Health Insurance Review and Assessment Service, Seoul, South Korea.
Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
JAMA Intern Med. 2020 Jan 1;180(1):54-61. doi: 10.1001/jamainternmed.2019.4644.
Current guidelines recommend that women delay pregnancy for 6 to 12 months after the receipt of radioactive iodine treatment (RAIT) following thyroidectomy for differentiated thyroid carcinoma. Although concerns exist regarding the risks associated with pregnancy after RAIT, no large-scale study, to date, has investigated the association between RAIT and pregnancy outcomes.
To investigate whether RAIT was associated with increases in adverse pregnancy outcomes among South Korean women who received RAIT after thyroidectomy for thyroid cancer and to evaluate the appropriate interval between RAIT and conception.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used the Health Insurance Review and Assessment database of South Korea to identify a total of 111 459 women of childbearing age (20-49 years) who underwent thyroidectomy for the treatment of differentiated thyroid carcinoma between January 1, 2008, and December 31, 2015. Participants were allocated to 2 cohorts: those who underwent surgery alone (n = 59 483 [53.4%]) and those who underwent surgery followed by RAIT (n = 51 976 [46.6%]). The pregnancy outcomes data were collected from January 1, 2008, to December 31, 2017.
The rates of abortion (both spontaneous and induced), preterm delivery, and congenital malformation were assessed. Multivariate logistic regression models were used to control for confounding variables.
Among the 111 459 women of childbearing age who underwent thyroidectomy with or without RAIT for the treatment of thyroid cancer, the mean (SD) age at surgery or RAIT was 39.8 (6.7) years. Of those, 10 842 women (9.7%) became pregnant, and the mean (SD) age at conception was 33.3 (4.4) years. The rates of abortion, preterm delivery, and congenital malformation among patients who underwent surgery alone compared with patients who underwent surgery followed by RAIT were 30.7% vs 32.1% for abortion, 12.8% vs 12.9% for preterm delivery, and 8.9% vs 9.0% for congenital malformation, respectively (P > .05). A subgroup analysis based on the interval between RAIT and conception indicated congenital malformation rates of 13.3% for the interval of 0 to 5 months, 7.9% for 6 to 11 months, 8.3% for 12 to 23 months, and 9.6% for 24 months or more. The adjusted odds ratio of congenital malformation was 1.74 (95% CI, 1.01-2.97; P = .04) in conceptions that occurred 0 to 5 months after RAIT compared with conceptions that occurred 12 to 23 months after RAIT. The abortion rates based on the interval between RAIT and conception were 60.6% for the interval of 0 to 5 months, 30.1% for 6 to 11 months, 27.4% for 12 to 23 months, and 31.9% for 24 months or more.
These large-scale real-world data indicate that receipt of RAIT before pregnancy does not appear to be associated with increases in adverse pregnancy outcomes when conception occurs 6 months or more after treatment.
目前的指南建议，在甲状腺癌手术后接受放射性碘治疗（RAIT）后，女性应延迟 6 至 12 个月怀孕。尽管人们对 RAIT 后怀孕相关的风险存在担忧，但迄今为止，尚无大型研究调查 RAIT 与妊娠结局之间的关系。
调查在韩国女性中，甲状腺癌手术后接受 RAIT 是否与不良妊娠结局增加相关，并评估 RAIT 与受孕之间的合适间隔。
设计、地点和参与者：本基于人群的队列研究使用韩国健康保险审查和评估数据库，共纳入 111459 名 20 至 49 岁行甲状腺切除术治疗分化型甲状腺癌的育龄妇女（2008 年 1 月 1 日至 2015 年 12 月 31 日）。参与者被分配到 2 个队列：单纯手术组（n=59483 [53.4%]）和手术加 RAIT 组（n=51976 [46.6%]）。从 2008 年 1 月 1 日至 2017 年 12 月 31 日收集妊娠结局数据。
评估流产（自然流产和人工流产）、早产和先天性畸形的发生率。使用多变量逻辑回归模型控制混杂变量。
在 111459 名接受甲状腺切除术（有或无 RAIT）治疗甲状腺癌的育龄妇女中，手术或 RAIT 时的平均（SD）年龄为 39.8（6.7）岁。其中 10842 名妇女（9.7%）怀孕，受孕时的平均（SD）年龄为 33.3（4.4）岁。单纯手术组与手术加 RAIT 组相比，流产、早产和先天性畸形的发生率分别为 30.7%比 32.1%、12.8%比 12.9%、8.9%比 9.0%（P>.05）。基于 RAIT 与受孕间隔的亚组分析显示，受孕间隔为 0 至 5 个月的先天性畸形发生率为 13.3%，6 至 11 个月为 7.9%，12 至 23 个月为 8.3%，24 个月或以上为 9.6%。与受孕间隔 12 至 23 个月相比，受孕间隔 0 至 5 个月的先天性畸形调整后的比值比为 1.74（95%CI，1.01-2.97；P=.04）。基于 RAIT 与受孕间隔的流产率分别为 0 至 5 个月间隔 60.6%，6 至 11 个月间隔 30.1%，12 至 23 个月间隔 27.4%，24 个月或以上间隔 31.9%。
这些大规模的真实世界数据表明，在治疗后 6 个月或更长时间受孕时，RAIT 前接受治疗似乎不会增加不良妊娠结局的风险。
