Leslie V Farland1, Judy E Stern2, Sunah S Hwang3, Chia-Ling Liu4, Howard Cabral5, Richard Knowlton6, Susan T Gershman6, Charles C Coddington7, Stacey A Missmer8,9. 1. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO Box: 245211, Tucson, AZ, 85724, USA. lfarland@email.arizona.edu. 2. Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, NH, USA. 3. Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA. 4. Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA. 5. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. 6. Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Office of Population Health, Massachusetts Department of Public Health, Boston, MA, USA. 7. Department of Obstetrics and Gynecology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA. 8. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 9. Department of Obstetrics and Gynecology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.
Abstract
PURPOSE: Investigate the relationship between history of cancer and adverse pregnancy outcomes according to subfertility/fertility treatment. METHODS: Deliveries (2004-2013) from Massachusetts (MA) Registry of Vital Records and Statistics were linked to MA assisted reproductive technology data, hospital discharge records, and Cancer Registry. The relative risks (RR) and 95% confidence intervals of adverse outcomes (gestational diabetes (GDM), gestational hypertension (GHTN), cesarean section (CS), low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), neonatal mortality, and prolonged neonatal hospital stay) were modeled with log-link and Poisson distribution generalized estimating equations. Differences by history of subfertility/fertility treatment were investigated with likelihood ratio tests. RESULTS: Among 662,630 deliveries, 2,983 had a history of cancer. Women with cancer history were not at greater risk of GDM, GHTN, or CS. However, infants born to women with prior cancer had higher risk of LBW (RR: 1.19 [1.07-1.32]), prolonged neonatal hospital stay (RR: 1.16 [1.01-1.34]), and PTB (RR: 1.19 [1.07-1.32]). We found clinically and statistically significant differences in the relationship between cancer history and SGA by subfertility/fertility treatment (p value, test for heterogeneity = 0.02); among deliveries with subfertility or fertility treatment, those with a history of cancer experienced a greater risk of SGA (RRsubfertile: 1.36 [1.02-1.83]). CONCLUSIONS: Women with a history of cancer had greater risk of some adverse pregnancy outcomes; this relationship varied by subfertility and fertility treatment.
PURPOSE: Investigate the relationship between history of cancer and adverse pregnancy outcomes according to subfertility/fertility treatment. METHODS: Deliveries (2004-2013) from Massachusetts (MA) Registry of Vital Records and Statistics were linked to MA assisted reproductive technology data, hospital discharge records, and Cancer Registry. The relative risks (RR) and 95% confidence intervals of adverse outcomes (gestational diabetes (GDM), gestational hypertension (GHTN), cesarean section (CS), low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), neonatal mortality, and prolonged neonatal hospital stay) were modeled with log-link and Poisson distribution generalized estimating equations. Differences by history of subfertility/fertility treatment were investigated with likelihood ratio tests. RESULTS: Among 662,630 deliveries, 2,983 had a history of cancer. Women with cancer history were not at greater risk of GDM, GHTN, or CS. However, infants born to women with prior cancer had higher risk of LBW (RR: 1.19 [1.07-1.32]), prolonged neonatal hospital stay (RR: 1.16 [1.01-1.34]), and PTB (RR: 1.19 [1.07-1.32]). We found clinically and statistically significant differences in the relationship between cancer history and SGA by subfertility/fertility treatment (p value, test for heterogeneity = 0.02); among deliveries with subfertility or fertility treatment, those with a history of cancer experienced a greater risk of SGA (RRsubfertile: 1.36 [1.02-1.83]). CONCLUSIONS: Women with a history of cancer had greater risk of some adverse pregnancy outcomes; this relationship varied by subfertility and fertility treatment.
Entities:
Keywords:
Cancer survivors; Infertility; Low birthweight; Neonatal mortality; Pregnancy; Preterm birth; Small for gestational age
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