Pregnancy outcomes among female childhood, adolescent, and young adult cancer survivors assessed using internet-based nationwide questionnaire surveys in Japan

Female cancer survivors planning to become pregnant are concerned about the impact of cancer treatment on their ability to maintain normal pregnancy and the negative impact on their offspring. However, studies on the pregnancy outcomes of cancer survivors in Japan are limited. Therefore, this study aimed to investigate the pregnancy outcomes of female cancer survivors by comparing them with women without a history of malignant tumors in Japan.

This cross-sectional study included 3308 subjects, based on an internet-based questionnaire (self-reported) survey conducted in Japan. Differences in pregnancy outcomes, including multiple pregnancies, stillbirth, preterm birth (PTB), and infant birthweight, between cancer survivors and subjects without a history of malignant tumors, were evaluated using a generalized linear mixed-effects model with adjustment for possible confounding factors.

Of 3308 subjects included in this study, 629 (19.0%) were cancer survivors, among whom cervical (40.4%), breast (19.1%), and thyroid (7.0%) malignancies were most frequent. 71 (2.2%) and 53 (1.6%) participants had a history of multiple pregnancies and stillbirth, respectively; 385 (11.8%), 179 (5.5%), and 137 (4.2%) participants, respectively, had histories of PTB at less than 37, 34, and 32 weeks of gestation. Further, 302 (10.7%), 326 (11.6%), and 330 (11.7%) participants delivered to low birthweight (LBW), small-for-gestational-age (SGA), and large-for-gestational-age (LGA) infants, respectively. Subjects with a history of cervical or breast cancers had significantly higher odds of PTB at

计划妊娠的女性癌症幸存者往往担忧癌症治疗对其维持正常妊娠能力的影响，以及对其子代产生的不良作用。然而，目前日本针对癌症幸存者妊娠结局的相关研究较为有限。为此，本研究旨在通过与日本无恶性肿瘤病史女性的对比，探究女性癌症幸存者的妊娠结局。

本研究为横断面研究，基于日本开展的互联网自我报告（self-reported）问卷调查，共纳入3308名研究对象。采用广义线性混合效应模型（generalized linear mixed-effects model），并对潜在混杂因素进行校正，对比分析癌症幸存者与无恶性肿瘤病史研究对象在多项妊娠结局指标上的差异，包括多胎妊娠、死产、早产（preterm birth, PTB）以及新生儿出生体重。

本研究纳入的3308名研究对象中，629名（19.0%）为癌症幸存者，其中最常见的恶性肿瘤为宫颈癌（40.4%）、乳腺癌（19.1%）与甲状腺癌（7.0%）。分别有71名（2.2%）与53名（1.6%）研究对象有多胎妊娠与死产病史；另有385名（11.8%）、179名（5.5%）与137名（4.2%）研究对象分别存在妊娠<37周、<34周与<32周的早产（preterm birth, PTB）病史。此外，分别有302名（10.7%）、326名（11.6%）与330名（11.7%）研究对象分娩出低出生体重（low birthweight, LBW）、小于胎龄（small-for-gestational-age, SGA）与大于胎龄（large-for-gestational-age, LGA）新生儿。有宫颈癌或乳腺癌病史的研究对象发生PTB的比值比显著更高——