Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Acta Obstet Gynecol Scand. 2019 Dec;98(12):1603-1611. doi: 10.1111/aogs.13690. Epub 2019 Aug 29.
Cancer treatment during childhood may lead to late adverse effects, such as reduced musculoskeletal development or vascular, endocrine and pulmonary dysfunction, which in turn may have an adverse effect on later pregnancy and childbirth. The aim of the present study was to investigate pregnancy and obstetric outcomes as well as the offspring's health among childhood and adolescent female cancer survivors.
This register-based study included all women born between 1973 and 1977 diagnosed with cancer in childhood or adolescence (age <21), as well as an age-matched comparison group. A total of 278 female cancer survivors with their first childbirth were included in the study, together with 829 age-matched individuals from the general population. Logistic regression and analysis of variance were used to investigate associations between having been treated for cancer and the outcome variables, adjusting for maternal age, nicotine use and comorbidity.
Survivors were more likely to have preeclampsia (adjusted odds ratio [aOR] 3.46, 95% confidence interval [CI] 1.58 to 7.56), undergo induction of labor (aOR 1.66, 95% CI 1.05 to 2.62), suffer labor dystocia (primary labor dystocia aOR 3.54, 95% CI 1.51 to 8.34 and secondary labor dystocia aOR 2.43, 95% CI 1.37 to 4.31), malpresentation of fetus (aOR 2.02, 95% CI 1.12 to 3.65) and imminent fetal asphyxia (aOR 2.55, 95% CI 1.49 to 4.39). In addition, deliveries among survivors were more likely to end with vacuum extraction (aOR 2.53, 95% CI 1.44 to 4.47), with higher risk of clitoral lacerations (aOR 2.18, 95% CI 1.47 to 3.23) and anal sphincter injury (aOR 2.76, 95% CI 1.14 to 6.70) and emergency cesarean section (aOR 2.34 95% CI 1.39 to 3.95). Survivors used pain-reliving methods to a higher extent compared with the comparison group. There was no increased risk of neonate diagnoses and malformations. The results showed that survivors who had been diagnosed with cancer when they were younger than 14 had an increased risk of adverse obstetric outcomes.
The study demonstrates increased risk of pregnancy and childbirth complications among childhood and adolescent cancer survivors. There is a need to optimize perinatal care, especially among survivors who were younger than 14 at time of diagnosis.
儿童期癌症治疗可能导致晚期不良影响，例如肌肉骨骼发育不良或血管、内分泌和肺功能障碍，这反过来又可能对以后的怀孕和分娩产生不利影响。本研究的目的是调查儿童和青少年期女性癌症幸存者的妊娠和产科结局以及后代的健康状况。
本基于登记的研究纳入了所有 1973 年至 1977 年期间出生的女性，她们在儿童期或青春期（<21 岁）被诊断患有癌症，并与年龄匹配的对照组进行比较。共有 278 名接受过癌症治疗的女性癌症幸存者及其首次分娩被纳入研究，共有 829 名来自普通人群的年龄匹配个体。使用逻辑回归和方差分析来研究患有癌症与结局变量之间的关联，同时调整了母亲年龄、尼古丁使用和合并症。
幸存者更有可能患有先兆子痫（调整后的优势比 [aOR] 3.46，95%置信区间 [CI] 1.58 至 7.56）、接受引产（aOR 1.66，95%CI 1.05 至 2.62）、分娩困难（原发性分娩困难 aOR 3.54，95%CI 1.51 至 8.34 和继发性分娩困难 aOR 2.43，95%CI 1.37 至 4.31）、胎儿胎位不正（aOR 2.02，95%CI 1.12 至 3.65）和胎儿窒息（aOR 2.55，95%CI 1.49 至 4.39）。此外，幸存者的分娩更有可能以真空抽吸结束（aOR 2.53，95%CI 1.44 至 4.47），更容易出现阴蒂裂伤（aOR 2.18，95%CI 1.47 至 3.23）和肛门括约肌损伤（aOR 2.76，95%CI 1.14 至 6.70）和紧急剖宫产（aOR 2.34，95%CI 1.39 至 3.95）。幸存者比对照组更倾向于使用缓解疼痛的方法。新生儿诊断和畸形的风险没有增加。结果表明，14 岁以下被诊断患有癌症的幸存者发生不良产科结局的风险增加。
本研究表明儿童和青少年期癌症幸存者的妊娠和分娩并发症风险增加。需要优化围产期护理，特别是在诊断时年龄小于 14 岁的幸存者中。
