PDF herunterladen
Am J Perinatol 2022; 39(02): 144-153
DOI: 10.1055/s-0040-1714394
Original Article

Cancer and Pregnancy: National Trends

Kimberly K. Ma
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington
,
Sarah E. Monsell
2   Department of Biostatistics, University of Washington, Seattle, Washington
,
Suchitra Chandrasekaran
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington
,
Vijayakrishna K. Gadi
3   Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
4   Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
5   Division of Medical Oncology, University of Washington, Seattle, Washington
,
Hilary S. Gammill
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington
3   Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
› Institutsangaben Funding This research was funded by a research grant from the Washington State Obstetrical Association, 2016.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective Cancer and pregnancy are likely increasing; however, updated estimates are needed to optimally address the unique needs of this patient population. The study aims to estimate the prevalence of cancer and cancer survivorship at delivery, to test the change in odds of cancer and cancer survivorship at delivery over the 10-year period, and to compare medical conditions, serious events, and obstetric complications between pregnancies with and without cancer at delivery.

Study Design We conducted a retrospective analysis of the National Inpatient Sample (NIS), the largest all-payer inpatient health database in the United States. We identified delivery admissions from 2004 to 2013 with a concurrent diagnosis of cancer using International Classification of Disease, ninth revision (ICD-9) codes. Multivariable logistic regression was used to test the change in prevalence of concurrent cancer, cancer survivorship, and pregnancy and to compare outcomes between deliveries with and without cancer. All analyses were adjusted for NIS-provided population weights and strata.

Results During the study period, the NIS represented a national estimate of 40,855,208 deliveries. The odds of cancer increased from 3.41/10,000 deliveries in 2004 to 4.33/10,000 in 2013. This trend was statistically significant, including after adjustment for maternal age (adjusted odds ratio [aOR] = 1.03 [95% confidence interval (CI): 1.01–1.04]). Cancer survivorship at delivery increased significantly (aOR = 1.07 [95% CI: 1.06–1.08]). Women with cancer more often experienced one or more of the following: death, ventilation, cardiac arrest, sepsis, or acute respiratory or renal failure during delivery (aOR for composite outcome 10.7 [95% CI: 6.6–17.2]), even after adjustment in a multivariable logistic regression model.

Conclusion The odds of cancer and cancer survivorship at delivery increased from 2004 to 2013, independent of maternal age. Women with cancer were more likely to experience medical or obstetric complications during their delivery compared with women without cancer. These findings highlight the importance of obstetric and oncologic clinical and research collaboration to improve patient care.

Key Points

  • The odds of cancer at delivery increased.

  • Women with cancer may have delivery complications.

  • Cancer survivorship at delivery increased.

Keywords

cancer - cancer survivorship - pregnancy - delivery

Note

This study was presented at the 38th Annual Meeting of the Society of Maternal-Fetal Medicine, Dallas, TX; January 29–February 3, 2018.


