在過去10年時(shí)間里患有癌癥的孕婦在妊娠期間接受化學(xué)藥物治療的例子越來越多,，然而醫(yī)學(xué)界關(guān)于孕婦接受化療是否會(huì)影響胎兒心臟和神經(jīng)系統(tǒng)的發(fā)育仍然沒有定論。近日,，發(fā)表在The Lancet Oncology雜志上一項(xiàng)研究證實(shí)：懷孕婦女在妊娠期間接受化療并不會(huì)影響胎兒心臟和神經(jīng)系統(tǒng)的發(fā)育,。
該研究的主要領(lǐng)導(dǎo)者--新澤西州羅文大學(xué)Elyce Cardonick教授表示：這項(xiàng)研究對(duì)罹患癌癥的孕婦具有很大的臨床指導(dǎo)意義,，一方面孕婦并不需要擔(dān)心化療會(huì)對(duì)胎兒造成影響，完全可以繼續(xù)接受癌癥化療,，另一方面也不必因擔(dān)心化療對(duì)胎兒有影響而終止妊娠,。
研究人員將不同年齡段的70名嬰兒納入研究（嬰兒包括剛出生的、18個(gè)月大的,、5至6歲,、8至9歲、11至12歲,、14至15歲,、18歲），對(duì)妊娠期期間接受化療的罹患癌癥孕婦所生嬰兒的做了一項(xiàng)多中心隊(duì)列觀察研究,。同時(shí)收集了孕婦平均妊娠期為35.7周,，接受236輪化療，平均隨訪時(shí)間為22.3月等相關(guān)數(shù)據(jù),。
為了分析嬰兒心臟和神經(jīng)系統(tǒng)發(fā)育情況,，工作人員運(yùn)用了臨床常規(guī)神經(jīng)功能檢查、整體認(rèn)知功能測(cè)試（語言測(cè)試或IQ測(cè)試）,、心電圖,、心回波描記以及與健康和發(fā)育相關(guān)的問卷調(diào)查等形式。對(duì)于年齡在5歲以上的孩子還做了聽力測(cè)試,、記憶能力測(cè)試和注意力測(cè)試等,。
結(jié)果發(fā)現(xiàn)那些接受化療的罹患癌癥孕婦所生的嬰兒的神經(jīng)認(rèn)知功能、機(jī)體行為,、整體健康狀況,、聽力、生長發(fā)育情況,、心臟容積,、心臟功能等指標(biāo)都處在正常值范圍內(nèi)。
研究人員表示：肚中胎兒暴露于化療環(huán)境下并不會(huì)影響中樞神經(jīng)系統(tǒng)的發(fā)育,、心臟功能以及聽力等功能,。拿這些嬰兒與正常嬰兒相比，結(jié)果在整體健康狀況,、生長發(fā)育情況上也未出現(xiàn)差異,。(生物谷 Bioon.com)
doi:10.1016/S1470-2045(11)70363-1
PMC:
PMID:
Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study
Dr Frédéric Amant PhD a , Kristel Van Calsteren PhD b, Michael J Halaska PhD e, Mina Mhallem Gziri MD b, Wei Hui MD k, Lieven Lagae PhD c, Michèl A Willemsen PhD f, Livia Kapusta PhD g i, Ben Van Calster PhD a b, Heidi Wouters MSc c, Liesbeth Heyns MSc a, Sileny N Han MD a, Viktor Tomek MD j, Luc Mertens PhD d k, Petronella B Ottevanger PhD h
Background
Chemotherapy for the treatment of maternal cancers during pregnancy has become more acceptable in the past decade; however, the effect of prenatal exposure to chemotherapy on cardiac and neurodevelopmental outcomes of the offspring is still uncertain. We aimed to record the general health, cardiac function, and neurodevelopmental outcomes of children who were prenatally exposed to chemotherapy.
Methods
We did an interim analysis of a multicentre observational cohort study assessing children who were prenatally exposed to maternal cancer staging and treatment, including chemotherapy. We assessed children at birth, at age 18 months, and at age 5—6, 8—9, 11—12, 14—15, or 18 years. We did clinical neurological examinations, tests of the general level of cognitive functioning (Bayley or intelligence quotient [IQ] test), electrocardiography and echocardiography, and administered a questionnaire on general health and development. From age 5 years, we also did audiometry, the Auditory Verbal Learning Test, and subtasks of the Children's Memory Scale, and the Test of Everyday Attention for Children, and we also completed the Child Behavior Checklist. This study is registered with ClinicalTrials.gov, number NCT00330447.
Findings
236 cycles of chemotherapy were administered in 68 pregnancies. We assessed 70 children, born at a median gestational age of 35·7 weeks (range 28·3—41·0; IQR 3·3; 47 women at <37 weeks), with a median follow-up period of 22·3 months (range 16·8—211·6; IQR 54·9). Although neurocognitive outcomes were within normal ranges, cognitive development scores were lower for children who were born preterm than for those born at full term. When controlling for age, sex, and country, the score for IQ increased by an average 11·6 points (95% CI 6·0—17·1) for each additional month of gestation (p<0·0001). Our measurements of the children's behaviour, general health, hearing, and growth corresponded with those of the general population. Cardiac dimensions and functions were within normal ranges. We identified a severe neurodevelopmental delay in both members of one twin pregnancy.
Interpretation
Fetal exposure to chemotherapy was not associated with increased CNS, cardiac or auditory morbidity, or with impairments to general health and growth compared with the general population. However, subtle changes in cardiac and neurocognitive measurements emphasise the need for longer follow-up. Prematurity was common and was associated with impaired cognitive development. Therefore, iatrogenic preterm delivery should be avoided when possible.
