母亲患恶性肿瘤性疾病对新生儿的影响

Effect of maternal malignant tumor on the neonatal outcome

目的回顾性研究母亲患恶性肿瘤性疾病及相关治疗对新生儿的影响。方法对2011年1月至2016年12月北京大学人民医院产科收治的78例患恶性肿瘤性疾病的孕产妇和同期转入儿科的15例母亲患恶性肿瘤性疾病的新生儿进行研究,并随机选取同期在产科住院的孕期未患任何疾病的孕产妇64例作为对照组,对比分析母亲患恶性肿瘤性疾病及化疗等相关治疗对新生儿生长发育等的影响。结果78例患恶性肿瘤性疾病的孕产妇中14例选择流产或引产,64例选择继续妊娠至分娩。78例孕产妇中患急性白血病23例,慢性粒细胞白血病20例,宫颈癌11例,甲状腺癌9例,分类尚不明确的白血病6例,卵巢癌、淋巴瘤各3例,子宫内膜癌2例,侵袭性葡萄胎1例。选择继续妊娠至分娩的64例孕产妇中20例未接受任何药物治疗,44例孕期接受手术、化疗及间断输血等治疗。64例新生儿顺产分娩24例,产钳助产6例,剖宫产分娩34例。母亲患恶性肿瘤组新生儿出生时胎龄[(37.6±2.3)周比(40.0±1.2)周]、体质量[(2 998±637) g比(3 389±360) g]及身长[(48.5±2.8) cm比(50.2±1.5) cm]均显著低于对照组,差异均有统计学意义(均P<0.05)。母亲患恶性肿瘤组新生儿中小于胎龄儿[7.8%(5/64例)比0(0/64例)]、晚期早产儿[25.0%(16/64例)比1.6 %(1/64例)]、低出生体质量儿[20.3%(13/64例)比0(0/64例)]发生率、剖宫产率[53.1%(34/64例)比31.2%(20/64例)]及入住新生儿重症监护室(NICU)率[23.4%(15/64例)比1.6%(1/64例)]均显著高于对照组,但足月儿发生率显著低于对照组[70.3%(45/64例)比98.4%(63/64例)],差异均有统计学意义(均P<0.05)。儿科收治的15例新生儿中仅1例于出生4 d入院,其余14例均在出生2 h内入院,住院时间为(8.9±4.3) d;存在先天畸形1例,发生新生儿感染6例;出生后首次血常规白细胞水平为(14.7±4.3)×10^9/L,血红蛋白水平为(170.6±21.4) g/L,血小板水平为(220.0±63.7)×10^9/L;出生后首次生化检查结果显示丙氨酸转氨酶增高1例,天冬氨酸氨基转移酶增高3例,新生儿低血糖1例,新生儿高血糖1例,清蛋白、胆固醇、三酰甘油、尿素氮及肌酐水平均在正常范围。结论母亲患恶性肿瘤性疾病及相关治疗方案可使子代早产、剖宫产及入住NICU率增加,并可对部分新生儿体格生长发育、血液系统及肝脏功能产生影响。

Objective To investigate the effect of maternal malignant tumor and related therapy on the outcome of newborns. MethodsThe clinical data of 78 pregnant women with malignant tumors and 15 newborns whose mothers suffered from malignant tumors between January 2011 and December 2016 in Peking University People′s Hospital were studied.At the same time, 64 cases of pregnant women with no disease were randomly selected as the control group, and the effect of maternal malignant tumors and related therapy on neonatal growth and development were analyzed. ResultsAmong the 78 pregnant women suffering from malignant tumors, 14 women chose abortion or induced labor, and 64 women chose to continue pregnancy until delivery.Among the 78 women, 23 cases suffered from acute leukemia, 20 cases suffered from chronic myeloid leukemia, 11 cases suffered from cervical cancer, 9 cases suffered from thyroid carcinoma, 6 cases suffered from unclassified leukemia, 3 cases suffered from oophoroma, 3 cases suffered from lymphoma, 2 cases suffered from endometrial carcinoma and 1 case suffered from invasive mole.Among the 64 mothers, 20 mothers did not receive any treatment during pregnancy and 44 cases received chemotherapy or other treatments such as intermittent transfusion therapy.Among the 64 newborns, 24 cases were vaginal deliveries, 6 cases were forceps deli-very and 34 cases were caesarean section.The mean gestational age [(37.6±2.3) weeks vs.(40.0±1.2) weeks], body weight[(2 998±637) g vs.(3 389±360) g]and body length[(48.5±2.8) cm vs.(50.2±1.5) cm]at birth of neonates, whose mothers with malignant tumors during pregnancy were smaller than those of the control group, and the differences were statistically significant (all P<0.05). The incidence of small for gestational age[7.8%(5/64 cases) vs.0(0/64 cases)], late preterm infants[25.0%(16/64 cases) vs.1.6%(1/64 cases)], low birth weight infants[20.3%(13/64 cases) vs.0(0/64 cases)], caesarean section rate[53.1%(34/64 cases) vs.31.2%(20/64 cases)] and the neonatal intensive care unit(NICU) admission[23.4%(15/64 cases) vs.1.6%(1/64 cases)] were higher than those of the control group, but the incidence of term infants was lower [70.3%(45/64 cases) vs.98.4%(63/64 cases)], and the differences were statistically significant (all P<0.05). Among the 15 neonates, there was only one neonate who was admitted to hospital 4 days after birth, while the other 14 newborns were all admitted within 2 hours after birth.Their average hospitalization time was (8.9±4.3)days.Among the 15 neonates, 1 case had congenital heart malformation and 6 cases suffered from infection.The average number of white blood cells, hemoglobin and platelet were (14.7±4.3)×10^9/L,(170.6±21.4) g/L and (220±63.7)×10^9/L, respectively.The first biochemical tests of the 15 newborns showed that 1 case had elevated alanine aminotransferase, 3 cases had elevated glutamic-oxalacetic transaminase, 1 case suffered from hypoglycemia and another one suffered from hyperglycemia.While albumin, cholesterol, triglyceride, urea nitrogen and creatinine were all in the normal range. ConclusionsMaternal cancer and related therapy increase the incidence of premature, cesarean section and NICU admission of their offspring.Meanwhile, it can also affect the growth, hematologic system and liver function of some newborns.