Birth Outcomes Among Adolescent and Young Adult Cancer Survivors
Birth Outcomes Among Adolescent and Young Adult Cancer Survivors
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DOI：
10.1001/jamaoncol.2017.0029
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发表时间：
2017-08-01
期刊：
影响因子：
28.4
通讯作者：
Nichols, Hazel B.
中科院分区：
文献类型：
--
作者：
Anderson, Chelsea;Engel, Stephanie M.;Nichols, Hazel B.
癌症诊断和治疗可能对女性癌症幸存者的生殖结果产生不利影响。目的比较青少年和年轻成年癌症幸存者（AYA[诊断年龄15-39岁]）与未诊断癌症的女性的出生结局。设计、环境和参与者：北卡罗莱纳州中央癌症登记处（CCR）用于识别2000年1月至2013年12月诊断的女性AYA癌症幸存者；CCR记录与2000年1月至2014年12月的全州出生证明文件相关联，以确定AYA幸存者的诊断后活产（n = 2598）。从出生证明文件（n = 12990）中随机选择无癌症诊断记录的分娩妇女作为比较队列，其频率与产妇年龄和分娩年份相匹配。主要结局和测量方法早产、低出生体重、小胎龄出生、剖宫产和低Apgar评分的发生率。结果：总共纳入了2598名AYA癌症幸存者的分娩（平均[SD]母亲年龄，31岁）。与1299名对照队列相比，AYA癌症幸存者的出生明显增加了早产（患病率比[PR]， 1.52; 95% CI, 1.34-1.71）、低出生体重（PR, 1.59; 95% CI, 1.38-1.83）和剖宫产（PR, 1.08; 95% CI, 1.01-1.14）的患病率。这些结果的较高流行率主要集中在怀孕期间诊断的妇女的分娩中。与早产和低出生体重相关的其他因素包括接受化疗和诊断为乳腺癌、非霍奇金淋巴瘤或妇科癌症。小胎龄儿和低阿普加评分(
IMPORTANCE Cancer diagnosis and treatment may adversely affect reproductive outcomes among female cancer survivors.OBJECTIVE To compare the birth outcomes of adolescent and young adult cancer survivors (AYA [diagnosed at ages 15-39 years]) with those of women without a cancer diagnosis.DESIGN, SETTING, AND PARTICIPANTS The North Carolina Central Cancer Registry (CCR) was used to identify female AYA cancer survivors diagnosed from January 2000 to December 2013; CCR records were linked to statewide birth certificate files from January 2000 to December 2014 to identify postdiagnosis live births to AYA survivors (n = 2598). A comparison cohort of births to women without a recorded cancer diagnosis was randomly selected from birth certificate files (n = 12 990) with frequency matching on maternal age and year of delivery.MAIN OUTCOMES AND MEASURES Prevalence of preterm birth, low birth weight, small-for-gestational-age births, cesarean delivery, and low Apgar score.RESULTS Overall, 2598 births to AYA cancer survivors (mean [SD] maternal age, 31 [5] years) were included. Births to AYA cancer survivors had a significantly increased prevalence of preterm birth (prevalence ratio [PR], 1.52; 95% CI, 1.34-1.71), low birth weight (PR, 1.59; 95% CI, 1.38-1.83), and cesarean delivery (PR, 1.08; 95% CI, 1.01-1.14) relative to the comparison cohort of 1299. The higher prevalence of these outcomes was most concentrated among births to women diagnosed during pregnancy. Other factors associated with preterm birth and low birth weight included treatment with chemotherapy and a diagnosis of breast cancer, non-Hodgkin lymphoma, or gynecologic cancers. The prevalence of small-for-gestational-age births and low Apgar score (