Walters Ben, Midwinter India, Chew-Graham Carolyn A, Jordan Kelvin P, Sharma Garima, Chappell Lucy C, Crosbie Emma J, Parwani Purvi, Mamas Mamas A, Wu Pensée
Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom.
School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom.
Mayo Clin Proc Innov Qual Outcomes. 2024 Mar 16;8(2):188-199. doi: 10.1016/j.mayocpiqo.2024.02.002. eCollection 2024 Apr.
This study aimed to systematically evaluate and quantify the risk of adverse maternal and neonatal outcomes in patients with pregnancy-associated cancer (PAC). This study was conducted from February 13, 2021, through July 24, 2023. A systematic search of MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials was conducted to identify studies reporting outcomes for patients with PAC. The study was registered on PROSPERO. Two reviewers independently conducted screening, data extraction, and quality assessment. The associations were quantified using random-effects meta-analysis. The initial search produced 29,401 titles and abstracts, after which 147 unique full-text articles were screened, of which 22 articles with 59,190 pregnancies with PAC from 70,097,167 births were included in the meta-analysis. Women with PAC were at significantly increased risk of cesarean deliveries (risk ratio [RR], 1.58; 95% CI, 1.31-1.89), preterm birth (RR, 3.07; 95% CI, 2.37-3.98), venous thromboembolism (RR, 6.76; 95% CI, 5.08-8.99), and maternal death (RR, 41.58; 95% CI, 20.38-84.83). The only outcome with reduced risk was instrumental mode of delivery (RR, 0.67; 95% CI, 0.52-0.87). Pregnancy-associated cancer increases risk of adverse outcomes, including a 7-fold risk of venous thromboembolism and a 42-fold risk of maternal death. Further research is required to better understand the mechanisms leading to these adverse outcomes, especially for women who are not diagnosed until the postpartum period. Affected women should have counseling regarding their increased risk of adverse outcomes.
本研究旨在系统评估和量化妊娠相关癌症（PAC）患者发生不良孕产妇和新生儿结局的风险。本研究于2021年2月13日至2023年7月24日进行。对MEDLINE、Embase、科学引文索引核心合集、Cochrane系统评价数据库和Cochrane对照试验中心注册库进行了系统检索，以识别报告PAC患者结局的研究。该研究已在国际前瞻性系统评价注册库（PROSPERO）登记。两名评价者独立进行筛选、数据提取和质量评估。采用随机效应荟萃分析对关联进行量化。初步检索产生了29401个标题和摘要，之后筛选了147篇独特的全文文章，其中22篇文章包含来自70097167例分娩中的59190例PAC妊娠，被纳入荟萃分析。PAC女性剖宫产（风险比[RR]，1.58；95%可信区间[CI]，1.31 - 1.89）、早产（RR，3.07；95%CI，2.37 - 3.98）、静脉血栓栓塞（RR，6.76；95%CI，5.08 - 8.99）和孕产妇死亡（RR，41.58；95%CI，20.38 - 84.83）的风险显著增加。唯一风险降低的结局是器械助产（RR，0.67；95%CI，0.52 - 0.87）。妊娠相关癌症会增加不良结局的风险，包括静脉血栓栓塞风险增加7倍和孕产妇死亡风险增加42倍。需要进一步研究以更好地了解导致这些不良结局的机制，特别是对于产后才被诊断的女性。应向受影响的女性提供关于其不良结局风险增加的咨询。
