Purpose: To review parental pre-pregnancy and pregnancy exposures in relation to pediatric cancer (diagnosis before age 20). Methods: We conducted literature searches using Ovid Medline and Scopus to find primary research studies, review articles, and meta-analyses published from 2014 to 17 March 2021. Results: Strong evidence links increased risk of childhood cancer with maternal diabetes, age, and alcohol and coffee consumption during pregnancy. Both paternal and maternal cigarette smoking before and during pregnancy are associated with childhood cancers. Diethylstilbestrol (DES) exposure in utero has long been known to be causally associated with increased risk of vaginal/cervical cancers in adolescent girls. More recent evidence implicates in utero DES exposure to testicular cancer in young men and possible intergenerational effects on ovarian cancer in the granddaughters of women exposed to DES during pregnancy. There is strong evidence that childhood cancer risk is also associated with both high and very low birth weight and with gestational age. Evidence is also strong for the protective effects of maternal vitamin consumption and a healthy diet during pregnancy. Unlike early studies, those reviewed here show no association between in utero exposure to medical ionizing radiation, which may be explained by reductions over time in radiation doses, avoidance of radiation during pregnancy, and/or by inadequate statistical power to detect small increases in risk, rather than a lack of causal association. Evidence is mixed or conflicting for an association between childhood cancer and maternal obesity, birth order, cesarean/instrumental delivery, and prenatal exposure to diagnostic medical radiation. Evidence is weak or absent for associations between childhood cancer and multiple gestations or assisted reproductive therapies, as well as prenatal exposure to hormones other than DES, and medications.
目的：综述父母孕前及孕期暴露因素与儿童期癌症（20岁前确诊）的关系。方法：通过Ovid Medline和Scopus数据库检索2014年至2021年3月17日期间发表的原始研究、综述及荟萃分析。结果：强有力的证据表明，母亲孕期糖尿病、高龄、饮酒及咖啡摄入与儿童癌症风险增加密切相关。父母双方孕前及孕期吸烟均与儿童期癌症存在关联。宫内暴露己烯雌酚（DES）长期被证实与青春期女性阴道/宫颈癌风险增加存在因果关联，新近证据还提示其与青年男性睾丸癌相关，并可能对孕期暴露DES女性的孙女代产生卵巢癌的跨代影响。出生体重过高或过低、孕周异常与儿童癌症风险的强关联性亦获证实。母亲孕期维生素摄入及健康饮食的保护作用证据充分。与早期研究不同，本次综述发现宫内医疗电离辐射暴露与儿童癌症无显著关联，这可能源于辐射剂量随时间递减、孕期辐射规避和/或统计学效力不足以检测微小的风险升高，而非缺乏因果关联。母亲肥胖、出生顺序、剖宫产/器械助产、产前诊断性医疗辐射暴露与儿童癌症的关联性证据存在矛盾或争议。多胎妊娠、辅助生殖技术、产前非DES类激素及药物暴露与儿童癌症的关联证据薄弱或缺失。
肿瘤(癌症)患者之家