Surveillance warranted for pregnancies in adolescent, young adult cancer survivors
medwireNews: Adverse birth outcomes, specifically preterm births and infants with low birth weight, are more likely among adolescent and young adult (AYA) cancer survivors than women without cancer, a US study shows.
“Our findings may inform the reproductive counseling of female AYA cancer survivors,” say the study authors who believe that “additional surveillance of pregnancies in this population is warranted.”
Using data from the North Carolina Central Cancer Registry and linked statewide birth records, they identified singleton live births to 2598 women diagnosed with cancer between the ages of 15 and 39 years and matched them by age and year of delivery to 12,990 mothers without a recorded cancer diagnosis.
Preterm births (gestation <37 weeks) and early preterm births (gestation <34 weeks) were significantly more common among AYA cancer survivors than women without cancer, as were infants with low birth weight, with prevalence ratios (PRs) of 1.52, 2.03, and 1.59, respectively.
There was also a “slight increase” in cesarean deliveries among the cancer survivors (PR=1.08), say Chelsea Anderson, from the University of North Carolina at Chapel Hill, and colleagues, but the prevalence of infants considered small for gestational age and those with poor physiologic health – as assessed by a 5-minute Apgar score below 7 – was comparable between the two groups.
Further analysis showed that adverse birth outcomes tended to be “most concentrated” among AYA survivors who were diagnosed during pregnancy, “some of whom may deliver early to begin treatment,” with, for instance, PRs of 2.97 for preterm births and 2.82 for low birth weight, the researchers report.
But they found that preterm births and infants with low birth weight remained more prevalent among cancer survivors than controls even when the diagnosis preceded pregnancy, with “modest though significant elevations” and PRs of 1.23 and 1.36, respectively.
Of note, women who received chemotherapy without radiation had a higher likelihood of giving birth prematurely and having infants with low birth weight relative to the control cohort (respective PRs of 2.11 and 2.36), whereas radiation alone did not appear to increase the risk for any of the evaluated adverse birth outcomes.
“This may be partly explained by cardiovascular or pulmonary impairments due to chemotherapy, which may impact blood volume regulation and adversely affect pregnancy outcomes,” write Anderson et al in JAMA Oncology.
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