Supplementary Material



Publikationsverlauf

Eingereicht: 13. April 2020

Angenommen: 13. Juni 2020

Artikel online veröffentlicht:
21. Juli 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Howlader N, Noone A, Krapcho M. et al. SEER Cancer Statistics Review, 1975–2014. Accessed April 1, 2017 at: https://seer.cancer.gov/csr/1975_2014/
    PubMedGoogle Scholar
  • 2 Eibye S, Kjær SK, Mellemkjær L. Incidence of pregnancy-associated cancer in Denmark, 1977-2006. Obstet Gynecol 2013; 122 (03) 608-617
    CrossrefPubMedGoogle Scholar
  • 3 Lee YY, Roberts CL, Dobbins T. et al. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG 2012; 119 (13) 1572-1582
    CrossrefPubMedGoogle Scholar
  • 4 Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 2003; 189 (04) 1128-1135
    CrossrefPubMedGoogle Scholar
  • 5 Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 2001; 184 (07) 1504-1512 , discussion 1512–1513
    CrossrefPubMedGoogle Scholar
  • 6 Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist 2002; 7 (04) 279-287
    CrossrefPubMedGoogle Scholar
  • 7 Williams TJ, Turnbull KE. Carcinoma in situ and pregnancy. Obstet Gynecol 1964; 24: 857-864
    PubMedGoogle Scholar
  • 8 Mathews TJ, Hamilton BE. Mean Age of Mothers is on the Rise: United States, 2000-2014. NCHS Data Brief 2016; (232) 1-8
    PubMedGoogle Scholar
  • 9 Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol 2004; 5 (05) 283-291
    CrossrefPubMedGoogle Scholar
  • 10 Morice P, Uzan C, Uzan S. Cancer in pregnancy: a challenging conflict of interest. Lancet 2012; 379 (9815): 495-496
    CrossrefPubMedGoogle Scholar
  • 11 Peccatori FA, Azim Jr HA, Orecchia R. et al; ESMO Guidelines Working Group. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (Suppl. 06) vi160-vi170
    CrossrefPubMedGoogle Scholar
  • 12 Amant F, Halaska MJ, Fumagalli M. et al; ESGO task force ‘Cancer in Pregnancy’. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer 2014; 24 (03) 394-403
    CrossrefPubMedGoogle Scholar
  • 13 Salani R, Billingsley CC, Crafton SM. Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol 2014; 211 (01) 7-14
    CrossrefPubMedGoogle Scholar
  • 14 Amant F, Han SN, Gziri MM, Vandenbroucke T, Verheecke M, Van Calsteren K. Management of cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29 (05) 741-753
    CrossrefPubMedGoogle Scholar
  • 15 Cardonick EH, Gringlas MB, Hunter K, Greenspan J. Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol 2015; 212 (05) 658.e1-658.e8
    CrossrefPubMedGoogle Scholar
  • 16 Lishner M, Avivi I, Apperley JF. et al. Hematologic malignancies in pregnancy: Management guidelines from an international consensus meeting. J Clin Oncol 2016; 34 (05) 501-508
    CrossrefPubMedGoogle Scholar
  • 17 Shim MH, Mok C-W, Chang KH-J. et al. Clinical characteristics and outcome of cancer diagnosed during pregnancy. Obstet Gynecol Sci 2016; 59 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 18 Mitrou S, Zarkavelis G, Fotopoulos G, Petrakis D, Pavlidis N. A mini review on pregnant mothers with cancer: a paradoxical coexistence. J Adv Res 2016; 7 (04) 559-563
    CrossrefPubMedGoogle Scholar
  • 19 de Haan J, Verheecke M, Van Calsteren K. et al; International Network on Cancer and Infertility Pregnancy (INCIP). Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol 2018; 19 (03) 337-346
    CrossrefPubMedGoogle Scholar
  • 20 Haas JF. Pregnancy in association with a newly diagnosed cancer: a population-based epidemiologic assessment. Int J Cancer 1984; 34 (02) 229-235
    CrossrefPubMedGoogle Scholar
  • 21 Lambe M, Ekbom A. Cancers coinciding with childbearing: delayed diagnosis during pregnancy?. BMJ 1995; 311 (7020): 1607-1608
    CrossrefPubMedGoogle Scholar
  • 22 Demeter A, Sziller I, Csapó Z, Szánthó A, Papp Z. Outcome of pregnancies after cold-knife conization of the uterine cervix during pregnancy. Eur J Gynaecol Oncol 2002; 23 (03) 207-210
    PubMedGoogle Scholar
  • 23 Dalrymple JL, Gilbert WM, Leiserowitz GS. et al. Pregnancy-associated cervical cancer: obstetric outcomes. J Matern Fetal Neonatal Med 2005; 17 (04) 269-276
    CrossrefPubMedGoogle Scholar
  • 24 Andersson TM-L, Johansson ALV, Hsieh C-C, Cnattingius S, Lambe M. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 2009; 114 (03) 568-572
    CrossrefPubMedGoogle Scholar
  • 25 Abenhaim HA, Azoulay L, Holcroft CA, Bure LA, Assayag J, Benjamin A. Incidence, risk factors, and obstetrical outcomes of women with breast cancer in pregnancy. Breast J 2012; 18 (06) 564-568
    CrossrefPubMedGoogle Scholar
  • 26 Eyre TA, Lau I-J, Mackillop L, Collins GP. Management and controversies of classical Hodgkin lymphoma in pregnancy. Br J Haematol 2015; 169 (05) 613-630
    CrossrefPubMedGoogle Scholar
  • 27 Pinnix CC, Osborne EM, Chihara D. et al. Maternal and fetal outcomes after therapy for Hodgkin or non-Hodgkin lymphoma diagnosed during pregnancy. JAMA Oncol 2016; 2 (08) 1065-1069
    CrossrefPubMedGoogle Scholar
  • 28 Shechter Maor G, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Neonatal outcomes of pregnancy-associated breast cancer: population-based study on 11 million births. Breast J 2019; 25 (01) 86-90
    CrossrefPubMedGoogle Scholar
  • 29 Spiegel E, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcomes after thyroid cancer. J Perinat Med 2019; 47 (07) 710-716
