Maternal and fetal outcomes of pregnancy-associated malignancy: A single-center retrospective cohort study

To analyze the disease spectrum, treatment patterns, and maternal and fetal outcomes of pregnancy-associated malignancy, and to explore factors associated with obstetric intervention, particularly iatrogenic preterm birth.

This single-center retrospective cohort study included pregnant women diagnosed with histologically confirmed malignancy from January 2013 to December 2021. Clinical, pathological, obstetric, neonatal, and follow-up data were extracted from electronic medical records. Maternal survival was assessed using the Kaplan-Meier method. Factors associated with iatrogenic preterm birth among women who continued pregnancy were explored using univariate analyses and multivariate logistic regression. Because of the limited sample size and multiple comparisons, inferential findings were interpreted cautiously and primarily as exploratory.

Fifty-three patients met the inclusion criteria. Nine terminated pregnancies in the first trimester because of disease severity, and four were lost to follow-up, leaving 40 pregnancies for obstetric and neonatal outcome analyses. The most common malignancies were hematologic cancers (30.19%, 16/53) and breast cancer (24.53%, 13/53). The median gestational age at diagnosis was 20 weeks. Among women who continued pregnancy, 19 (47.5%) received antitumor therapy during pregnancy. Compared with controls (n = 50), the malignancy cohort had higher rates of preterm birth (62.5% vs. 8.0%), low birth weight (45.0% vs. 6.0%), and cesarean delivery (60.0% vs. 32.0%) (all P < 0.001). Nineteen patients died during follow-up (35.8%, 19/53). In multivariate analysis for iatrogenic preterm birth, advanced tumor stage was associated with higher odds (OR = 5.82, 95% CI 1.21-27.98, P = 0.028). Other variables showed wide confidence intervals and were interpreted with caution.

Pregnancy-associated malignancy is associated with increased obstetric intervention and adverse neonatal outcomes, largely driven by prematurity. Tumor stage and the timing of diagnosis appear closely related to delivery decisions. Individualized multidisciplinary management is essential to balance maternal treatment needs with fetal maturity and neonatal safety.