2017.0029.
Cancer diagnosis and treatment may adversely affect reproductive outcomes among female cancer survivors.
To compare the birth outcomes of adolescent and young adult cancer survivors (AYA [diagnosed at ages 15-39 years]) with those of women without a cancer diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: The North Carolina Central Cancer Registry (CCR) was used to identify female AYA cancer survivors diagnosed from January 2000 to December 2013; CCR records were linked to statewide birth certificate files from January 2000 to December 2014 to identify postdiagnosis live births to AYA survivors (n = 2598). A comparison cohort of births to women without a recorded cancer diagnosis was randomly selected from birth certificate files (n = 12 990) with frequency matching on maternal age and year of delivery.
Prevalence of preterm birth, low birth weight, small-for-gestational-age births, cesarean delivery, and low Apgar score.
Overall, 2598 births to AYA cancer survivors (mean [SD] maternal age, 31 [5] years) were included. Births to AYA cancer survivors had a significantly increased prevalence of preterm birth (prevalence ratio [PR], 1.52; 95% CI, 1.34-1.71), low birth weight (PR, 1.59; 95% CI, 1.38-1.83), and cesarean delivery (PR, 1.08; 95% CI, 1.01-1.14) relative to the comparison cohort of 1299. The higher prevalence of these outcomes was most concentrated among births to women diagnosed during pregnancy. Other factors associated with preterm birth and low birth weight included treatment with chemotherapy and a diagnosis of breast cancer, non-Hodgkin lymphoma, or gynecologic cancers. The prevalence of small-for-gestational-age births and low Apgar score (<7) did not differ significantly between groups.
Live births to AYA cancer survivors may have an increased risk of preterm birth and low birth weight, suggesting that additional surveillance of pregnancies in this population is warranted. Our findings may inform the reproductive counseling of female AYA cancer survivors.
癌症诊断和治疗可能会对女性癌症幸存者的生殖结果产生不利影响。
比较青少年和年轻成年癌症幸存者（诊断年龄为 15-39 岁）与无癌症诊断女性的生育结局。
设计、地点和参与者：北卡罗来纳州中央癌症登记处（CCR）用于确定 2000 年 1 月至 2013 年 12 月诊断为女性青少年和年轻成年癌症幸存者的病例；CCR 记录与 2000 年 1 月至 2014 年 12 月全州出生证明文件相关联，以确定癌症幸存者的产后活产（n=2598）。从出生证明文件中随机选择具有匹配母亲年龄和分娩年份的无记录癌症诊断的分娩作为对照组（n=12990）。
早产、低出生体重、小于胎龄儿、剖宫产和低 Apgar 评分的发生率。
共纳入 2598 例青少年和年轻成年癌症幸存者的分娩（母亲年龄[标准差]为 31[5]岁）。与对照组（12990 例）相比，青少年和年轻成年癌症幸存者的早产（患病率比[PR]，1.52；95%CI，1.34-1.71）、低出生体重（PR，1.59；95%CI，1.38-1.83）和剖宫产（PR，1.08；95%CI，1.01-1.14）的发生率显著增加。这些结果的较高发生率主要集中在妊娠期间诊断的女性分娩中。其他与早产和低出生体重相关的因素包括化疗治疗和乳腺癌、非霍奇金淋巴瘤或妇科癌症的诊断。小于胎龄儿和低 Apgar 评分（<7）的发生率在组间无显著差异。
青少年和年轻成年癌症幸存者的活产可能有早产和低出生体重的风险增加，这表明需要对该人群的妊娠进行额外监测。我们的研究结果可能为女性青少年和年轻成年癌症幸存者的生殖咨询提供信息。
