儿童癌症女性幸存者的妊娠和分娩并发症：英国儿童癌症幸存者研究
Pregnancy and Labor Complications in Female Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study.
作者信息
Reulen Raoul C, Bright Chloe J, Winter David L, Fidler Miranda M, Wong Kwok, Guha Joyeeta, Kelly Julie S, Frobisher Clare, Edgar Angela B, Skinner Roderick, Wallace W Hamish B, Hawkins Mike M
机构信息
Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK.
Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK.
出版信息
J Natl Cancer Inst. 2017 Nov 1;109(11). doi: 10.1093/jnci/djx056.
BACKGROUND
Female survivors of childhood cancer treated with abdominal radiotherapy who manage to conceive are at risk of delivering premature and low-birthweight offspring, but little is known about whether abdominal radiotherapy may also be associated with additional complications during pregnancy and labor. We investigated the risk of developing pregnancy and labor complications among female survivors of childhood cancer in the British Childhood Cancer Survivor Study (BCCSS).
METHODS
Pregnancy and labor complications were identified by linking the BCCSS cohort (n = 17 980) to the Hospital Episode Statistics (HES) for England. Relative risks (RRs) of pregnancy and labor complications were calculated by site of radiotherapy treatment (none/abdominal/cranial/other) and other cancer-related factors using log-binomial regression. All statistical tests were two-sided.
RESULTS
A total of 2783 singleton pregnancies among 1712 female survivors of childhood cancer were identified in HES. Wilms tumor survivors treated with abdominal radiotherapy were at threefold risk of hypertension complicating pregnancy (relative risk = 3.29, 95% confidence interval [CI] = 2.29 to 4.71), while all survivors treated with abdominal radiotherapy were at risk of gestational diabetes mellitus (RR = 3.35, 95% CI = 1.41 to 7.93) and anemia complicating pregnancy (RR = 2.10, 95% CI = 1.27 to 3.46) compared with survivors treated without radiotherapy. Survivors treated without radiotherapy had similar risks of pregnancy and labor complications as the general population, except survivors were more likely to opt for an elective cesarean section (RR = 1.39, 95% CI = 1.16 to 1.70).
CONCLUSIONS
Treatment with abdominal radiotherapy increases the risk of developing hypertension complicating pregnancy in Wilms tumor survivors, and diabetes mellitus and anemia complicating pregnancy in all survivors. These patients may require extra vigilance during pregnancy.
背景
接受腹部放疗的儿童癌症女性幸存者成功受孕后，有早产和分娩低体重儿的风险，但对于腹部放疗是否也与妊娠和分娩期间的其他并发症有关，人们知之甚少。我们在英国儿童癌症幸存者研究（BCCSS）中调查了儿童癌症女性幸存者发生妊娠和分娩并发症的风险。
方法
通过将BCCSS队列（n = 17980）与英格兰医院事件统计（HES）相链接，确定妊娠和分娩并发症。使用对数二项回归，根据放疗部位（无/腹部/颅脑/其他）和其他癌症相关因素计算妊娠和分娩并发症的相对风险（RRs）。所有统计检验均为双侧检验。
结果
在HES中，共识别出1712名儿童癌症女性幸存者的2783例单胎妊娠。接受腹部放疗的肾母细胞瘤幸存者发生妊娠合并高血压的风险是未接受放疗者的三倍（相对风险 = 3.29，95%置信区间[CI] = 2.29至4.71），而与未接受放疗的幸存者相比，所有接受腹部放疗的幸存者均有发生妊娠期糖尿病（RR = 3.35，95%CI = 1.41至7.93）和妊娠合并贫血（RR = 2.10，95%CI = 1.27至3.46）的风险。未接受放疗的幸存者发生妊娠和分娩并发症的风险与普通人群相似，但这些幸存者更有可能选择择期剖宫产（RR = 1.39，95%CI = 1.16至1.70）。
结论
腹部放疗会增加肾母细胞瘤幸存者发生妊娠合并高血压的风险，以及所有幸存者发生妊娠期糖尿病和妊娠合并贫血的风险。这些患者在妊娠期间可能需要格外警惕。
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