Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.
Acta Obstet Gynecol Scand. 2024 Apr;103(4):695-706. doi: 10.1111/aogs.14654. Epub 2023 Aug 14.
Since malignancy during pregnancy is uncommon, information regarding contraception selection or sterilization at delivery is limited. The objective of this study was to examine the type of long-acting reversible contraception or surgical sterilization procedure chosen by pregnant patients with malignancy at delivery.
This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample in the USA. The study population was vaginal and cesarean deliveries in a hospital setting from January 2017 to December 2020. Pregnant patients with breast cancer (n = 1605), leukemia (n = 1190), lymphoma (n = 1120), thyroid cancer (n = 715), cervical cancer (n = 425) and melanoma (n = 400) were compared with 14 265 319 pregnant patients without malignancy. The main outcome measures were utilization of long-acting reversible contraception (subdermal implant or intrauterine device) and performance of permanent surgical sterilization (bilateral tubal ligation or bilateral salpingectomy) during the index hospital admission for delivery, assessed with a multinomial regression model controlling for clinical, pregnancy and delivery characteristics.
When compared with pregnant patients without malignancy, pregnant patients with breast cancer were more likely to proceed with bilateral salpingectomy (adjusted odds ratio [aOR] 2.30) or intrauterine device (aOR 1.91); none received the subdermal implant. Pregnant patients with leukemia were more likely to choose a subdermal implant (aOR 2.22), whereas those with lymphoma were more likely to proceed with bilateral salpingectomy (aOR 1.93) and bilateral tubal ligation (aOR 1.76). Pregnant patients with thyroid cancer were more likely to proceed with bilateral tubal ligation (aOR 2.21) and none received the subdermal implant. No patients in the cervical cancer group selected long-acting reversible contraception, and they were more likely to proceed with bilateral salpingectomy (aOR 2.08). None in the melanoma group chose long-acting reversible contraception. Among pregnant patients aged <30, the odds of proceeding with bilateral salpingectomy were increased in patients with breast cancer (aOR 3.01), cervical cancer (aOR 2.26) or lymphoma (aOR 2.08). The odds of proceeding with bilateral tubal ligation in pregnant patients aged <30 with melanoma (aOR 5.36) was also increased.
The results of this nationwide assessment in the United States suggest that among pregnant patients with malignancy, the preferred contraceptive option or method of sterilization at time of hospital delivery differs by malignancy type.
由于怀孕期间的恶性肿瘤并不常见，因此关于避孕方法选择或分娩时绝育的信息有限。本研究的目的是检查在分娩时患有恶性肿瘤的孕妇选择的长效可逆避孕方法或手术绝育方法的类型。
这是一项在美国进行的回顾性队列研究，使用了美国医疗保健成本和利用项目的全国住院患者样本。研究人群为 2017 年 1 月至 2020 年 12 月在医院进行的阴道分娩和剖宫产。与 14265319 名无恶性肿瘤的孕妇相比，比较了患有乳腺癌（n=1605）、白血病（n=1190）、淋巴瘤（n=1120）、甲状腺癌（n=715）、宫颈癌（n=425）和黑色素瘤（n=400）的孕妇。主要结局指标是在分娩时的指数住院期间使用长效可逆避孕方法（皮下埋植或宫内节育器）和进行永久性手术绝育（双侧输卵管结扎或双侧输卵管切除术），采用多变量回归模型控制临床、妊娠和分娩特征。
与无恶性肿瘤的孕妇相比，患有乳腺癌的孕妇更有可能选择双侧输卵管切除术（调整后的优势比[aOR]2.30）或宫内节育器（aOR1.91）；没有人选择皮下埋植。患有白血病的孕妇更有可能选择皮下埋植（aOR2.22），而患有淋巴瘤的孕妇更有可能选择双侧输卵管切除术（aOR1.93）和双侧输卵管结扎（aOR1.76）。患有甲状腺癌的孕妇更有可能选择双侧输卵管结扎（aOR2.21），没有人选择皮下埋植。宫颈癌组的患者均未选择长效可逆避孕方法，且更有可能选择双侧输卵管切除术（aOR2.08）。黑色素瘤组的患者均未选择长效可逆避孕方法。在年龄<30 岁的孕妇中，患有乳腺癌（aOR3.01）、宫颈癌（aOR2.26）或淋巴瘤（aOR2.08）的孕妇行双侧输卵管切除术的可能性增加。年龄<30 岁且患有黑色素瘤的孕妇行双侧输卵管结扎术的可能性也增加（aOR5.36）。
这项在美国进行的全国性评估结果表明，在患有恶性肿瘤的孕妇中，在医院分娩时，避孕方法的选择或绝育方法因恶性肿瘤类型而异。
