Maternal and obstetric outcomes in women with pregnancy-associated haematological malignancies: an observational nationwide cohort study.

IF 15.4 1区 医学 Q1 HEMATOLOGY
Lancet Haematology Pub Date : 2024-11-01 Epub Date: 2024-10-07 DOI:10.1016/S2352-3026(24)00288-6
Pierre Pinson, Ismael Boussaid, Justine Decroocq, Laurent Chouchana, Gary Birsen, Mathilde Barrois, Vassilis Tsatsaris, Charlotte Godeberge, Jeremie Zerbit, Barbara Burroni, Frederic Pene, Laurence Huynh, Caroline Charlier, Jerome Tamburini, Nathanael Beeker, Mathis Collier, Didier Bouscary, Jean Marc Treluyer, Rudy Birsen
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A Cox proportional hazards model was used to assess overall survival, defined as the date of haematological malignancy diagnosis to either death or the end of the study follow-up, in the haematological malignancy during pregnancy group (pregnancies with a diagnosis of haematological malignancy during pregnancy) compared with the haematological malignancy post-pregnancy group (pregnancies with a diagnosis of haematological malignancy in the year following pregnancy). Severe maternal morbidity was compared in the haematological malignancy during pregnancy group versus the reference group (pregnancies without a history of haematological malignancy or a diagnosis of pregnancy-associated haematological malignancy). Births were classified as very preterm (<32 weeks of pregnancy), preterm (32-36 weeks), and term (≥37 weeks) and compared in the haematological malignancy during pregnancy group versus the reference group. Inverse probability weighting (IPW) was used for confounder adjustment, using maternal age (categorised), comorbidities, socioeconomic status, and year of delivery (as a category).</p><p><strong>Findings: </strong>Of 9 996 523 pregnancies in 5 995 235 women, 1366 pregnancy-associated haematological malignancies were identified: 413 during pregnancy (4·13 per 100 000 pregnancies) and 953 (9·53 per 100 000 pregnancies) within 12 months of the end of pregnancy (post-pregnancy). No significant differences in overall survival were observed between the haematological malignancy during and post-pregnancy groups across all types of haematological malignancy (IPW-adjusted hazard ratio 0·91 [95% CI 0·62-1·34], p=0·63), specifically for Hodgkin lymphoma (0·56 [0·07-4·53], p=0·59), aggressive B-cell non-Hodgkin lymphoma (0·52 [0·12-2·38], p=0·40), and acute leukaemia alone (0·84 [0·50-1·41], p=0·51). 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引用次数: 0

Abstract

Background: Pregnancy-associated haematological malignancy is a rare event; therefore, data available to guide the treatment are scarce. We aimed to evaluate the incidence, overall survival, and maternal morbidity and mortality of women with pregnancy-associated haematological malignancies.

Methods: We conducted a nationwide observational cohort study using the French National Healthcare Data System (SNDS), a health-care administrative database covering up to 99% of the French population. We included all pregnancies in France ending between Jan 1, 2012, and Dec 31, 2022. Pregnancies with terminations or miscarriages managed on an outpatient basis, and women with a history of haematological malignancies before pregnancy were excluded. A Cox proportional hazards model was used to assess overall survival, defined as the date of haematological malignancy diagnosis to either death or the end of the study follow-up, in the haematological malignancy during pregnancy group (pregnancies with a diagnosis of haematological malignancy during pregnancy) compared with the haematological malignancy post-pregnancy group (pregnancies with a diagnosis of haematological malignancy in the year following pregnancy). Severe maternal morbidity was compared in the haematological malignancy during pregnancy group versus the reference group (pregnancies without a history of haematological malignancy or a diagnosis of pregnancy-associated haematological malignancy). Births were classified as very preterm (<32 weeks of pregnancy), preterm (32-36 weeks), and term (≥37 weeks) and compared in the haematological malignancy during pregnancy group versus the reference group. Inverse probability weighting (IPW) was used for confounder adjustment, using maternal age (categorised), comorbidities, socioeconomic status, and year of delivery (as a category).

Findings: Of 9 996 523 pregnancies in 5 995 235 women, 1366 pregnancy-associated haematological malignancies were identified: 413 during pregnancy (4·13 per 100 000 pregnancies) and 953 (9·53 per 100 000 pregnancies) within 12 months of the end of pregnancy (post-pregnancy). No significant differences in overall survival were observed between the haematological malignancy during and post-pregnancy groups across all types of haematological malignancy (IPW-adjusted hazard ratio 0·91 [95% CI 0·62-1·34], p=0·63), specifically for Hodgkin lymphoma (0·56 [0·07-4·53], p=0·59), aggressive B-cell non-Hodgkin lymphoma (0·52 [0·12-2·38], p=0·40), and acute leukaemia alone (0·84 [0·50-1·41], p=0·51). Severe maternal morbidity was more frequent in the haematological malignancy during pregnancy group than in the reference group (86 [26·2%] of 328 completed pregnancies vs 120 335 [1·5%] of 7 945 909 completed pregnancies; IPW-adjusted odds ratio 22·71 [95% CI 17·72-29·10], p<0·0001). We observed an increase in very preterm birth (32 [9·8%] vs 92 712 [1·2%]; IPW-adjusted odds ratio 11·90 [95% CI 7·91-17·91], p<0·0001) and preterm birth (116 [35·4%] vs 430 472 [5·4%]; 11·76 [9·34-14·81], p<0·0001) in the haematological malignancy during pregnancy group compared with the reference group.

