In a population-based retrospective cohort study (Teenage and Young Adult Cancer Survivor Study; TYACSS) reported in The Lancet Oncology, Sunguc et al identified risks of adverse obstetric outcomes among female survivors of adolescent and young adult cancers in England and Wales.
Study Details
The study included data from 5-year survivors of cancers diagnosed at age 15 to 39 years in the TYACSS cohort. Births and obstetric complications observed among these women between April 1997 and March 2022 were ascertained and compared with those in the general population of England.
Key Findings
Median follow-up was 11.9 years (interquartile range = 7.7–15.7 years).
A total of 21,437 births were observed among 13,866 survivors. The observed-to-expected ratio of births compared with the general population of England was 68% (ratio = 0.68, 95% confidence interval [CI] = 0.67–0.69, P < .0001).
The observed-to-expected birth ratios were significantly lower for survivors of most cancers, except bladder cancer (0.89, 95% CI = 0.78–1.01, P = .08) and lung cancer (0.84, 95% CI = 0.70–1.01, P = .06). Ratios were lowest (all P < .0001) for survivors of genitourinary cancers other than cervical, ovarian, bladder, or kidney cancer (0.35, 95% CI = 0.29–0.43), cervical cancer (0.42, 95% CI = 0.40–0.44), breast cancer (0.49, 95% CI = 0.47–0.52), and leukemia (0.53, 95% CI = 0.49–0.58).
In analysis including specific obstetric complications that occurred in ≥100 patients at an observed-to-expected ratio of ≥ 1.25, it was found that survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labor, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta previa, and antepartum hemorrhage. Survivors of leukemia were at risk of preterm delivery, obstructed labor, postpartum hemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded the ≥1.25 ratio.
The investigators concluded, “Survivors of cervical cancer and leukemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer.”
Raoul C. Reulen, PhD, of the Centre for Childhood Cancer Survivor Studies, University of Birmingham, Institute of Applied Health Research, Birmingham, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences. For full disclosures of the study authors, visit thelancet.com.
