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Obstetrical management of cancer in pregnancy and risk of adverse pregnancy and neonatal outcomes: a nationwide cohort study
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  • Iben Greiber,
  • Jakob Viuff,
  • Lene Mellemkjær,
  • Cristel Hjortshøj,
  • Ojvind Lidegaard,
  • Lone Storgaard,
  • Mona Karlsen
Iben Greiber
Rigshospitalet

Corresponding Author:[email protected]

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Jakob Viuff
Danish Cancer Society Research Center
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Lene Mellemkjær
Danish Cancer Society Research Center
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Cristel Hjortshøj
Rigshospitalet
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Ojvind Lidegaard
Rigshospitalet
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Lone Storgaard
Rigshospitalet
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Mona Karlsen
Rigshospitalet
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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.
03 Sep 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
05 Sep 2021Submission Checks Completed
05 Sep 2021Assigned to Editor
06 Sep 2021Reviewer(s) Assigned
25 Sep 2021Review(s) Completed, Editorial Evaluation Pending
05 Nov 2021Editorial Decision: Revise Major
30 Nov 20211st Revision Received
01 Dec 2021Submission Checks Completed
01 Dec 2021Assigned to Editor
01 Dec 2021Review(s) Completed, Editorial Evaluation Pending
17 Dec 2021Editorial Decision: Accept