The risk of preterm birth and growth restriction in pregnancy after cancer

Ward, Kevin C.; Kramer, Michael R.; Lash, Timothy L.; Mertens, Ann C.; Spencer, Jessica B.; Fothergill, Amy; Howards, Penelope P.

doi:10.1002/ijc.30914

Cited by 46 publications

(58 citation statements)

References 31 publications

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“…Compared to women with ER‐negative tumors, those with ER‐positive tumors had a lower cumulative incidence at 5 years, but not at 10 years, after diagnosis. After accounting for maternal age and other risk factors, we observed modest increases in preterm birth and low birth weight among births to women with invasive breast cancer relative to the noncancer comparison cohort, consistent with previous reports of women who conceived after a breast cancer diagnosis …”

Section: Discussionsupporting

confidence: 90%

“…Previous U.S.‐based studies have suggested that low birth weight and preterm deliveries are more common among breast cancer survivors relative to the general population . However, among women who conceive after diagnosis, the magnitude of these associations appears to be modest.…”

Section: Discussionmentioning

confidence: 92%

“…reported risk ratios (RR) of 1.3 (95% CI: 1.1–1.7) and 1.6 (95% CI: 1.3–2.0) for preterm birth and low birth weight, respectively, among postdiagnosis births to women diagnosed with invasive breast cancer at ages 20–45 in Georgia, Tennessee and North Carolina relative to a matched comparison group. The corresponding RR for SGA was 1.2 (95% CI: 0.9–1.5) . Likewise, in an older study from Denmark, PRs compared to women without cancer were 1.3 (95% CI: 0.7–2.2) for preterm birth and 1.2 (95% CI: 0.4–3.8) for low birth weight among women diagnosed with breast cancer before pregnancy .…”

Section: Discussionmentioning

confidence: 92%

“…Recent studies from Canada and Europe have documented a decreased incidence of childbirth among breast cancer survivors relative to age‐matched women in the general population. Other reports suggest that those who do give birth after breast cancer may have an increased risk of low birth weight and preterm deliveries compared to women without cancer . However, variation in these outcomes according to factors such as hormone receptor status and endocrine therapy use has not been previously explored.…”

Section: Introductionmentioning

confidence: 99%

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Live birth outcomes after adolescent and young adult breast cancer

Anderson

Engel

Anders

et al. 2018

Intl Journal of Cancer

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Reproductive outcomes are an important survivorship concern for women diagnosed with cancer as adolescents and young adults (AYAs). We examined the incidence of live birth and the prevalence of adverse birth outcomes according to tumor and treatment characteristics among AYAs with breast cancer. Women diagnosed with breast cancer at ages 15-39 during 2000-2013 were identified using the North Carolina Central Cancer Registry (n = 4,978). Cancer registry records were linked to state birth certificate files from 2000 to 2014 to identify births to women with and without a breast cancer history. The breast cancer cohort was followed until live birth, death, age 46, or December 31, 2014, whichever occurred first. For each birth to breast cancer survivors (n = 338), we sampled 20 births to women without a recorded cancer diagnosis, with frequency matching on maternal age and year of delivery. The cumulative incidence of live births after breast cancer was 8% at 10 years. Births were less common among women treated with chemotherapy. Overall, the prevalence of preterm birth, low birth weight, small-for-gestational age (SGA) and Cesarean delivery did not differ substantially between births to women with and without breast cancer. However, births to women with ER-negative disease were more likely to be preterm (PR = 1.84; 95% CI: 1.11-3.06). In this population-based study, <10% of AYA breast cancer survivors had a live birth within 10 years of their diagnosis. The increase in risk of preterm delivery among ER-negative survivors in our cohort warrants further investigation in larger studies.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Live birth outcomes after adolescent and young adult breast cancer

Anderson

Engel

Anders

et al. 2018

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…As in previous studies, we found survivors to have a significantly increased risk for preterm delivery compared to comparison subjects. We also found a 45% higher risk for overall hospitalization among survivors compared to population comparisons but could not identify any specific reasons for the increased risk for hospitalization as most survivors belonged to the category hospitalization for other reasons than vaginal bleeding, pre‐eclampsia or threatened preterm labor.…”

Section: Discussionsupporting

confidence: 87%

Risk factors for preterm delivery among early onset cancer survivors: A Finnish register‐based study

