期刊
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE
卷 114, 期 4, 页码 553-564出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/jnci/djac005
关键词
-
类别
资金
- ICES - Ontario Ministry of Health (MOH)
- Ministry of Long-Term Care (MLTC)
- Canadian Institutes of Health Research (CIHR) Foundation Grant (CIHR) [388395]
- SickKids Research Training Competition (Restracomp) Scholarship
- Childhood Cancer Canada Institutes of Health Research (CIHR) [133618]
- Alex's Lemonade Stand
- CIHR Foundation Grant [CIHR 148470]
Female survivors of pediatric cancer have a lower likelihood of achieving pregnancy and, once pregnant, are at higher risk for preterm birth and maternal complications.
Background The likelihood of pregnancy and risk of obstetrical or perinatal complications is inadequately documented in female survivors of pediatric cancer. Methods We assembled a population-based cohort of female survivors of cancer diagnosed at age 21 years and younger in Ontario, Canada, between 1985 and 2012. Survivors were matched 1:5 to women without prior cancer. Multivariable Cox proportional hazards and modified Poisson models assessed the likelihood of a recognized pregnancy and perinatal and maternal complications. Results A total of 4062 survivors were matched to 20 308 comparisons. Median (interquartile range) age was 11 (4-15) years at cancer diagnosis and 25 (19-31) years at follow-up. By age 30 years, the cumulative incidence of achieving a recognized pregnancy was 22.3% (95% confidence interval [CI] = 20.7% to 23.9%) among survivors vs 26.6% (95% CI = 25.6% to 27.3%) among comparisons (hazard ratio = 0.80, 95% CI = 0.75 to 0.86). A lower likelihood of pregnancy was associated with a brain tumor, alkylator chemotherapy, cranial radiation, and hematopoietic stem cell transplantation. Pregnant survivors were as likely as cancer-free women to carry a pregnancy >20 weeks (relative risk [RR] = 1.01, 95% CI = 0.98 to 1.04). Survivors had a higher relative risk of severe maternal morbidity (RR = 2.31, 95% CI = 1.59 to 3.37), cardiac morbidity (RR = 4.18, 95% CI = 1.89 to 9.24), and preterm birth (RR = 1.57, 95% CI = 1.29 to 1.92). Preterm birth was more likely in survivors treated with hematopoietic stem cell transplantation (allogenic: RR = 8.37, 95% CI = 4.83 to 14.48; autologous: RR = 3.72, 95% CI = 1.66 to 8.35). Conclusions Survivors of childhood or adolescent cancer are less likely to achieve a pregnancy and, once pregnant, are at higher risk for severe maternal morbidity and preterm birth.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据