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Neonatal outcomes of pregnancy-associated breast cancer: Population-based study on 11 million births
Gil Shechter Maor1, Nicholas Czuzoj-Shulman2, Andrea R Spence2
1Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
Insights
Pregnancy-associated breast cancer (PABC) incidence is rising. While PABC increases preterm birth risk, it does not raise risks for congenital anomalies, growth restriction, or fetal demise.
Area of Science:
- Reproductive Health
- Oncology
- Perinatal Medicine
Background:
- Increasing maternal age at first pregnancy correlates with rising breast cancer diagnoses during pregnancy.
- Pregnancy-associated breast cancer (PABC) presents unique challenges for both mother and neonate.
Purpose of the Study:
- To evaluate temporal trends in PABC incidence in the United States.
- To assess neonatal outcomes associated with PABC.
Main Methods:
- Population-based cohort study utilizing the 1999-2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS).
- Logistic regression models adjusted for maternal characteristics were used to examine PABC's effect on neonatal outcomes.
Main Results:
- An overall incidence of 6.5 PABC cases per 100,000 pregnancies was observed, with a significant increasing trend from 1999-2012.
- Women with PABC were often older, white, of higher socioeconomic status, and treated in urban teaching hospitals.
- PABC significantly increased the risk of preterm delivery (OR 4.84) and preterm premature rupture of membranes (OR 1.79), but not intrauterine growth restriction, congenital anomalies, or fetal demise.
Conclusions:
- The rising incidence of PABC necessitates increased patient counseling and awareness.
- While PABC is linked to higher rates of premature birth, neonates are not at increased risk for major adverse outcomes like congenital anomalies or fetal demise.
Background:
As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy-associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC.
Methods:
We conducted a population-based cohort study using the 1999-2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from the United States. Logistic regression models, adjusted for maternal baseline characteristics, examined the effect of PABC on neonatal outcomes.
Results:
There were 11 846 300 deliveries between 1999 and 2012, of which 772 cases of PABC were identified, resulting in an overall incidence of 6.5 cases/100 000 pregnancies. There was a significant increase in the incidence of PABC during the study period (P < 0.05). Women with PABC tended to be older, of white ethnicity, belong to a higher income quartile and to be treated in an urban teaching hospital. In pregnancies complicated by breast cancer, there was a greater risk of preterm delivery (OR 4.84, 95% CI 4.05-5.79) and preterm premature rupture of membranes (OR 1.79, 95% CI 1.06-3.05). No associations were observed between PABC and intrauterine growth restriction, congenital anomalies or intrauterine fetal demise.
Conclusion:
There is an uptrend in the incidence of PABC and therefore, the need for counseling these patients is also increasing. Although pregnancies with the diagnosis of maternal breast cancer are more prone to premature births, it is encouraging that these babies do not appear to be at increased risk for congenital anomalies, growth restriction, or fetal demise.
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