Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 169

Van de Loo et al. [9] assessed the impact of abdominal‐pelvic RT for childhood cancer survivors (CCS) on uterine function and pregnancy outcomes. In this nested‐cohort study, they compared RT‐exposed CCS (n = 55) with age‐ and parity‐matched nonirradiated CCSs (non–RT‐exposed CCSs; n = 110) and general population controls (n = 110). Uterine volume was assessed by three‐dimensional ultrasound, and pregnancy outcome was obtained from a self‐reported questionnaire. Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6–52.8) mL for RT‐exposed CCSs, 48.1 (35.7–61.8) mL for non–RT‐exposed CCSs, and 61.3 (49.1–75.5) mL for general population controls. RT‐exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio [OR] 5.31 [95% confidence interval 1.98–14.23]). Surprisingly, the same was true for non–RT‐exposed CCSs (OR 2.61 [1.16–5.91]). Among gravidous participants, RT‐exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 [2.55–63.40], OR 9.74 [1.49–63.60], and OR 15.66 [1.43–171.35], respectively). Compared with non–RT‐exposed CCSs, RT‐exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 [1.08–43.75]). They concluded that uterine exposure to RT during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. CCS should be counseled preconceptionally about these risks and receive appropriate obstetric monitoring in case they become pregnant. The authors did not specify if the RT exposure was pre‐ or postpuberty.