目的 采用系统综述与Meta分析方法,探讨女性癌症患病史与新生儿不良出生结局的相关性,为女性癌症幸存者生育保护措施的制订提供参考依据。方法 系统检索从2008年1月1日－2018年8月1日PubMed,Web of Science数据库公开发表的女性癌症患病史与新生儿出生结局的相关研究。文献质量评价采用纽卡斯尔-渥太华量表(NOS量表)。结局指标为早产、低出生体重、先天性畸形、小于胎龄儿(SGA)和活产。对纳入文献进行异质性检验,根据异质性检验结果选择固定效应模型或随机效应模型进行Meta分析并计算合并效应值。采用逐一剔除法进行敏感性分析。采用Begg检验和Egger检验评价研究文献的发表偏倚。结果 共纳入12篇文献,根据异质性检验结果,采用随机效应模型计算早产、先天性畸形、活产的合并RR值(95%CI)分别为2.058(1.337~3.169)(P＝0.001),0.929(0.676~1.277)(P＝0.650),0.852(0.756~0.960)(P＝0.008);采用固定效应模型计算低出生体重、SGA的合并RR值(95%CI)分别为1.563(1.386~1.763)(P＜0.001),1.017(0.859~1.205)(P＝0.843)。结论 女性癌症患病史可显著增加早产、低出生体重的风险,降低活产的风险;女性癌症患病史与先天性畸形、SGA的发生风险无统计学相关性。
Abstract
Objective To evaluate the risk of adverse pregnancy outcomes in female cancer survivors by systematic review and meta-analysis,in order to provide reference for the development of maternity protection technologies for cancer survivors. Methods Articles regarding adverse pregnancy outcomes in neonates born to female cancer survivors from January 1st,2008 to August 1st,2018,published in the Web of Science database and PubMed,were retrieved.Newcastle-Ottawa Scale (NOS) standard was used for literature quality evaluation.Outcomes included premature birth,low birth weight,congenital malformations,small for gestational age (SGA) infants and live birth.The heterogeneity test was carried out on the included literature,and the fixed effect model or the random effect model was used to perform the Meta analysis and to calculate the combined effect value according to the heterogeneity test result.Sensitivity analysis was performed using the one-by-one culling method.The publication bias of the research literature was evaluated using the Begg test and the Egger test. Results Finally 12 articles were included.According to the heterogeneity test results,the randomized effect model indicated that the combined RR (95% CI) values of premature delivery,congenital malformation in children,and live births in children born by cancer survivors were 2.058 (1.337-3.169)(P＜0.001),0.929 (0.676-1.277) (P=0.650),0.852 (0.756-0.960) (P=0.008),respectively.The fixed effect model showed that the combined RR (95% CI) values of SGA and low birth weight infants born to mothers with childhood cancer survivors were 1.563 (1.386-1.763) (P＜0.001),1.017 (0.859-1.205) (P=0.843). Conclusions Female cancer survivors have an increasing risk of preterm birth,low birth weight infants and stillbirths.However,the history of female cancer is not significantly associated with congenital malformations and SGA risk in neonates.
关键词
癌症患病史 /
早产 /
低出生体重 /
先天性畸形 /
小于胎龄儿 /
活产
Key words
history of cancer /
premature birth /
low birth weight /
congenital malformation /
small for gestational age infant /
live birth
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