Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
ICES, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Can J Diabetes. 2024 Apr;48(3):171-178.e1. doi: 10.1016/j.jcjd.2023.12.007. Epub 2023 Dec 30.
Diabetes is associated with an increased risk of several cancers, including postmenopausal breast cancer. The evidence for higher breast cancer risk after diabetes in pregnancy is conflicting. We compared the incidence of breast and other cancers between pregnant women with and without diabetes.
This work was a propensity-matched, retrospective cohort study using population-based health-care databases from Ontario, Canada. Those deliveries with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pregestational DM) were identified and matched to deliveries without diabetes mellitus (non-DM). Deliveries from each diabetes cohort were matched 1:2 on age, parity, year of delivery, and propensity score to non-DM deliveries. Matched subjects were followed from delivery for incidence of breast cancer as a primary outcome, and other site-specific cancers as secondary outcomes. We performed Cox proportional hazards regression to compare rates of breast cancer between matched groups.
Over a median of 8 (interquartile range 4 to 13) years of follow-up, compared with non-DM deliveries, the incidence of breast cancer was significantly lower for GDM but similar for pregestational DM deliveries (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82 to 0.98; and HR 0.92, 95% CI 0.80 to 1.07, respectively). GDM was associated with a significantly higher incidence of pancreatic and hepatocellular cancer, and pregestational DM was associated with a higher incidence of thyroid, hepatocellular, and endometrial cancers.
Diabetes in pregnancy does not have a higher short-term risk of subsequent breast cancer, but there may be a higher incidence of other cancers.
糖尿病与多种癌症（包括绝经后乳腺癌）的风险增加相关。妊娠期糖尿病与较高乳腺癌风险之间的证据存在矛盾。我们比较了患有和未患有糖尿病的孕妇的乳腺癌和其他癌症的发病率。
这是一项基于人群的回顾性队列研究，使用了加拿大安大略省的基于人群的医疗保健数据库。确定了患有妊娠糖尿病（GDM）和孕前糖尿病（pregestational DM）的分娩，并与无糖尿病（非 DM）的分娩相匹配。每个糖尿病队列的分娩与非 DM 分娩按年龄、产次、分娩年份和倾向得分进行 1:2 匹配。对匹配的受试者从分娩开始进行随访，以乳腺癌作为主要结局，以其他部位特异性癌症作为次要结局。我们使用 Cox 比例风险回归比较了匹配组之间乳腺癌的发生率。
在中位数为 8 年（四分位距为 4 至 13 年）的随访期间，与非 DM 分娩相比，GDM 的乳腺癌发病率显著降低，但 pregestational DM 分娩的乳腺癌发病率相似（风险比 [HR] 0.90，95%置信区间 [CI] 0.82 至 0.98；和 HR 0.92，95%CI 0.80 至 1.07）。GDM 与胰腺癌和肝细胞癌的发病率显著升高相关，而 pregestational DM 与甲状腺癌、肝细胞癌和子宫内膜癌的发病率升高相关。
妊娠糖尿病短期内并不会增加乳腺癌的风险，但可能会增加其他癌症的发病率。
