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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2025, Vol. 21 ›› Issue (06): 634 -642. doi: 10.3877/cma.j.issn.1673-5250.2025.06.005

Original Article

Clinical characteristics and maternal-fetal outcomes of pregnancy complicated by malignancy

Qi Liu1, Ning Gu2, Ling Yang2, Yan Zhou2, Yanjing Rui2, Yimin Dai1,2,†()   

  1. 1Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
    2Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
  • Received:2025-07-18 Revised:2025-11-10 Published:2025-12-01
  • Corresponding author: Yimin Dai
  • Supported by:
    National Key Research and Development Program of China(2021YFC2701601)
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Objective

To explore the clinical characteristics and maternal and fetal outcomes of pregnant women with malignant tumors.

Methods

A total of 30 455 women with singleton pregnancies who delivered at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between January 2020 and December 2024 were enrolled in this study, including 385 cases complicated by malignancy. According to the presence or absence of malignancy, participants were divided into a malignancy group (n=385) and a control group (n=30 070). Propensity score matching (PSM) was performed at a ratio of 1∶4 using age, gravidity, parity, chronic hypertension, pregestational diabetes mellitus, pre-pregnancy body mass index(BMI) ≥ 28 kg/m2, and history of assisted reproductive technology as covariates. The malignancy group was further stratified by the timing of cancer diagnosis into a pre-pregnancy subgroup (n=367, malignancy diagnosed before pregnancy) and a pregnancy-associated subgroup (n=18, malignancy diagnosed during pregnancy or the puerperium). The clinical characteristics and maternal–fetal outcomes were retrospectively analyzed for all groups. This study was approved by the Medical Ethics Committee of Drum Tower Hospital, the Affiliated of Hospital Nanjing University Medical School (Approval No. 2025-0873-01). As this was a retrospective single-center cohort study, the requirement for informed consent was waived.

Results

①The incidence of pregnancy complicated by malignancy was 1.26% (385/30 455) and showed a significant increasing trend over the study period (χ2trend=33.61, P<0.001), with thyroid cancer being the most common type (77.9%, 300/385). After propensity score matching, 384 women were included in the malignancy group and 1 533 in the control group. ②Compared with the control group, women in the malignancy group had a significantly lower gestational age at delivery and a lower incidence of premature rupture of membranes (PROM), but significantly higher rates of intensive care unit (ICU) admission and postpartum blood transfusion (P<0.05); no significant differences were observed in other maternal or neonatal outcomes (P>0.05). ③Within the malignancy group, women diagnosed during pregnancy had a lower gestational age at delivery, higher proportions of pre-delivery hemoglobin levels <110 g/L, higher ICU admission and transfusion rates, and lower neonatal birth weight than those diagnosed before pregnancy (P<0.001). ④Among the 18 women diagnosed with malignancy during pregnancy, six received chemotherapy or surgical treatment during pregnancy, one maternal death occurred, and all neonates survived.

Conclusions

The incidence of pregnancy complicated by malignancy has shown an increasing trend over recent years. Women who were diagnosed before pregnancy and conceived after completing standard treatment with stable disease generally had favorable maternal and neonatal outcomes, whereas those diagnosed during pregnancy tended to have poorer outcomes. Early identification and multidisciplinary standardized management are therefore essential for improving maternal and neonatal prognosis in women with pregnancy complicated by malignancy.

