Department of Gynecologic Oncology and Reproductive Medicine, the Department of Breast Oncology, the Department of Health Services Research, and the Division of Cancer Prevention and Population Sciences, the University of Texas MD Anderson Cancer Center, and the University of Texas Health Science Center at Houston, Houston, Texas; the UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NewYork-Presbyterian/Columbia University Medical Center, and the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York; and the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Program, Massachusetts General Hospital, Boston, Massachusetts.
Obstet Gynecol. 2022 Dec 1;140(6):939-949. doi: 10.1097/AOG.0000000000004936. Epub 2022 Nov 2.
To evaluate obstetric and neonatal outcomes of the first live birth conceived 1 or more years after breast cancer diagnosis.
We performed a population-based study to compare live births between women with a history of breast cancer (case group) and matched women with no cancer history (control group). Individuals in the case and control groups were identified using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development data sets. Individuals in the case group were diagnosed with stage I-III breast cancer at age 18-45 years between January 1, 2000, and December 31, 2012, and conceived 12 or more months after breast cancer diagnosis. Individuals in the control group were covariate-matched women without a history of breast cancer who delivered during 2000-2012. The primary outcome was preterm birth at less than 37 weeks of gestation. Secondary outcomes were preterm birth at less than 32 weeks of gestation, small for gestational age (SGA), cesarean delivery, severe maternal morbidity, and neonatal morbidity. Subgroup analyses were used to assess the effect of time from initial treatment to fertilization and receipt of additional adjuvant therapy before pregnancy on outcomes of interest.
Of 30,021 women aged 18-45 years diagnosed with stage I-III breast cancer during 2000-2012, 553 met the study inclusion criteria. Those with a history of breast cancer and matched women in the control group had similar odds of preterm birth at less than 37 weeks of gestation (odds ratio [OR], 1.29; 95% CI 0.95-1.74), preterm birth at less than 32 weeks of gestation (OR 0.77; 95% CI 0.34-1.79), delivering an SGA neonate (less than the 5th percentile: OR 0.60; 95% CI 0.35-1.03; less than the 10th percentile: OR 0.94; 95% CI 0.68-1.30), and experiencing severe maternal morbidity (OR 1.61; 95% CI 0.74-3.50). Patients with a history of breast cancer had higher odds of undergoing cesarean delivery (OR 1.25; 95% CI 1.03-1.53); however, their offspring did not have increased odds of neonatal morbidity compared with women in the control group (OR 1.15; 95% CI 0.81-1.62).
Breast cancer 1 or more years before fertilization was not strongly associated with obstetric and neonatal complications.
评估乳腺癌诊断后 1 年或以上首次活产的母婴结局。
我们进行了一项基于人群的研究，比较了有乳腺癌病史（病例组）和无癌症病史的匹配女性（对照组）的活产儿。病例组和对照组的个体通过加利福尼亚癌症登记处和加利福尼亚州全州卫生规划和发展数据集的关联数据确定。病例组中的个体在 2000 年 1 月 1 日至 2012 年 12 月 31 日期间被诊断为 18-45 岁的 I-III 期乳腺癌，并在乳腺癌诊断后 12 个月或以上怀孕。对照组中的个体是在 2000-2012 年期间分娩且无乳腺癌病史的匹配女性。主要结局是早产，胎龄不足 37 周。次要结局是早产，胎龄不足 32 周，小于胎龄儿（SGA），剖宫产，严重产妇发病率和新生儿发病率。亚组分析用于评估从初始治疗到受精以及在怀孕前接受额外辅助治疗的时间对相关结局的影响。
在 2000-2012 年期间被诊断为 I-III 期乳腺癌的 30021 名 18-45 岁女性中，有 553 名符合研究纳入标准。患有乳腺癌的女性和对照组中的匹配女性在早产胎龄不足 37 周的几率相似（比值比[OR]，1.29；95%置信区间[CI]，0.95-1.74），早产胎龄不足 32 周（OR 0.77；95%CI 0.34-1.79），分娩 SGA 新生儿（第 5 百分位以下：OR 0.60；95%CI 0.35-1.03；第 10 百分位以下：OR 0.94；95%CI 0.68-1.30）和经历严重产妇发病率（OR 1.61；95%CI 0.74-3.50）。有乳腺癌病史的患者更有可能进行剖宫产（OR 1.25；95%CI 1.03-1.53）；然而，与对照组的女性相比，他们的后代并没有增加新生儿发病率的几率（OR 1.15；95%CI 0.81-1.62）。
乳腺癌在受精前 1 年或以上与产科和新生儿并发症并无强烈关联。
