Stillbirth, early death and neonatal morbidity among offspring of female cancer survivors.
Stillbirth, early death and neonatal morbidity among offspring of female cancer survivors.
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DOI：
10.3109/0284186x.2012.758870
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发表时间：
2013-08
期刊：
影响因子：
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通讯作者：
Malila N
中科院分区：
文献类型：
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作者：
Madanat-Harjuoja LM;Lähteenmäki PM;Dyba T;Gissler M;Boice JD Jr;Malila N
人们对癌症治疗副作用的认识不断提高，促使人们为越来越多希望自己生孩子的癌症幸存者开发出保留生育能力的方案。我们进行了一项基于登记的研究，以评估女性癌症幸存者(确诊时为0-34岁)的子女与女性兄弟姐妹的子女相比，死产、早期死亡和新生儿发病率的风险。共有3501名女性癌症患者和16,908名女性兄弟姐妹的孩子分别与国家医疗出生和死因登记有关。与兄弟姐妹相比，癌症幸存者的后代死产或早期死亡的风险没有显著增加：早期新生儿死亡的风险(OR)为1.35，即第一周内死亡，其95%可信区间(CI)为0.58-3.18，28天内为1.40，95%可信区间为0.46-4.24，第一年内为1.11，调整主要解释变量后，95%可信区间为0.64-1.93。在对孕期进行进一步调整后，所有这些风险估计值都降为1。在幸存者的子女中，新生儿严重发病率的指标没有显著增加。然而，癌症幸存者子女对新生儿病情的监测显著增加(OR 1.56，95%CI 1.35~1.80)，即使在校正孕期后仍持续存在，这可能与双亲癌症及其治疗或儿童监测增加有关。癌症幸存者的后代更有可能需要在新生儿重症监护病房进行监测或护理，但在对早产进行调整后，过早死亡或死产的风险并未增加。由于所研究的死亡结果很罕见，合作研究可能有助于排除癌症幸存者后代风险增加的可能性。
Increased awareness of the adverse effects of cancer treatments has prompted the development of fertility preserving regimens for the growing population of cancer survivors who desire to have children of their own. We conducted a registry-based study to evaluate the risk of stillbirth, early death and neonatal morbidity among children of female cancer survivors (0–34 years at diagnosis) compared with children of female siblings. A total of 3,501 and 16,908 children of female cancer patients and siblings, respectively, were linked to the national medical birth and cause-of-death registers. The risk of stillbirth or early death was not significantly increased among offspring of cancer survivors as compared to offspring of siblings: the risk (Odds Ratio (OR) of early neonatal death, i.e. mortality within the first week was 1.35, with a 95% confidence interval (CI) of 0.58–3.18, within 28 days 1.40, 95% CI 0.46–4.24 and within the first year of life 1.11, 95% CI 0.64–1.93 after adjustment for the main explanatory variables. All these risk estimates were reduced towards one after further adjustment for duration of pregnancy. Measures of serious neonatal morbidity were not significantly increased among the children of survivors. However, there was a significant increase in the monitoring of children of cancer survivors for neonatal conditions (OR 1.56, 95% CI 1.35–1.80), which persisted even after correcting for duration of pregnancy, that might be related to parental cancer and its treatment or increased surveillance among the children. Offspring of cancer survivors were more likely to require monitoring or care in a neonatal intensive care unit, but the risk of early death or stillbirth was not increased after adjustment for prematurity. Due to the rarity of the mortality outcomes studied, collaborative studies may be helpful in ruling out the possibility of an increased risk among offspring of cancer survivors.