Obstetrical management of cancer in pregnancy and risk of adverse
pregnancy and neonatal outcomes: a nationwide cohort study
Abstract
Objectives. To investigate the obstetrical management of cancer in
pregnancy and to determine adverse pregnancy and neonatal outcomes.
Design. A register-based nationwide historical prospective cohort study.
Setting and population. We assessed all pregnancies (N = 4,071,848) in
Denmark from 1 January 1973 to 31 December 2018. Methods. We linked data
on maternal cancer, obstetrical, and neonatal outcomes. Exposure was
defined as pregnancies exposed to maternal cancer (n = 1,068). The
control group comprised pregnancies without cancer. The groups were
compared using logistic regression analysis and adjusted for potential
confounders. Main outcome Measures. The primary outcome was the
iatrogenic termination of the pregnancy (induced abortions/labor
induction or elective caesarean section). Secondary outcomes were
adverse neonatal outcomes. Results. More women with cancer in pregnancy,
as compared to the control group, experienced first-trimester induced
abortion; adjusted odds ratio (aOR) 3.7 (95% CI 2.8─4.7),
second-trimester abortion; aOR 9.0 (6.4─12.6), iatrogenic preterm
delivery; aOR 10.9 (8.1─14.7), and iatrogenic delivery below 32
gestational weeks; aOR 16.5 (8.5─32.2). Neonates born to mothers with
cancer in pregnancy had a higher risk of respiratory distress syndrome;
aOR 1.5 (1.2─2.0), but not of low birth weight; aOR 0.6 (0.4─0.8),
admission to neonatal intensive care unit more than seven days; aOR 1.4
(1.1─1.9), neonatal infection; aOR 0.9 (0.5─1.5) nor neonatal mortality;
aOR1.3 (0.6─2.6). Conclusion. Cancer in pregnancy implies an increased
risk of iatrogenic termination of pregnancy and iatrogenic premature
birth. Neonates born to mothers with cancer in pregnancy had no
increased risk of severe adverse neonatal outcomes.