Perinatal risks in female cancer survivors: A population-based analysis

Abstract

Background/objectivesAdvances in cancer management have resulted in improved survival rates, particularly in children and young adults. However, treatment may adversely affect reproductive outcomes among female cancer survivors. The objective of this study was to investigate their risk of adverse perinatal outcomes compared to the general population.Design/methodsWe performed a population-based analysis, including all female cancer survivors diagnosed before the age of 40 years between 1981 and 2012. Pregnancy and perinatal complications were identified through linkage of the Scottish Cancer Registry with hospital discharge records based on the Community Health Index (CHI) database. We compared 1,629 female cancer survivors with a first ever singleton pregnancy after diagnosis, with controls matched on age, deprivation quintile, and year of cancer diagnosis selected from the general population (n = 8,899). Relative risks and 95%-confidence intervals of perinatal risks were calculated using log-binomial regression.ResultsSurvivors were more likely to give birth before 37 weeks of gestation (relative risk (RR]) 1.32, 95%-CI 1.10–1.59), but did not show an increased risk of low birth weight (<2.5kg: RR 1.15, 95%-CI 0.94–1.39), and were less likely to give birth to offspring small for gestational age (RR 0.81, 95%-CI 0.68–0.98). Operative delivery and postpartum haemorrhage were more common but approached rates in controls with more recent diagnosis. The risk of congenital abnormalities was not increased (RR 1.01, 95%-CI 0.85–1.20).ConclusionCancer survivors have an increased risk of premature delivery and postpartum haemorrhage, but their offspring are not at increased risk for low birth weight or congenital abnormalities. In recent decades there has been a normalisation of delivery method in cancer survivors, nevertheless careful management remains appropriate particularly for those diagnosed in childhood.

Perinatal complications in female survivors of cancer: a systematic review and meta-analysis

“…There were five studies that reported on the incidence of spontaneous vaginal deliveries, in total reporting on 3,497 cancer survivors and 24,370 controls [12,13,23,24,28]. In the random effect model, cancer survivors were equally likely to have a spontaneous vaginal delivery: relative risk was 0.95 (95% CI 0.84 -1.07) ( Figure 3A).…”

“…Five studies with in total 5,471 survivors and 45,593 controls reported the incidence of emergency caesarean sections in their cohorts [9,12,13,27,28]. The relative risk was 1.22 (95% CI 1.15 -1.30) ( Figure 3C).…”

“…Some early studies suggested an increased relative risk of congenital abnormalities in the offspring of cancer survivors [15,16]. These findings have not been confirmed in more recent analyses [9,12,17,18]. Due to the low prevalence of both cancer in children and young adults and of some pregnancy and labor complications, evaluation of these data benefits from large number of subjects being involved, giving increased statistical power.…”

“…Increased risks for preterm birth were reported in the US Childhood Cancer Survivors Study (CCSS) and the British Childhood Cancer Survivors Study (BCCSS) [8,9], as well as in other large populations with survivors diagnosed in their reproductive life [10,11]. However, contrasting findings were observed for the risk of offspring being small for gestational age [8,11,12]. Despite being an important landmark in pregnancy planning for psychological reasons, less is known about the method of delivery in cancer survivors.…”

“…Despite being an important landmark in pregnancy planning for psychological reasons, less is known about the method of delivery in cancer survivors. Nonetheless, the largest studies showed decreased rates of spontaneous vaginal delivery and increased rates of caesarean section [9,[12][13][14]. Some early studies suggested an increased relative risk of congenital abnormalities in the offspring of cancer survivors [15,16].…”