Key words: Pregnancy, Malignant tumors, Thyroid neoplasms, Pregnancy outcomes, Infant, newborn, Perinatal prognosis, Pregnant women
图1 2020－2024年妊娠合并恶性肿瘤不同组织来源发生率的分布堆积柱状图
表1 本研究385例妊娠合并恶性肿瘤患者的恶性肿瘤组织来源分类比较[例数(%)]
组织来源分类 占比
甲状腺 300(77.9)
甲状腺乳头状癌 296(76.9)
甲状腺原位癌 3(0.8)
甲状腺髓样癌 1(0.3)
肺癌 37(9.6)
乳腺癌 11(2.9)
宫颈癌 9(2.3)
血液系统 9(2.3)
淋巴瘤 4(1.0)
白血病 5(1.3)
消化系统 8(2.1)
胃癌 6(1.6)
肝母细胞瘤 1(0.3)
结肠癌 1(0.3)
卵巢 5(1.3)
卵巢上皮性癌 1(0.3)
生殖细胞瘤 4(1.0)
其他 11(2.9)
表2 研究组与对照组患者PSM后一般临床资料比较
组别 例数 年龄[岁，M(Q1，Q3)] 孕次[次，M(Q1，Q3)] 产次[次，M(Q1，Q3)] 辅助生殖[例数(%)] 孕前糖尿病[例数(%)] 慢性高血压[例数(%)] 孕前BMI≥28 kg/m2[例数(%)]
研究组 384 32(29，34) 1(1，2) 1(1，2) 46(12.0) 9(2.3) 13(3.4) 22(5.7)
对照组 1 533 32(29，34) 1(1，2) 1(1，2) 147(9.6) 19(1.2) 35(2.3) 65(4.2)
统计量   Z＝－0.07 Z＝－0.47 Z＝－0.14 χ2＝1.94 χ2＝2.60 χ2＝1.53 χ2＝1.57
P值   0.942 0.642 0.890 0.164 0.107 0.216 0.210
表3 孕前亚组和孕期亚组孕妇的一般临床资料比较
组别 例数 年龄[岁，M(Q1，Q3)] 孕次[次，M(Q1，Q3)] 产次[次，M(Q1，Q3)] 辅助生殖[例数(%)] 孕前糖尿病[例数(%)] 慢性高血压[例数(%)] 孕前BMI≥28 kg/m2[例数(%)]
孕前亚组 366 32(29，34) 1(1，2) 1(1，2) 42(11.5) 10(2.5) 13(3.6) 21(5.7)
孕期亚组 18 32(29，35) 2(1，4) 2(1，2) 4(22.2) 0(0) 0(0) 1(5.6)
统计量   Z＝－0.41 Z＝－3.04 Z＝－2.52 χ2＝1.01 —a —a —a
P值   0.665 0.002 0.011 0.318 >0.999 >0.999 >0.999
表4 研究组和对照组妊娠并发症及母儿结局比较[例数(%)]
组别 例数 分娩孕龄[周，M(Q1，Q3)] 分娩孕龄<37孕周[例数(%)] 剖宫产术分娩[例数(%)] PROM[例数(%)] GDM[例数(%)] 孕期高血压疾病[例数(%)]
32~36＋6孕周 <32孕周 合计
研究组 384 39.0(38.3，39.6) 34(6.9) 11(2.9) 45(11.7) 149(38.8) 54(14.1) 56(14.6) 25(6.5)
对照组 1 533 39.1(38.3，39.9) 105(6.9) 28(1.8) 133(8.7) 580(37.8) 292(19.1) 219(14.3) 137(8.9)
统计量   Z＝－2.85 χ2＝0.03 χ2＝3.38 χ2＝0.03 χ2＝5.16 χ2＝0.02 χ2＝2.34
P值   0.004 0.867 0.066 0.867 0.023 0.882 0.126
组别 例数 分娩前Hb<110 g/L[例数(%)] ICP[例数(%)] 妊娠合并甲状腺功能减退[例数(%)] 妊娠合并甲状腺功能亢进[例数(%)] 胎儿生长受限[例数(%)] 产后24 h出血量[mL，M(Q1，Q3)] PPH[例数(%)] 入住ICU[例数(%)]
研究组 384 22(5.7) 5(1.3) 49(14.6) 2(0.5) 28(7.3) 397(287，514) 54(14.1) 3(0.8)
对照组 1 533 70(4.6) 17(1.1) 179(11.7) 21(1.4) 139(9.1) 390(280，520) 211(13.8) 1(0.1)
统计量   χ2＝0.91 χ2＝0.002 χ2＝2.41 χ2＝1.22 χ2＝1.22 Z＝－0.79 χ2＝0.03 －a
P值   0.340 0.960 0.120 0.269 0.270 0.430 0.865 0.027
组别 例数 产后输血[例数(%)] 新生儿出生体重[g，M(Q1，Q3)] SGA儿[例数(%)] LGA儿[例数(%)] 新生儿生后5 min Apgar评分≤7分[例数(%)] 出生缺陷[例数(%)] 死胎[例数(%)]
研究组 384 6(1.6) 3 250(2 930，3 480) 60(15.6) 47(12.2) 2(0.5) 2(0.5) 0(0)
对照组 1 533 6(0.4) 3 260(2 980，3 550) 213(13.9) 205(13.4) 14(0.9) 7(0.5) 3(0.2)
统计量   χ2＝5.02 Z＝－1.35 χ2＝0.75 χ2＝0.35 χ2＝0.20 —a —a
