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?
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.
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.
Cancer diagnosis and treatment may adversely affect reproductive outcomes among female cancer survivors.
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.
Overall, 2598 births to AYA cancer survivors (mean [SD] maternal age, 31  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.
Anderson C, Engel SM, Mersereau JE, Black KZ, Wood WA, Anders CK, Nichols HB. Birth Outcomes Among Adolescent and Young Adult Cancer Survivors. JAMA Oncol. Published online March 23, 2017. doi:10.1001/jamaoncol.2017.0029