Sekiguchi Masaki, Miyoshi Yoko, Kikuchi Norihiko, Sago Haruhiko
Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.
Pediatr Int. 2018 Mar;60(3):254-258. doi: 10.1111/ped.13483. Epub 2018 Feb 12.
The aim of this study was to investigate the outcomes of pregnancy in female childhood cancer survivors (CCS) in Japan, to encourage greater attention to the reproductive health of CCS.
This was a retrospective nationwide questionnaire survey of delivery at ≥22 weeks of gestation in CCS at perinatal centers registered with the Japanese Perinatologists Association between 2010 and 2014. We evaluated the maternal characteristics, pregnancy and neonatal outcomes and the relationship between cancer treatment and these outcomes.
The total number of CCS was 61, and the total number of deliveries was 71, corresponding to 0.019% of total deliveries. Regarding cancer, 46% of the patients had had leukemia. Epilepsy was seen in seven (11%). Mean gestational age at delivery was 37.9 weeks. The rate of preterm delivery was 24%. Mean birthweight was 2,718 g. There were three congenital anomalies (4.2%). The rate of preterm delivery was higher and mean birthweight lower in the women treated with radiotherapy than in those without radiotherapy (42% vs 16%, P = 0.025; 2,436 ± 737 g vs 2,827 ± 483 g, P = 0.010). The adjusted OR of radiotherapy for preterm deliveries was 3.53 (P = 0.049).
Although the number of deliveries by CCS was low in Japan, the pregnancy outcomes were favorable. The important points for managing pregnancy in CCS were preterm delivery as an obstetric complication, especially in CCS who had been treated with radiotherapy, and epilepsy as a maternal complication, which may be related to previously received treatment.
本研究旨在调查日本儿童癌症幸存者（CCS）的妊娠结局，以促使人们更加关注CCS的生殖健康。
这是一项对2010年至2014年间在日本围产医学会注册的围产中心的CCS进行的回顾性全国问卷调查，调查对象为妊娠≥22周的分娩情况。我们评估了母亲的特征、妊娠和新生儿结局以及癌症治疗与这些结局之间的关系。
CCS总数为61例，分娩总数为71例，占分娩总数的0.019%。关于癌症，46%的患者患有白血病。7例（11%）出现癫痫。分娩时的平均孕周为37.9周。早产率为24%。平均出生体重为2718克。有3例先天性异常（4.2%）。接受放疗的女性早产率高于未接受放疗的女性，平均出生体重低于未接受放疗的女性（42%对16%，P = 0.025；2436±737克对2827±483克，P = 0.010）。放疗导致早产的校正比值比为3.53（P = 0.049）。
虽然日本CCS的分娩数量较少，但妊娠结局良好。管理CCS妊娠的要点是将早产作为产科并发症，尤其是接受过放疗的CCS，以及将癫痫作为母亲并发症，这可能与之前接受的治疗有关。
