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Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997
L H Smith1, J L Dalrymple, G S Leiserowitz
1Department of Obstetrics and Gynecology, University of California, Davis, School of Medicine, Sacramento 95817, USA.
American Journal of Obstetrics and Gynecology
|June 16, 2001
Summary
Malignant neoplasms in pregnant women occurred at a rate of 0.71 per 1000 births, most often diagnosed postpartum. While maternal death risk was not elevated, neonatal morbidity and mortality risks increased, particularly for infants of mothers with cervical cancer.
Area of Science:
- Obstetrics and Gynecology
- Oncology
- Perinatology
Background:
- Malignant neoplasms diagnosed during pregnancy present unique challenges for maternal and fetal outcomes.
- Understanding the incidence and characteristics of cancer in pregnant populations is crucial for clinical management and public health.
- Previous studies, often hospital-based, may not fully represent the population-level occurrence of cancer during childbirth.
Purpose of the Study:
- To determine the incidence rate of malignant neoplasms in women undergoing obstetrical delivery.
- To characterize the timing of cancer diagnosis (prenatal, at delivery, postpartum) in relation to childbirth.
- To analyze the maternal and neonatal outcomes associated with pregnancy complicated by cancer.
Main Methods:
- A population-based retrospective study utilizing linked birth/death certificates and maternal/neonatal discharge records from California (1992-1997).
- Malignant neoplasms were identified using ICD-9 codes (140-208), excluding noninvasive and in situ types.
- Outcomes were analyzed using Mantel-Haenszel estimates for adjusted odds ratios.
Main Results:
- A total of 2247 primary malignancies were identified among 3,168,911 deliveries, yielding an overall incidence of 0.71 per 1000 live births.
- The majority of cancers (53.3%) were first diagnosed postpartum.
- Breast, thyroid, cervical, Hodgkin's, and ovarian cancers were the most common. Advanced maternal age (>40) was a significant risk factor. Cesarean delivery, blood transfusion, and longer hospital stays were associated with increased maternal morbidity. Neonatal risks included prematurity and low birth weight. Infants of mothers with cervical cancer faced an increased risk of neonatal death. Hospital charges were significantly higher for mothers with cancer.
Conclusions:
- The population-based incidence of cancer during childbirth is lower than previously reported in hospital-based studies.
- Malignant neoplasms are most frequently diagnosed postpartum, highlighting the importance of postpartum surveillance.
- While in-hospital maternal mortality was not significantly increased, maternal and neonatal morbidity were substantially elevated, with specific risks for neonatal death in certain cancer types (e.g., cervical cancer).