Maternal comorbidities, prescription drug use in pregnancy and childhood cancer

描述（由申请人提供）：近年来，人们越来越认识到产妇保健和子宫环境对儿童后期健康的重要性。许多妇女在怀孕期间经历了慢性或急性健康问题，一些研究将某些疾病与儿童癌症风险增加联系起来。产妇保健可能进一步涉及使用药物治疗先前存在的疾病或产前期间出现的疾病。孕妇摄入己烯雌酚（DES）会导致后代癌症，这是公认的事实，然而对于大多数药物来说，孕期安全性的证据有限。本研究的目的是检查常见的孕产妇健康状况和怀孕期间处方药的使用与儿童后期癌症发展的关系。具体目标：(1)建立丹麦所有儿童癌症（1977-2012）的关联数据库，其中包括孕产妇合并症和药物使用信息。(2)检查产妇合并症与儿童癌症的关系。(3)探讨孕产妇孕期处方药使用与儿童期癌症的关系。设计和方法：一项使用丹麦国家登记处的国家病例对照研究，使用丹麦现有儿童癌症研究的数据（n=537,000）。产妇合并症信息可从丹麦国家患者登记册（1977-2012）获得，并可从丹麦国家处方登记册（1994-2012）获得孕期处方药使用信息。有关人口统计、妊娠和其他因素的数据将从其他国家登记处获得。启示：这一发现将为有某些健康状况或在怀孕期间服用特定药物的母亲的孩子的儿童癌症风险提供更多证据。研究结果将表明，是否需要进行更积极的监测和筛查，以降低未出生婴儿可能增加的风险，并有助于指导孕期用药建议。

DESCRIPTION (provided by applicant): In recent years there has been a growing recognition of the importance of maternal health and the uterine environment in the later health of children. Many women experience chronic or acute health conditions while pregnant, and a few studies have linked certain conditions with increased pediatric cancer risk. Maternal health care may further involve the use of medications to treat a preexisting condition or a condition that develops during the prenatal period. It is well-established that maternal intake of diethylstilbestrol (DES) causes cancer in offspring, however for most drugs, the evidence on safety in pregnancy is limited. The aim of this study is to examine common maternal health conditions and prescription drug use in pregnancy in relation to later childhood cancer development. Specific aims: (1) Create a linked database of all childhood cancers in Denmark (1977-2012) with information on maternal comorbidities and medication use. (2) Examine the relation between maternal comorbid conditions and childhood cancers. (3) Examine the relation between maternal prescription drug use in pregnancy and childhood cancers. Design and methods: A national case-control study using national registries in Denmark, using data from an existing study on childhood cancers in Denmark (n=537,000). Maternal comorbidity information will be available from the Danish National Patient Register (1977-2012), and prescription drug use in pregnancy from the Danish National Prescription Register (1994-2012). Data on demographic, gestational, and other factors will be available from other national registers. Implications: the findings will add evidence on childhood cancer risk among children of mothers with certain health conditions or who took specific medications during pregnancy. The results will indicate if more active monitoring and screening is needed to reduce the potentially increased risk for the unborn child, and can help guide recommendations on medication use in pregnancy.