Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Houston, TX, USA.
Center for Health Promotion and Prevention Research, Houston, TX, USA.
J Natl Cancer Inst. 2022 Dec 8;114(12):1674-1680. doi: 10.1093/jnci/djac168.
Gonadotoxic effects of cancer treatment may increase risk of adverse birth outcomes in adolescent and young adult (AYA, aged 15-39 years) women diagnosed with cancer. We estimated risk of stillbirth (fetal death of gestational age ≥20 weeks or weighing ≥350 grams) in a population-based sample of AYA women.
AYA women diagnosed with cancer between January 1, 1995, and December 31, 2015, were identified using the Texas Cancer Registry and linked to live birth and fetal death certificates through December 31, 2016. Among AYA women, cumulative incidence of stillbirth was estimated by gestational age, and Poisson regression models identified factors associated with stillbirth. Standardized fetal mortality ratios (SMR) compared the observed fetal mortality rate in AYA women with the expected fetal mortality rate in the general population.
A total of 11 628 live births and 68 stillbirths occurred to 8402 AYA women after diagnosis. Cumulative incidence of stillbirth in AYA women was 0.70% (95% confidence interval [CI] = 0.51% to 0.96%) at 40 weeks of gestation. Risk of stillbirth was higher among Hispanic (risk ratio [RR] = 2.64, 95% CI = 1.29 to 5.41) and non-Hispanic Black (RR = 4.13, 95% CI = 1.68 to 10.16) women compared with non-Hispanic White women; there was no association with receipt of chemotherapy or time since diagnosis. Age- and race and ethnicity-adjusted fetal mortality rate in AYA women was similar to the general population (SMR = 0.99, 95% CI = 0.77 to 1.26).
AYA women may be counseled that overall risk of stillbirth is low, and for most, cancer does not appear to confer additional risk.
癌症治疗的性腺毒性作用可能会增加青少年和年轻成年（AYA，年龄 15-39 岁）女性癌症患者不良出生结局的风险。我们估计了在基于人群的 AYA 女性样本中死胎（胎龄≥20 周或体重≥350 克的胎儿死亡）的风险。
使用德克萨斯癌症登记处确定了 1995 年 1 月 1 日至 2015 年 12 月 31 日期间被诊断患有癌症的 AYA 女性，并通过 2016 年 12 月 31 日与活产和胎儿死亡证书相关联。在 AYA 女性中，通过胎龄估计死胎的累积发生率，并使用泊松回归模型确定与死胎相关的因素。标准化胎儿死亡率比（SMR）将 AYA 女性的观察到的胎儿死亡率与一般人群的预期胎儿死亡率进行比较。
在被诊断后的 8402 名 AYA 女性中，共有 11628 例活产和 68 例死胎。AYA 女性在 40 周时死胎的累积发生率为 0.70%（95%置信区间[CI] = 0.51%至 0.96%）。与非西班牙裔白人女性相比，西班牙裔（风险比[RR] = 2.64，95%CI = 1.29 至 5.41）和非西班牙裔黑人（RR = 4.13，95%CI = 1.68 至 10.16）女性的死胎风险更高；与接受化疗或诊断后时间无关。调整年龄、种族和族裔后，AYA 女性的胎儿死亡率与一般人群相似（SMR = 0.99，95%CI = 0.77 至 1.26）。
AYA 女性可能会得到这样的建议，即总体死胎风险较低，而且对于大多数女性而言，癌症似乎不会带来额外的风险。
