Abstract
PurposeTo evaluate pregnancy rates, time to pregnancy (TTP) and obstetric outcomes in female childhood cancer survivors (CCSs) and to identify specific diagnosis- and treatment-related factors associated with these outcomes.MethodsThe study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating fertility among long-term Dutch female CCSs. Data were collected by questionnaire. The current study included 1095 CCSs and 812 controls, consisting of sisters of CCSs and a random sample of women from the general population.ResultsAmong the subgroup of women who ever had the desire to become pregnant, the chance of becoming pregnant was significantly lower for CCSs than controls (OR 0.5, 95%CI 0.4–0.8). Moreover, TTP was 1.1 times longer for CCSs compared to controls (p = 0.09) and was significantly longer in survivors of CNS and renal tumours. Overall, no differences were found between CCSs and controls regarding the probability of ever having had a miscarriage, still birth, or induced abortion. However, CCSs had a significantly increased risk of delivering preterm (OR 2.2, 95%CI 1.3–3.7) and delivering via caesarean section (OR 1.8, 95%CI 1.2–2.6). Treatment with lower abdominal/pelvic radiotherapy was strongly associated with several adverse obstetric outcomes.ConclusionCCSs are less likely to have ever been pregnant. Among those who do become pregnant, certain subgroups of CCSs are at increased risk of longer TTP. Moreover, as pregnant CCSs, especially those treated with lower abdominal/pelvic radiotherapy, are more likely to develop various adverse obstetric outcomes, appropriate obstetric care is highly advocated.
Highlights
Increased survival rates for childhood cancer have resulted in a growing population of childhood cancer survivors (CCSs) (Gatta et al 2014)
Overall analyses showed that treatment with cranial/spinal radiotherapy resulted in a significantly higher probability of delivering via caesarean section. This is the first study which assessed pregnancy rates among female CCSs and controls who ever pursued pregnancy. This is one of the first studies assessing specific diagnosis- and treatment-related factors associated with pregnancy rates, time to pregnancy (TTP) and adverse obstetric outcomes using a large, nationwide, cohort of female CCSs
Our results show that the chance of becoming pregnant was significantly lower for CCSs compared to controls, which is in line with previous studies (Green et al 2009b; Chow et al 2016; Armuand et al 2017)
Summary
Increased survival rates for childhood cancer have resulted in a growing population of childhood cancer survivors (CCSs) (Gatta et al 2014). Journal of Cancer Research and Clinical Oncology (2020) 146:1451–1462 reproductive function resulting in infertility, subfertility, or a premature menopause due to a depletion of the ovarian follicle pool (Green et al 2002, 2009a; Chemaitilly et al 2006; Sklar et al 2006; van den Berg 2018). This may put CCSs at increased risk of a longer time to pregnancy (TTP) as seen in ageing women. The impact of a possible treatment-related reduced ovarian reserve on TTP for subsequent pregnancies remains unknown
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