After Surviving Cancer, Young Women at Higher Risk of Adverse Birth Outcomes

Women who were diagnosed with cancer at a young age are more likely to experience adverse birth outcomes like preterm birth, low birth weight, and cesarean delivery, particularly if the diagnosis occurred during pregnancy, according to a study in JAMA Oncology.

As cancer detection efforts and oncology therapies continue to advance, more cancer survivors diagnosed at young ages are reaching adulthood, though the long-term effects of their cancer on their fertility and birth outcomes are not always clear. Prior research has linked diagnosis at age 14 and younger to increased risk of having a preterm birth or low birth weight later in life, but there have been no studies on the prevalence of these outcomes in US women who had cancer as an adolescent or young adult (AYA), although over 45,000 more are diagnosed each year.

This study examined the birth outcomes for AYA female cancer survivors and compared their risk of adverse events with comparable women who had never had cancer. The analysis looked at variables including the site of the cancer, type of treatment received, and time to birth since diagnosis.

Using data from the North Carolina Central Cancer Registry, researchers identified 2598 births between 2000 and 2014 to women who had survived cancer as an adolescent or young adult. They also gathered a comparison cohort of 12,990 births during that time to women who had no history of cancer diagnosis. The study outcomes were low birth weight, small-for-gestational-age birth, Apgar score less than 7, cesarean delivery, and preterm birth. Statistical analysis showed that the cancer survivors had a higher prevalence of babies born preterm or at low birth weight, as well as a small but significant increase in the likelihood of cesarean delivery. There was no difference between the 2 groups in the proportion of small-for-gestational-age births or low Apgar scores at birth.

The prevalence of low birth weight was highest among women who had survived breast cancer, non-Hodgkin lymphoma, or gynecologic cancer, while the prevalence of preterm birth was increased among women diagnosed with 1 of those 3 cancer types or Hodgkin lymphoma. Women diagnosed with cancer during pregnancy were more likely to experience preterm birth, low birth weight, cesarean delivery, and low Apgar score than the women in the comparison cohort. Among women diagnosed with cancer before pregnancy, only preterm birth and low birth weight were more prevalent than for women without cancer.

Preterm birth and low birth weight were more common among women who had been treated with chemotherapy, which the authors suggested “may be partly explained by cardiovascular or pulmonary impairments due to chemotherapy, which may impact blood volume regulation and adversely affect pregnancy outcomes.”

According to the study authors, the findings of increased risk of low birth weight and preterm birth among young women who had survived cancer were consistent with the results of prior research in other settings, such as a study of birth outcomes among young cancer survivors diagnosed in Western Australia between 1982 and 2007.

The researchers indicated that women diagnosed with cancer as an AYA may benefit from counseling before they conceive or while they are pregnant, and wrote that their findings “suggest the need for additional surveillance of pregnancies in this population.”