Influence of cancer in pregnancy on obstetric and neonatal outcomes: An
observational retrospective cohort study
Abstract
Objective: Determine the effects of cancer treatment in pregnancy.
Design: Observational retrospective cohort study. Setting: 7 Chinese
tertiary A hospitals during 2003–2021. Population: Pregnant patients
with cancer. Methods: We conducted multiple logistic regression to
determine the influence of various factors on preterm birth and
small-for-gestational-age infants, log-binomial regression to analyze
temporal changes, and chi-square tests to explore the effects of cancer
type/treatment. Main outcome measures: Obstetric outcomes; Neonatal
outcomes. Results: Of 204 women, 17% terminated pregnancies; 59%
received pre-delivery treatment. Rates of pregnancy termination
([RR]: 0.48, 95% confidence interval [CI]: 0.35–0.67) and
iatrogenic preterm births (RR: 0.73, 95% CI: 0.54–0.98) reduced, and
that of pre-delivery treatment increased, mainly due to increased rates
of surgery (RR: 1.87, 95% CI: 1.31–2.67). Maternal systemic diseases
were related to a higher risk of small-for-gestational-age infants
([OR]: 12.02, 95% CI: 1.82–79.43). Chemotherapy with taxanes plus
platinum-based agents was related to adverse obstetric outcomes (OR:
1.87, 95% CI: 1.42–2.46, P < 0.05). Thyroid (OR: 0.36, 95%
CI: 0.22–0.57) and ovarian cancer (OR: 0.70, 95% CI: 0.50–0.98) were
associated with fewer cesarean sections. Thyroid cancer was associated
with fetal growth restriction (OR: 5.21, 95% CI: 1.21–22.55).
Conclusions: Rates of pregnancy termination in cancer have declined.
Taxane plus platinum-based chemotherapy was associated with adverse
obstetric outcomes. Cancer type influenced outcomes. Funding: Special
Project for clinical Research in health industry of Shanghai Municipal
Health Commission; Shanghai Science and Technology Commission. Tweetable
abstract: Cancer in pregnancy on obstetric and neonatal outcomes: higher
risks of adverse obstetric and neonatal outcomes.