In an English and Welsh study (The Teenage and Young Adult Cancer Survivor Study) reported in The Lancet Oncology, Sunguc et al found that cervical cancer and leukemia survivors have a heightened risk of experiencing several serious obstetric complications.

“Therefore, any pregnancy [in these populations] should be considered high-risk and would benefit from obstetrician-led antenatal care,” the investigators commented.  

Study Details

The investigators of the retrospective, population-based cohort study used cancer registration data from England and Wales to identify 5-year survivors of 17 types of adolescent and young adult cancers who were diagnosed between the ages of 15 and 39 (n = 200,945). Birth and obstetric outcomes data were obtained by linking this cohort with the Hospital Episode Statistics for England; the investigators ascertained 27 specific obstetric complications among 96,947 female survivors. They compared the observed number of affected births in the cohort with the expected number in the general population of England.

Deficits in Birth Rates

Between April 1997 and March 2022, a total of 21,437 births were documented among 13,886 English female adolescent and young adult cancer survivors (observed-to-expected ratio = 0.68). Survivors of most types of cancer were found to have fewer observed births than expected in the general population, with those who survived bladder (observed-to-expected ratio = 0.89) and lung (observed-to-expected ratio = 0.84) cancers being the exceptions. The investigators reported the greatest birth deficit in survivors of other genitourinary cancers (other than those of the cervix, ovaries, bladder, or kidneys; observed-to-expected ratio = 0.35), followed by cervical cancer (observed-to-expected ratio = 0.42), breast cancer (observed-to-expected ratio = 0.49), and leukemia (observed-to-expected ratio = 0.53).

Risks of Obstetric Complications

Focusing on more common (observed ≥ 100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥ 1.25), the investigators reported a heightened risk of malpresentation of the fetus, obstructed labor, amniotic fluid and membrane disorders, premature rupture of membranes, preterm birth, placental disorders (ie, placenta previa), and antepartum hemorrhage for cervical cancer survivors. Leukemia survivors appeared to have an increased risk of preterm delivery, obstructed labor, postpartum hemorrhage, and retained placenta. In survivors of all other specific cancers, no more than two obstetric complications that were at least moderately in excess were documented.

“Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors concerning their risk of almost all obstetric complications,” the investigators concluded. “Our results provide evidence for the development of clinical guidelines relating to counseling and surveillance of obstetric risk for female adolescent and young adult cancer survivors.”

Raoul C. Reulen, PhD, of the University of Birmingham, United Kingdom, is the corresponding author of the article in The Lancet Oncology.

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.