Aisha Nathoo MSc , Susan B. Brogly PhD , Maria P. Velez MD, PhD
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引用次数: 0
Abstract
Objectives
To evaluate the association between adolescent and young adult (AYA) breast cancer (BC) and the adverse pregnancy outcomes of preterm birth, small for gestational age birth, cesarean delivery, and preeclampsia, and the effect of fertility treatment on this association.
Methods
Population-based cohort study with universal coverage health data for Ontario, Canada. BC was identified from the Ontario Cancer Registry. All births >220 weeks gestation between April 2006 to March 2018 were included. Modified Poisson regression generated risk ratios between AYA BC and adverse pregnancy outcomes, adjusted for maternal characteristics. Models were stratified by fertility treatment.
Results
Among 1 189 980 deliveries, 474 mothers had AYA BC history (exposed), while 1 189 506 had no cancer history (unexposed). AYA BC was associated with cesarean delivery (adjusted risk ratio [aRR] 1.26; 95% CI 1.14–1.39). There was no association between AYA BC and other adverse outcomes. Modelling cesarean delivery subtypes, AYA BC was associated with increased risk of planned (aRR 1.27; 95% CI 1.08–1.49) and unplanned cesarean delivery (aRR 1.41; 95% CI 1.20–1.66). An increased risk of cesarean delivery in exposed persisted among singleton pregnancies (aRR 1.27; 95% CI 1.15–1.41), but not in models stratified by mode of conception (fertility treatment: aRR 1.07; 95% CI 0.84–1.36; unassisted conception: aRR 1.30; 95% CI 1.16–1.46).
Conclusions
A history of AYA BC did not confer an elevated risk of adverse pregnancy outcomes, except for planned and unplanned cesarean delivery. The risk of adverse pregnancy outcomes does not appear to be an indication for delayed pregnancy after AYA BC diagnosis.
研究目的评估青少年乳腺癌（AYA）与早产、小于胎龄产、剖宫产和子痫前期等不良妊娠结局之间的关联，以及生育治疗对这种关联的影响：方法：基于加拿大安大略省全民健康数据的人群队列研究。先兆子痫是从安大略省癌症登记处确定的。研究纳入了 2006 年 4 月至 2018 年 3 月期间妊娠期大于 22 周的所有新生儿。修改后的泊松回归生成了AYA BC与不良妊娠结局之间的风险比，并对产妇特征进行了调整。模型按生育治疗分层：在 1 189 980 例分娩中，474 位母亲有 AYA BC 病史（暴露），1 189 506 位母亲无癌症病史（未暴露）。AYA BC 与剖宫产有关（aRR 1.26，95% CI 1.14-1.39）。AYA BC 与其他不良后果之间没有关联。在建立剖宫产亚型模型时，AYA BC 与计划内剖宫产（aRR 1.27，95% CI 1.08-1.49）和计划外剖宫产（aRR 1.41，95% CI 1.20-1.66）风险增加有关。在单胎妊娠中，暴露的剖宫产风险持续增加（aRR 1.27，95% CI 1.15-1.41），但在按受孕方式分层的模型中（生育治疗：aRR 1.07，95% CI 0.84-1.36；非辅助受孕：aRR 1.30，95% CI 1.16-1.46），暴露的剖宫产风险没有增加：除了计划内和计划外剖宫产外，AYA BC 史并不会增加不良妊娠结局的风险。不良妊娠结局的风险似乎并不是诊断出 AYA BC 后推迟妊娠的指征。
期刊介绍：
Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.
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