Cancer diagnosis during pregnancy is associated with severe maternal and neonatal morbidity

Data on maternal and fetal outcomes in patients diagnosed with cancer during pregnancy are limited. Given expected increase in patients diagnosed with cancer during pregnancy, there is a growing need to evaluate clinical outcomes.

To evaluate obstetric outcomes among women with early-stage gynecologic or breast cancer who were diagnosed during pregnancy compared to women without cancer in a population-based cohort.

We performed a population-based study of women aged 18 to 45 years with stage I gynecologic or stage I to III breast cancer reported to the California Cancer Registry for the years 2000 to 2012. Data were linked to the 2000 to 2012 California birth data to produce a database with cancer characteristics and obstetric outcomes. We included patients who had a delivery within the 10 months following cancer diagnosis. The primary outcome was severe maternal morbidity. Secondary outcomes included preterm birth and neonatal morbidity. Propensity scores were used to match similar controls to cases in a 2:1 ratio based on demographic attributes and medical comorbidities included in the Obstetric Comorbidity Index. Logistic regressions were used to evaluate outcomes.

The cohort consisted of 503 women with cancer in pregnancy (319 breast, 125 ovarian, 59 cervical) and 1006 matched controls. Cancer during pregnancy was associated with higher odds of severe maternal morbidity (6.8% vs <1.1%; odds ratio 8.03, 95% confidence interval 3.82-16.88), preterm birth between 32 and 36 weeks (32.6% vs 8.3%, odds ratio 5.38, 95% confidence interval 4.02-7.20), and neonatal morbidity (12.5% vs 6.1%; odds ratio 2.22, 95% confidence interval 1.53-3.21) compared to matched controls. In subanalysis of severe maternal morbidity indicators, hysterectomy and sepsis were significantly associated with cancer during pregnancy (4.8% vs <1.1%, P<.001; <2.2% vs 0.0%, P=.037, respectively).

Cancer during pregnancy is associated with increased risk of maternal and neonatal morbidity. These findings highlight the need for careful management and consideration of obstetric outcomes in these patients.