Melin

Heinävaara

Malila

et al. 2018

Intl Journal of Cancer

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Previous studies have shown an elevated risk for preterm delivery among early onset cancer survivors. Whether the preterm delivery starts spontaneously, due to possible uterine damage because of cancer treatment, or is induced due to maternal conditions is unclear. Our aim was to assess pregnancy related conditions in female cancer survivors possibly underlying the elevated risk for preterm labor. Nationwide cancer and birth registries were merged to identify 1,753 first deliveries of cancer survivors (diagnosed below 40 years of age) and 5,123 first deliveries of matched female comparison subjects between January 1991 and December 2013. Conditional logistic regression models were used to estimate the risk for pregnancy related conditions adjusting for maternal age, gestational age and smoking. We found an overall increased risk for hospitalization during pregnancy (OR 1.45, 95% CI 1.25–1.68), intrahepatic cholestasis (OR 2.86, 95% CI 1.09–7.49), fear of childbirth (OR 2.25, 95% CI 1.31–3.85) and mental disorders and diseases of the nervous system complicating pregnancy and labor (OR 5.89, 95% CI 2.31–15.00). Among survivors, 129 (7.4%) delivered preterm compared to 268 (5.2%) comparisons subjects (p = 0.004). We found a statistically significant increased risk for preterm delivery among cancer survivors with vaginal bleeding (OR 1.35, 95% CI 1.07–1.71) and pre‐eclampsia (1.35, 95% CI 1.06–1.72) compared to comparison subjects with the same condition. Health professionals treating these women should be aware of these risks. In general, however, our results are reassuring when it comes to pregnancies among cancer survivors.

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Pregnancy after cancer: Timing is everything

Partridge

2018

Cancer

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Cancer is a relatively infrequent diagnosis in young adults and yet, when it occurs, the medical and psychosocial impact can be profound. Beyond individual mortality, cancer and cancer treatment may threaten or thwart the ability of young survivors to have children. As the field of cancer survivorship has grown, there has been increasing awareness of the risk of infertility after cancer, and research programs and policy initiatives have focused on addressing fertility at diagnosis and developing fertility preservation opportunities for this population. 1 Studies of birth outcomes of pregnancies among childhood cancer survivors have suggested an increased risk of low-birth-weight and preterm births. 2,3 However, relatively little prior work has focused on pregnancy outcomes in adult cancer survivor populations.In this issue of Cancer, Hartnett and colleagues seek to address this gap and build on the existing literature by evaluating fetal outcomes in a large population-based sample of women with a history of cancer. 4 They present an analysis of first subsequent pregnancy outcomes among women who were diagnosed with cancer between ages 20 and 45 years in 3 US states using cancer registry data linked to birth registries. The investigators compare this large group of survivors' pregnancy outcomes with those of matched controls without cancer history. Their main findings suggest that timing of pregnancy in cancer survivors may be critical to the early health of the subsequent progeny. First, early pregnancy after cancer treatment was associated with nearly 2 and 3 times the risk of preterm birth after starting chemotherapy without or with radiation, respectively. However, women who had later conception, with the exception of those with a history of cervical cancer, did not appear to be at greater risk than controls. The risk of low birth weight was similarly associated with conception closer to treatment in the survivor population.Hampering clear understanding of the potential contributors and mechanisms to account for these findings is a lack of information in the report by Hartnett regarding stage of cancer and whether women were receiving ongoing therapy (eg, continued chemotherapy for leukemia or hormone therapy for breast cancer during early or later pregnancy) or continued to have physiologic stressors from early complications of treatment, or had progressive cancer or early recurrence. Similar to other population-based reports of nonpregnant women of reproductive age in the United States, the most common cancers observed in this study were breast, melanoma, thyroid, Hodgkin lymphoma, and cervical, the majority of which would be treated for cure. 5 In addition, whereas most therapies for early stage or curable disease would be completed within a few months of diagnosis, certainly some pregnancies considered in the analysis by Hartnett and colleagues would have been among women who were receiving antineoplastic therapy at conception and/or in the peripartum period, including those living with advanced cancer or ...

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The risk of preterm birth and growth restriction in pregnancy after cancer

Cited by 46 publications

References 31 publications

Live birth outcomes after adolescent and young adult breast cancer

Live birth outcomes after adolescent and young adult breast cancer

Risk factors for preterm delivery among early onset cancer survivors: A Finnish register‐based study

Pregnancy after cancer: Timing is everything

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