P值   0.025 0.178 0.385 0.557 0.658 >0.999 >0.999
表5 孕前亚组和孕期亚组孕妇妊娠并发症及母儿结局比较
组别 例数 分娩孕龄[周，M (Q1，Q3)] 分娩孕龄<37孕周[例数(%)] 剖宫产术分娩[例数(%)] PROM[例数(%)] GDM[例数(%)] 孕期高血压疾病[例数(%)]
32~36＋6孕周 <32孕周 合计
孕前亚组 366 39.1(38.3，39.6) 26(7.1) 9(2.5) 35(9.6) 138(37.6) 53(14.5) 53(14.5) 25(6.8)
孕期亚组 18 36.0(33.9，38.9) 8(44.4) 2(11.1) 10(55.6) 11(61.1) 1(5.6) 4(22.2) 0(0)
统计量   Z＝－3.90 χ2＝0.14 χ2＝30.77 χ2＝4.08 χ2＝0.51 χ2＝0.36 χ2＝0.43
P值   <0.001 <0.001 0.710 0.130 0.474 0.549 0.511
组别 例数 分娩前Hb<110 g/L[例数(%)] ICP[例数(%)] 妊娠合并甲状腺功能减退[例数(%)] 妊娠合并甲状腺功能亢进[例数(%)] 胎儿生长受限[例数(%)] 产后24 h出血量[mL，M (Q1，Q3)] PPH[例数(%)]
孕前亚组 366 15(4.1) 5(1.4) 53(14.5) 2(0.6) 28(7.7) 395(287，507) 50(13.6)
孕期亚组 18 7(38.9) 0(0) 3(16.7) 0(0) 0(0) 455(340，650) 4(23.5)
统计量   χ2＝32.38 —a —a —a χ2＝0.57 χ2＝1.19 χ2＝0.62
P值   <0.001 >0.999 >0.999 >0.999 0.451 0.236 0.432
组别 例数 入住ICU[例数(%)] 产后输血[例数(%)] 新生儿出生体重[g，M (Q1，Q3)] SGA儿[例数(%)] LGA儿[例数(%)] 新生儿生后5 minApgar评分≤7分[例数(%)] 出生缺陷[例数(%)]b
孕前亚组 366 3(16.7) 1(0.3) 3 258(2 960, 3 488) 58(15.9) 45(12.3) 2(0.6) 2(0.6)
孕期亚组 18 0(0) 5(27.8) 3 003(2 215, 3 309) 2(11.1) 2(11.1) 0(0) 0(0)
统计量   —a —a Z＝－2.67 χ2＝0.04 —a —a —a
P值   <0.001 <0.001 0.008 0.835 >0.999 >0.999 >0.999
表6 孕期亚组中18例被诊断为孕期合并恶性肿瘤孕妇的诊治情况和母儿结局
序号 年龄(岁) 肿瘤类型 确诊时妊娠时间(周) 分娩孕龄(周) 分娩/产时手术方式 孕期肿瘤治疗方案 产后严重并发症 新生儿转入NICU 新生儿并发症a
1 29 宫颈癌，FIGO临床分期ⅠB2期 17＋2 35＋2 剖宫产术/广泛全子宫切除术＋淋巴结清扫术 紫杉醇＋顺铂化疗4个疗程 SPPH 17 d NRDS、肺炎
2 36 肺腺癌Ⅳ期 产褥期 36＋1 剖宫产术/— — 无 7 d 感染
3 32 甲状腺癌 产褥期 39＋5 自然分娩/— — 无 否 无
4 38 卵黄囊瘤 产褥期 34＋3 剖宫产术/全子宫切除术＋盆腹腔肿瘤切除术 — SPPH 12 d NRDS、肺炎
5 33 宫颈癌，FIGO临床分期ⅠB2期 28 35＋6 剖宫产术/广泛全子宫术＋淋巴结清扫术 紫杉醇＋卡铂化疗2个疗程 无 11 d 无
6 32 宫颈癌，FIGO临床分期ⅠB3期 30＋1 34＋5 剖宫产术/广泛全子宫切除术＋淋巴结清扫术 紫杉醇＋顺铂化疗1个疗程 无 7 d 肺炎
7 26 甲状腺癌 4＋6 39＋3 自然分娩/— — 无 否 无
8 34 乳腺癌Ⅳ期 27＋4 28＋1 自然分娩/— — Ⅰ型呼吸衰竭、ICU呼吸支持、恶病质、肺部感染、低钾血症 转院 无
9 29 甲状腺癌 5 39 剖宫产术/— — 无 否 无
10 31 宫颈小细胞神经内分泌癌ⅣB期 32＋1 32＋1 剖宫产术/— — 无 11 d NRDS
11 33 降结肠恶性肿瘤ⅡB期 29＋4 30 剖宫产术/结肠根治术＋肠造口术 — 无 转院 无
12 36 甲状腺癌 4 37＋6 剖宫产术/— — SPPH 否 否
13 29 胃癌Ⅳ期 产褥期 32＋2 剖宫产术/腹腔探查＋大网膜活检术 — 消化道大出血、凝血功能障碍 32 d 呼吸暂停、脓毒症、化脓性脑膜炎
14 36 慢性粒细胞性白血病 31＋5 38＋3 自然分娩/— 人干扰素a1b注射液 无 否 无
15 37 恶性黑色素瘤Ⅳ期 36＋6 38 自然分娩/— — 无 否 无
16 28 肾细胞癌 18 39 自然分娩/— 19孕周时行左肾切除＋淋巴结清扫术 产后26 d确诊为结肠中分化腺癌 否 无
17b 29 甲状腺乳头状癌Ⅰ期 17＋1 39＋4 自然分娩/— 18＋6孕周时行甲状腺部分切除＋淋巴结清扫术 无 否 无
18 30 支气管黏液表皮样癌 24＋1 33＋5 剖宫产术/— — 无 7 d 肺炎
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