Interpretation: This nationwide observational study examines pregnancy-associated haematological malignancies in France, revealing no significant difference in overall survival between women diagnosed during pregnancy and post-pregnancy. Our data highlight an increased frequency of severe maternal morbidity and obstetric complications among women diagnosed during pregnancy. Notably, the study underscores the necessity for specialised care to manage these complex cases effectively.

Funding: None.

Translation: For the French translation of the abstract see Supplementary Materials section.

妊娠相关血液恶性肿瘤妇女的产妇和产科结局:一项全国范围的观察性队列研究。
背景:妊娠相关性血液恶性肿瘤是一种罕见的疾病,因此可用于指导治疗的数据很少。我们旨在评估妊娠相关血液恶性肿瘤妇女的发病率、总生存率、孕产妇发病率和死亡率:我们利用法国国家医疗保健数据系统(SNDS)开展了一项全国性的观察性队列研究,该系统是一个医疗保健管理数据库,覆盖了法国 99% 的人口。我们纳入了法国2012年1月1日至2022年12月31日期间的所有妊娠。不包括门诊终止妊娠或流产的孕妇,也不包括怀孕前有血液恶性肿瘤病史的妇女。采用考克斯比例危险模型评估妊娠期血液恶性肿瘤组(妊娠期诊断为血液恶性肿瘤的孕妇)与妊娠后血液恶性肿瘤组(妊娠后一年诊断为血液恶性肿瘤的孕妇)的总生存率,总生存率的定义为从血液恶性肿瘤诊断日期到死亡或研究随访结束的时间。妊娠期血液恶性肿瘤组与参照组(无血液恶性肿瘤病史或诊断出与妊娠相关的血液恶性肿瘤的孕妇)的孕产妇严重发病率进行了比较。早产儿被归类为极早产儿(研究结果显示:在 9 996 523 名孕妇中,早产儿的比例为 1:1:在 5 995 235 名妇女的 9 996 523 次妊娠中,发现了 1 366 例与妊娠相关的血液恶性肿瘤:其中 413 例发生在妊娠期(每 10 万例妊娠中有 4-13 例),953 例发生在妊娠结束后 12 个月内(妊娠后)(每 10 万例妊娠中有 9-53 例)。在所有类型的血液恶性肿瘤中,妊娠期血液恶性肿瘤组和妊娠后血液恶性肿瘤组的总生存率无明显差异(IPW 调整后的危险比为 0-91 [95% CI 0-62-1-34]、p=0-63),尤其是霍奇金淋巴瘤(0-56 [0-07-4-53],p=0-59)、侵袭性 B 细胞非霍奇金淋巴瘤(0-52 [0-12-2-38],p=0-40)和单纯急性白血病(0-84 [0-50-1-41],p=0-51)。与参照组相比,妊娠期间患血液恶性肿瘤组的孕产妇更容易出现严重的发病率(328 例完成妊娠中的 86 例 [26-2%] vs 7 945 909 例完成妊娠中的 120 335 例 [1-5%];IPW 调整后的几率比 22-71 [95% CI 17-72-29-10],p解释:这项全国性观察研究对法国与妊娠相关的血液恶性肿瘤进行了调查,结果显示,在妊娠期间和妊娠后确诊的妇女在总生存率方面没有明显差异。我们的数据显示,在妊娠期确诊的妇女中,严重孕产妇发病率和产科并发症的发生率有所增加。值得注意的是,这项研究强调了有效管理这些复杂病例的专业护理的必要性:无:摘要的法文译文见 "补充材料 "部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Lancet Haematology
Lancet Haematology HEMATOLOGY-
CiteScore
26.00
自引率
0.80%
发文量
323
期刊介绍: Launched in autumn 2014, The Lancet Haematology is part of the Lancet specialty journals, exclusively available online. This monthly journal is committed to publishing original research that not only sheds light on haematological clinical practice but also advocates for change within the field. Aligned with the Lancet journals' tradition of high-impact research, The Lancet Haematology aspires to achieve a similar standing and reputation within its discipline. It upholds the rigorous reporting standards characteristic of all Lancet titles, ensuring a consistent commitment to quality in its contributions to the field of haematology.
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