Abstract
BackgroundPregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy.MethodsThis population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women.ResultsOut of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57–2.07), cesarean section (aPR=1.78, 95% CI: 1.49–2.11) and premature birth (aPR=6.34, 95% CI: 4.59–8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36–1.35 and aPR=1.04, 95% CI: 0.78–1.39, respectively), but newborn among PAC women had a lower birth weight (p-value< 0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96–7.33) as compared to cancer-free women.ConclusionPAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.
Highlights
Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes
All Italian citizens have equal access to health care services as part of the National Health Service (NHS), and in Lombardy this has been associated with an automated system of databases to collect a variety of information on residents who receive NHS assistance (NHS beneficiaries), diagnoses and procedures of inpatients of public or private hospitals, outpatient drug prescriptions (coded according to the Anatomical Therapeutic Chemical (ATC) Classification System), specialist visits and diagnostic examinations reimbursable by the NHS
We excluded 625 deliveries with missing values on Apgar score, 483 on vitality status and 77 on birth weight, 7408 deliveries who did not match to a hospital International Classification of Diseases (ICD)-9 code related to childbirth and 39 deliveries with infant missing identification code
Summary
Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. The risk of spontaneous preterm birth is not significantly higher [9]. Medically induced labor or elective cesarean section are more frequently performed, due to the need of an early pregnancy termination in order to start surgical or pharmacological treatment [8,9,10]. Most of these results come from clinical series based on a specific context. Limited evidence has been published on the perinatal outcomes in women with PAC in populationbased studies [6]
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