School of Public Health, University College Cork, Cork, Ireland.
INFANT Research Centre, University College Cork, Cork, Ireland.
BJOG. 2023 Mar;130(4):336-347. doi: 10.1111/1471-0528.17347. Epub 2022 Dec 12.
The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years.
Synthesise published literature on the relationship between HL and maternal and perinatal outcomes.
Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand-searching reference lists.
Two reviewers independently reviewed titles, abstracts and full-text articles. Published studies containing original data were eligible.
Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta-analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9-3.1, and aOR 1.84, 95% CI 0.81-4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65-1.51, and aOR 6.74, 95% CI 0.52-88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55-1.10, and aOR 0.38, 95% CI 0.05-2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05-1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97-21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%-80% vs 4%, 95% CI 4%-5%, respectively). The GRADE certainty of findings ranged from low to very low.
Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.
霍奇金淋巴瘤（HL）的初始发病高峰发生在生育期。
综合已发表的文献，探讨 HL 与母婴围生期结局的关系。
系统检索 PubMed/Medline、Cochrane 图书馆、Scopus、Embase 和 Science Direct 自成立至 2022 年 6 月的文献，补充手检参考文献列表。
两位评审员独立筛选标题、摘要和全文文章。有原始数据的已发表研究符合入选标准。
两位评审员独立提取数据并评估研究质量。分别比较了有既往/现患 HL 诊断的孕妇和从未诊断过 HL 的孕妇的结局。如果数据允许，进行优势比和比例的荟萃分析。使用推荐评估、制定与评估（GRADE）框架确定证据确定性。
在 5527 项研究中，有 33 项符合纳入标准。在妊娠前和妊娠期间有 HL 的组中，先天性畸形的调整比值比无统计学意义（aOR 1.7，95%CI 0.9-3.1 和 aOR 1.84，95%CI 0.81-4.15），早产（PTB）（aOR 0.99，95%CI 0.65-1.51 和 aOR 6.74，95%CI 0.52-88.03）和流产（aOR 0.78，95%CI 0.55-1.10 和 aOR 0.38，95%CI 0.05-2.72）。除了妊娠期间有 HL 的组中输血（aOR 1.38，95%CI 1.05-1.82）和静脉血栓栓塞（VTE）（aOR 7.93，95%CI 2.97-21.22）外，其他结局的 aOR 均无统计学意义。该组的贫血比例也增加（69%，95%CI 57%-80% vs 4%，95%CI 4%-5%）。研究结果的 GRADE 确定性从低到极低。
与一般孕妇人群相比，有既往/现患 HL 诊断的妇女大多数不良妊娠结局的发生率没有显著增加。在妊娠期间诊断出 HL 的妇女可能有更高的 PTB 率，并且更有可能发生 VTE、贫血和输血；然而，研究数量较少且 GRADE 确定性低到极低，无法得出明确的结论。
