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Original Investigation
March 23, 2017

Birth Outcomes Among Adolescent and Young Adult Cancer Survivors

Author Affiliations
  • 1Department of Epidemiology, University of North Carolina, Chapel Hill
  • 2Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill
  • 3Department of Health Behavior, University of North Carolina, Chapel Hill
  • 4Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
JAMA Oncol. Published online March 23, 2017. doi:10.1001/jamaoncol.2017.0029
Key Points

Question  Are adverse birth outcomes more prevalent among births to adolescent and young adult (AYA, diagnosed at ages 15-39 years) cancer survivors than among births to women without a recorded cancer diagnosis?

Findings  This case-control cohort study used a data linkage between the North Carolina Central Cancer Registry and statewide birth certificate files to identify births to AYA cancer survivors, and a comparison cohort of births to women without a recorded cancer diagnosis randomly selected from birth certificate files. The results suggest an excess risk of preterm birth and low birth weight among births to AYA cancer survivors.

Meaning  These findings may inform the preconception and prenatal counseling of AYA cancer survivors and suggest the need for additional surveillance of pregnancies in this population.

Abstract

Importance  Cancer diagnosis and treatment may adversely affect reproductive outcomes among female cancer survivors.

Objective  To compare the birth outcomes of adolescent and young adult cancer survivors (AYA [diagnosed at ages 15-39 years]) with those of women without a cancer diagnosis.

Design, Setting, and Participants  The North Carolina Central Cancer Registry (CCR) was used to identify female AYA cancer survivors diagnosed from January 2000 to December 2013; CCR records were linked to statewide birth certificate files from January 2000 to December 2014 to identify postdiagnosis live births to AYA survivors (n = 2598). A comparison cohort of births to women without a recorded cancer diagnosis was randomly selected from birth certificate files (n = 12 990) with frequency matching on maternal age and year of delivery.

Main Outcomes and Measures  Prevalence of preterm birth, low birth weight, small-for-gestational-age births, cesarean delivery, and low Apgar score.

Results  Overall, 2598 births to AYA cancer survivors (mean [SD] maternal age, 31 [5] years) were included. Births to AYA cancer survivors had a significantly increased prevalence of preterm birth (prevalence ratio [PR], 1.52; 95% CI, 1.34-1.71), low birth weight (PR, 1.59; 95% CI, 1.38-1.83), and cesarean delivery (PR, 1.08; 95% CI, 1.01-1.14) relative to the comparison cohort of 1299. The higher prevalence of these outcomes was most concentrated among births to women diagnosed during pregnancy. Other factors associated with preterm birth and low birth weight included treatment with chemotherapy and a diagnosis of breast cancer, non-Hodgkin lymphoma, or gynecologic cancers. The prevalence of small-for-gestational-age births and low Apgar score (<7) did not differ significantly between groups.

Conclusions and Relevance  Live births to AYA cancer survivors may have an increased risk of preterm birth and low birth weight, suggesting that additional surveillance of pregnancies in this population is warranted. Our findings may inform the reproductive counseling of female AYA cancer survivors.

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