Cancer diagnosis during pregnancy is associated with severe maternal and neonatal morbidity - 20/11/24

Doi : 10.1016/j.ajog.2024.10.022

Alexa Kanbergs, MD, ScM, MS ^a, Mark Clapp, MD, MPH ^b, Chi-Fang Wu, PhD ^c, Alexander Melamed, MD, MPH ^b, Nuria Agusti, MD ^a, David Viveros-Carreño, MD ^d,^e, Abigail S. Zamorano, MD ^f, Florencia Virili, MD ^g, Jose Alejandro Rauh-Hain, MD, MPH ^a, Roni Nitecki Wilke, MD, MPH ^a,^⁎
^a Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
^b Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
^c Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
^d Unidad Ginecología Oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia
^e Clínica Universitaria Colombia, Bogotá, Colombia
^f Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Health Sciences, The University of Texas Health Science Center at Houston, Houston, TX
^g Servicio Ginecología y Obstetricia, Sanatorio De La Trinidad San Isidro, Buenos Aires, Argentina

^∗Corresponding author: Roni Nitecki Wilke, MD, MPH.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 20 November 2024

Abstract

Background

Data on maternal and fetal outcomes in patients diagnosed with cancer during pregnancy are limited. Given expected increase in patients diagnosed with cancer during pregnancy, there is a growing need to evaluate clinical outcomes.

Objective

To evaluate obstetric outcomes among women with early-stage gynecologic or breast cancer who were diagnosed during pregnancy compared to women without cancer in a population-based cohort.

Study Design

We performed a population-based study of women aged 18 to 45 years with stage I gynecologic or stage I to III breast cancer reported to the California Cancer Registry for the years 2000 to 2012. Data were linked to the 2000 to 2012 California birth data to produce a database with cancer characteristics and obstetric outcomes. We included patients who had a delivery within the 10 months following cancer diagnosis. The primary outcome was severe maternal morbidity. Secondary outcomes included preterm birth and neonatal morbidity. Propensity scores were used to match similar controls to cases in a 2:1 ratio based on demographic attributes and medical comorbidities included in the Obstetric Comorbidity Index. Logistic regressions were used to evaluate outcomes.

Results

The cohort consisted of 503 women with cancer in pregnancy (319 breast, 125 ovarian, 59 cervical) and 1006 matched controls. Cancer during pregnancy was associated with higher odds of severe maternal morbidity (6.8% vs <1.1%; odds ratio 8.03, 95% confidence interval 3.82–16.88), preterm birth between 32 and 36 weeks (32.6% vs 8.3%, odds ratio 5.38, 95% confidence interval 4.02–7.20), and neonatal morbidity (12.5% vs 6.1%; odds ratio 2.22, 95% confidence interval 1.53–3.21) compared to matched controls. In subanalysis of severe maternal morbidity indicators, hysterectomy and sepsis were significantly associated with cancer during pregnancy (4.8% vs <1.1%, P<.001; <2.2% vs 0.0%, P=.037, respectively).

Conclusion

Cancer during pregnancy is associated with increased risk of maternal and neonatal morbidity. These findings highlight the need for careful management and consideration of obstetric outcomes in these patients.

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Key words : cancer, maternal morbidity, neonatal morbidity, pregnancy, preterm birth

Plan

Introduction

Materials and methods

Subanalyses by cancer type

Results of sensitivity analyses

Comment

Principal findings

Results in the context of what is known

Clinical implications

Research implications

Strengths and limitations

Conclusions

CRediT authorship contribution statement

	J.A.R.-H. and R.N.W. co-senior authors.
	M.C. serves on the scientific advisory board and has private equity in Delfina Care. A.K., C.W., A.M., N.A., D.V., A.S.Z., F.V., J.A.R., and R.N.W. report no conflict of interest.
	Funding for this study was supported by grants from the National Institutes of Health National Cancer Institute (NIH/NCI) under Cancer Center Support Grant number P30 CA016672 (JAR-H, RNW, AK, and C-FW), grant number K08 CA234333 (JAR-H), and grant number T32 CA101642 (AK), and by the Fundación Alfonso Martin Escudero (NA) and Department of Defense Ovarian Cancer Research Program grant number OC210024 (AM). The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; the Centers for Disease Control and Prevention National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco; contract HHSN261201800015I awarded to the University of Southern California; and contract HHSN261201800009I awarded to the Public Health Institute. The funding sources were not involved in the development of the research hypothesis or study design, data analysis, or manuscript writing.
	Cite this article as: Kanbergs A, Clapp M, Wu C-F, et al. Cancer diagnosis during pregnancy is associated with severe maternal and neonatal morbidity. Am J Obstet Gynecol 2024;XXX:XX–XX.
	Disclaimer: The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.