    CrossrefPubMedGoogle Scholar
  • 30 Stensheim H, Møller B, van Dijk T, Fosså SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 2009; 27 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 31 de Moor JS, Mariotto AB, Parry C. et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev 2013; 22 (04) 561-570
    CrossrefPubMedGoogle Scholar
  • 32 Miller KD, Siegel RL, Lin CC. et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66 (04) 271-289
    CrossrefPubMedGoogle Scholar
  • 33 Howden LM, Meyer JA. Age and Sex Composition: 2010. Accessed July 1, 2016 at: http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf
    PubMedGoogle Scholar
  • 34 Green DM, Whitton JA, Stovall M. et al. Pregnancy outcome of female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Am J Obstet Gynecol 2002; 187 (04) 1070-1080
    CrossrefPubMedGoogle Scholar
  • 35 Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol 2005; 6 (05) 328-333
    CrossrefPubMedGoogle Scholar
  • 36 Signorello LB, Cohen SS, Bosetti C. et al. Female survivors of childhood cancer: preterm birth and low birth weight among their children. J Natl Cancer Inst 2006; 98 (20) 1453-1461
    CrossrefPubMedGoogle Scholar
  • 37 Wo JY, Viswanathan AN. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys 2009; 73 (05) 1304-1312
    CrossrefPubMedGoogle Scholar
  • 38 Stensheim H, Cvancarova M, Møller B, Fosså SD. Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer 2011; 129 (05) 1225-1236
    CrossrefPubMedGoogle Scholar
  • 39 Watanabe T, Matsubara S, Saito Y, Usui R, Mugishima H, Suzuki M. Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood. J Obstet Gynaecol Res 2012; 38 (03) 559-561
    CrossrefPubMedGoogle Scholar
  • 40 Beneventi F, Locatelli E, Giorgiani G. et al. Adolescent and adult uterine volume and uterine artery Doppler blood flow among subjects treated with bone marrow transplantation or chemotherapy in pediatric age: a case-control study. Fertil Steril 2015; 103 (02) 455-461
    CrossrefPubMedGoogle Scholar
  • 41 Dominick SA, McLean MR, Whitcomb BW. et al. Contraceptive practices among female cancer survivors of reproductive age. Obstet Gynecol 2015; 126 (03) 498-507
    CrossrefPubMedGoogle Scholar
  • 42 Chait-Rubinek L, Mariani JA, Goroncy N. et al. A retrospective evaluation of risk of peripartum cardiac dysfunction in survivors of childhood, adolescent and young adult malignancies. Cancers (Basel) 2019; 11 (08) 11
    CrossrefPubMedGoogle Scholar
  • 43 Centers for Medicare and Medicaid Services. CD-9-CM Diagnosis and Procedure Codes: Abbreviated and Full Code Titles. Accessed June 1, 2016 at: https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html
    PubMedGoogle Scholar
  • 44 Kuklina EV, Whiteman MK, Hillis SD. et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
    CrossrefPubMedGoogle Scholar
  • 45 Podulka J, Stranges E, Steiner C. Hospitalizations Related to Childbirth, 2008. Accessed June 1, 2017 at: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb110.pdf
    PubMedGoogle Scholar
  • 46 Patel EM, Swamy GK, Heine RP. et al. Medical and obstetric complications among pregnant women with cystic fibrosis. Am J Obstet Gynecol 2015; 212 (01) 98e1-98e9
    CrossrefPubMedGoogle Scholar
  • 47 Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA. Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol 2015; 126 (02) 346-354
    CrossrefPubMedGoogle Scholar
  • 48 StataCorp 14. Stata 14 Release. Accessed July 3, 2020 at: https://www.stata.com/stata14/
    PubMedGoogle Scholar
  • 49 R Foundation for Statistical Computing. R: A language and environment for statistical computing. Accessed July 3, 2020 at: https://www.gbif.org/tool/81287/r-a-language-and-environment-for-statistical-computing
    PubMedGoogle Scholar
  • 50 Ries L, Melbert D, Krapcho M. et al. SEER Cancer Statistics Review, 1975–2004. Accessed on April 1, 2017 at: http://seer.cancer.gov/csr/1975_2004
    PubMedGoogle Scholar
  • 51 Zagouri F, Sergentanis TN, Chrysikos D, Papadimitriou CA, Dimopoulos MA, Bartsch R. Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat 2013; 137 (02) 349-357
    CrossrefPubMedGoogle Scholar
  • 52 Thorpe PG, Gilboa SM, Hernandez-Diaz S. et al; National Birth Defects Prevention Study. Medications in the first trimester of pregnancy: most common exposures and critical gaps in understanding fetal risk. Pharmacoepidemiol Drug Saf 2013; 22 (09) 1013-1018
    CrossrefPubMedGoogle Scholar
  • 53 Boere I, Lok C, Vandenbroucke T, Amant F. Cancer in pregnancy: safety and efficacy of systemic therapies. Curr Opin Oncol 2017; 29 (05) 328-334
    CrossrefPubMedGoogle Scholar
  • 54 Agnecy for Healthcare Research and Quality. Overview of the National (Nationwide) Inpatient Sample (NIS). Accessed July 1, 2016 at: https://www.hcup-us.ahrq.gov/nisoverview.jsp
    PubMedGoogle Scholar
  • 55 Lawthers AG, McCarthy EP, Davis RB. et al. Identification of in-hospital complication from claims data identification complications is it valid?. Med Care 2000; 38: 785-795
    CrossrefPubMedGoogle Scholar
  • 56 MacDorman MF, Declercq E. Trends and state variations in out-of-hospital births in the United States, 2004-2017. Birth 2019; 46 (02) 279-288
    CrossrefPubMedGoogle Scholar