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October 5, 2009

Pregnancy Outcomes in Female Childhood and Adolescent Cancer Survivors: A Linked Cancer-Birth Registry Analysis

Author Affiliations

Author Affiliations: Public Health Sciences Division, Fred Hutchinson Cancer Research Center (Drs Mueller, Chow, and Daling and Ms Kamineni), and Department of Epidemiology, University of Washington (Drs Mueller and Daling and Ms Kamineni, Seattle); Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City (Ms Fraser and Dr Mineau); New Mexico Tumor Registry, Epidemiology and Cancer Control Program, University of New Mexico, Albuquerque (Dr Wiggins); Children's Hospital at Providence, Anchorage, Alaska (Dr Hamre); Departments of Family Medicine and Public Health Sciences, Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan (Dr Severson); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Drews-Botsch).

Arch Pediatr Adolesc Med. 2009;163(10):879-886. doi:10.1001/archpediatrics.2009.112

Objective  To compare birth outcomes among female survivors of childhood and adolescent cancer who subsequently bear children, relative to those of women without a history of cancer.

Design  Retrospective cohort study.

Setting  Four US regions.

Participants  Cancer registries identified girls younger than 20 years who were diagnosed as having cancer from 1973 through 2000. Linked birth records identified the first live births after diagnosis (n = 1898). Comparison subjects were selected from birth records (n = 14 278). Survivors of genital tract carcinomas underwent separate analysis.

Main Exposure  Cancer diagnosis at younger than 20 years.

Main Outcome Measures  Infant low birth weight, preterm delivery, sex ratio, malformations, mortality, and delivery method, and maternal diabetes, anemia, and preeclampsia.

Results  Infants born to childhood cancer survivors were more likely to be preterm (relative risk [RR], 1.54; 95% confidence interval [CI], 1.30-1.83) and to weigh less than 2500 g (1.31; 1.10-1.57). For the offspring of genital tract carcinoma survivors, RRs were 1.33 (95% CI, 1.13-1.56) and 1.29 (1.10-1.53), respectively. There were no increased risks of malformations, infant death, or altered sex ratio, suggesting no increased germ cell mutagenicity. In exploratory analysis, bone cancer survivors had an increased risk of diabetes (RR, 4.92; 95% CI, 1.60-15.13), and anemia was more common among brain tumor survivors (3.05; 1.16-7.98) and childhood cancer survivors whose initial treatment was chemotherapy only (2.45; 1.16-5.17).

Conclusions  Infants born to female survivors of childhood and adolescent cancer were not at increased risk of malformations or death. Increased occurrence of preterm delivery and low birth weight suggest that close monitoring is warranted. Increased diabetes and anemia among subgroups have not been reported, suggesting areas for study.