Farhana Sultana, Frawley Jane, Safi Nadom, Anazodo Antoinette, Mcgee Richard, Remond Marc, Sullivan Elizabeth
Department of Health, University of Technology Sydney, Sydney, New South Wales, Australia
University of Technology Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2025 Jun 9;15(6):e084717. doi: 10.1136/bmjopen-2024-084717.
The incidence of cancer diagnosed during pregnancy is increasing, but data relating to perinatal outcomes for infants exposed to systemic cancer treatment in utero remain limited. This systematic review and meta-analysis aimed to synthesise evidence from the available literature to investigate whether perinatal outcomes for babies born to women with gestational cancer differ based on whether they are exposed to systemic cancer treatment in utero.
A systematic review was conducted according to PRISMA-P guidelines. We extracted raw data from the eligible studies to calculate ORs and 95% CIs for perinatal outcomes reported in the included studies.
A comprehensive search of Medline, Embase, Cochrane Library and CINAHL databases identified studies published between January 2001 and May 2025.
Studies were eligible for inclusion in the review that reported on both a study group (women with gestational cancer who received systemic therapy during pregnancy) and a comparison group (women with gestational cancer who did not receive systemic therapy during pregnancy).
Two independent reviewers extracted data. Perinatal outcomes included spontaneous abortion, pregnancy termination, intrauterine growth restrictions (IUGR), stillbirth, intrauterine foetal death, neonatal mortality, preterm birth (<37 weeks), Apgar score at 5 min, small for gestational age (SGA), low birth weight, congenital anomalies, admission to neonatal intensive care (NICU) and long-term infant and child outcomes (cognitive skill and academic achievement) following systemic therapy. Raw data were extracted from the eligible studies to calculate ORs and 95% CIs for perinatal outcomes, and the ROBINS-I tool was used to assess bias.
Five cohort studies (a total of 416 women and 427 neonates exposed to systemic therapy in utero) met the inclusion criteria. Across these studies, a higher rate of preterm birth was consistently observed among exposed neonates compared with those unexposed, with reported ORs ranging from 1.85 to 24.00. Although effect sizes varied and CIs were wide, the overall trend suggests a potential association between in utero exposure to systemic therapy and increased risk of preterm birth. No significant differences were observed in the rates of spontaneous abortion, congenital anomalies, stillbirth, IUGR or SGA births between exposed and non-exposed babies.
Very few studies have compared outcomes of systemic therapy-exposed and non-exposed babies of women with gestational cancer. These studies are of limited quality. The available evidence suggests that while some studies indicate a possible association between systemic cancer therapy and increased risk of preterm birth, the overall findings should be interpreted cautiously given the small sample sizes, lack of adjusted analyses, and clinical heterogeneity among included studies. Further research is required to better understand the impact of systemic therapy exposure in utero on perinatal outcomes.
孕期诊断出癌症的发病率正在上升，但关于子宫内暴露于全身性癌症治疗的婴儿围产期结局的数据仍然有限。本系统评价和荟萃分析旨在综合现有文献中的证据，以调查患有妊娠期癌症的女性所生婴儿的围产期结局是否因在子宫内是否暴露于全身性癌症治疗而有所不同。
根据PRISMA-P指南进行系统评价。我们从符合条件的研究中提取原始数据，以计算纳入研究中报告的围产期结局的比值比（OR）和95%可信区间（CI）。
对Medline、Embase、Cochrane图书馆和CINAHL数据库进行全面检索，确定了2001年1月至2025年5月期间发表的研究。
报告了研究组（孕期接受全身治疗的妊娠期癌症女性）和对照组（孕期未接受全身治疗的妊娠期癌症女性）的研究有资格纳入本评价。
两名独立审阅者提取数据。围产期结局包括自然流产、终止妊娠、宫内生长受限（IUGR）、死产、宫内胎儿死亡、新生儿死亡率、早产（<37周）、5分钟时的阿氏评分、小于胎龄儿（SGA）、低出生体重、先天性异常、入住新生儿重症监护病房（NICU）以及全身治疗后婴儿和儿童的长期结局（认知技能和学业成绩）。从符合条件的研究中提取原始数据，以计算围产期结局的OR和95%CI，并使用ROBINS-I工具评估偏倚。
五项队列研究（共有416名女性和427名在子宫内暴露于全身治疗的新生儿）符合纳入标准。在这些研究中，与未暴露的新生儿相比，暴露的新生儿中早产率始终较高，报告的OR范围为1.85至24.00。尽管效应大小不同且可信区间较宽，但总体趋势表明子宫内暴露于全身治疗与早产风险增加之间可能存在关联。在暴露和未暴露的婴儿之间，自然流产、先天性异常、死产、IUGR或小于胎龄儿出生的发生率没有显著差异。
很少有研究比较妊娠期癌症女性中暴露于全身治疗和未暴露于全身治疗的婴儿的结局。这些研究质量有限。现有证据表明，虽然一些研究表明全身癌症治疗与早产风险增加之间可能存在关联，但鉴于样本量小、缺乏校正分析以及纳入研究之间的临床异质性，总体研究结果应谨慎解释。需要进一步研究以更好地了解子宫内暴露于全身治疗对围产期结局的影响。
