Obstetric and neonatal outcomes in women with pregnancy associated cancer: a population-based study in Lombardy, Northern Italy

Abstract

Background Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy. Methods This population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women. Results Out of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57–2.07), cesarean section (aPR=1.78, 95% CI: 1.49–2.11) and premature birth (aPR=6.34, 95% CI: 4.59–8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36–1.35 and aPR=1.04, 95% CI: 0.78–1.39, respectively), but newborn among PAC women had a lower birth weight (p-value< 0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96–7.33) as compared to cancer-free women. Conclusion PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.

Pregnancy associated cancer, timing of birth and clinical decision making—a NSW data linkage study

“…Our results confirmed findings from previous studies that infants born to women with PAC are more likely to be born preterm and to be of low birthweight but that there is no significant association between PAC and the odds of a baby being born SGA [ 5 ]. These results suggest that the high prevalence of low birthweight observed in PAC infants is more likely to be due to preterm birth rather than restricted fetal growth.…”

“…It is noteworthy that melanoma was the major contributor to diagnoses of PAC in our study cohort. This contrasts previous international studies that report breast cancer as the major contributor to PAC [ 1 , 5 , 8 ] and reflects the overall high incidence of skin cancers in Australia [ 33 ].…”

“…Although the diagnosis of PAC is relatively rare, with estimates of incidence varying from 71 to 172 cases per 100,000 women giving birth, [ 4 ] it is associated with adverse outcomes for affected mothers and their babies. Adverse maternal outcomes include higher rates of hysterectomy, blood transfusion, thromboembolism, sepsis, delivery by cesarean section, and preterm birth [ 2 , 3 , 5 – 9 ]. Adverse neonatal outcomes include elevated risk of lower birthweight, smaller for gestational age, lower Apgar scores, and greater need for resuscitation [ 2 , 3 , 5 – 9 ].…”

“…Adverse maternal outcomes include higher rates of hysterectomy, blood transfusion, thromboembolism, sepsis, delivery by cesarean section, and preterm birth [ 2 , 3 , 5 – 9 ]. Adverse neonatal outcomes include elevated risk of lower birthweight, smaller for gestational age, lower Apgar scores, and greater need for resuscitation [ 2 , 3 , 5 – 9 ]. Cancer management during pregnancy is particularly challenging as treating clinicians must carefully appraise the likely benefits of any intervention to the mother against potential harm to her fetus [ 2 , 10 , 11 ].…”

Perinatal outcomes of women with gestational breast cancer in Australia and New Zealand: A prospective population‐based study

“…20 Over 40% of the women with GBC included in this study had a preterm birth. Although this result is marginally lower than rates previously reported in an Italian study (50%) and a retrospective NSW data-linkage study (52%), 9,21 it is more than five times the overall rate of preterm birth in Australia. 22 Our study further revealed that the rate of preterm birth was higher among women who received systemic therapy during pregnancy compared with those who delayed treatment until after birth.…”