Department of Public Health Sciences, Queen's University, Kingston, ON; ICES, Kingston, ON.
ICES, Kingston, ON; Department of Surgery, Queen's University, Kingston, ON.
J Obstet Gynaecol Can. 2024 Oct;46(10):102638. doi: 10.1016/j.jogc.2024.102638. Epub 2024 Aug 21.
To evaluate the association between adolescent and young adult (AYA) breast cancer (BC) and the adverse pregnancy outcomes of preterm birth, small for gestational age birth, cesarean delivery, and preeclampsia, and the effect of fertility treatment on this association.
Population-based cohort study with universal coverage health data for Ontario, Canada. BC was identified from the Ontario Cancer Registry. All births >22 weeks gestation between April 2006 to March 2018 were included. Modified Poisson regression generated risk ratios between AYA BC and adverse pregnancy outcomes, adjusted for maternal characteristics. Models were stratified by fertility treatment.
Among 1 189 980 deliveries, 474 mothers had AYA BC history (exposed), while 1 189 506 had no cancer history (unexposed). AYA BC was associated with cesarean delivery (adjusted risk ratio [aRR] 1.26; 95% CI 1.14-1.39). There was no association between AYA BC and other adverse outcomes. Modelling cesarean delivery subtypes, AYA BC was associated with increased risk of planned (aRR 1.27; 95% CI 1.08-1.49) and unplanned cesarean delivery (aRR 1.41; 95% CI 1.20-1.66). An increased risk of cesarean delivery in exposed persisted among singleton pregnancies (aRR 1.27; 95% CI 1.15-1.41), but not in models stratified by mode of conception (fertility treatment: aRR 1.07; 95% CI 0.84-1.36; unassisted conception: aRR 1.30; 95% CI 1.16-1.46).
A history of AYA BC did not confer an elevated risk of adverse pregnancy outcomes, except for planned and unplanned cesarean delivery. The risk of adverse pregnancy outcomes does not appear to be an indication for delayed pregnancy after AYA BC diagnosis.
评估青少年和年轻成人（AYA）乳腺癌（BC）与早产、胎儿生长受限、剖宫产和子痫前期等不良妊娠结局的关联，并评估生育治疗对这种关联的影响。
这是一项基于人群的队列研究，使用加拿大安大略省的全民覆盖健康数据。BC 是从安大略癌症登记处确定的。纳入 2006 年 4 月至 2018 年 3 月期间妊娠 22 周以上的所有分娩。采用改良泊松回归分析 AYA BC 与不良妊娠结局之间的风险比，调整了产妇特征。模型按生育治疗进行分层。
在 1189980 例分娩中，474 例母亲有 AYA BC 病史（暴露组），1189506 例母亲无癌症病史（未暴露组）。AYA BC 与剖宫产相关（调整后的风险比[aRR]1.26；95%置信区间[CI]1.14-1.39）。AYA BC 与其他不良结局无关。对剖宫产亚型进行建模，AYA BC 与计划性剖宫产（aRR 1.27；95%CI 1.08-1.49）和非计划性剖宫产（aRR 1.41；95%CI 1.20-1.66）的风险增加相关。在单胎妊娠中，暴露组的剖宫产风险增加仍然存在（aRR 1.27；95%CI 1.15-1.41），但在按受孕方式分层的模型中（生育治疗：aRR 1.07；95%CI 0.84-1.36；未辅助受孕：aRR 1.30；95%CI 1.16-1.46）则不然。
AYA BC 病史并不会增加不良妊娠结局的风险，除了计划性和非计划性剖宫产。AYA BC 诊断后，不良妊娠结局的风险似乎不是延迟妊娠的指征。
