Pregnancy outcomes among adult survivors of childhood cancer


Year:

Session type:

Raoul Reulen, Maurice Zeegers, Emma Lancashire, Dave Winter, Mike Hawkins

University of Birmingham, Birmingham, UK

Abstract

Objectives

One of the principal uncertainties in predicting the risk of untoward pregnancy outcomes among survivors of childhood cancer arises from the fact that most previous studies either lacked sufficient statistical power or were non-population based, which may have hindered accurate or valid quantification of risks. We used data from a large-scale population-based study to quantify the risk of untoward pregnancy outcomes in survivors of childhood cancer in relation to aspects of childhood cancer and its treatment.

Method

A questionnaire including questions inquiring about pregnancy outcomes of the survivor or their partner was completed by 10,477 survivors. A total of 6887 singleton pregnancies were reported. Logistic regression models were used to calculate odds ratios (ORs) for various untoward pregnancy outcomes by type of childhood cancer, whether initial treatment involved radiotherapy and/or chemotherapy, and whether the reproductive organs had been exposed to high-dose radiation.

Results

Female survivors with reproductive organs previously exposed to high-dose radiation had a significantly increased odds of delivering preterm (OR=2.7; 95%CI:1.9-3.8) and producing offspring with a low birth weight (OR=3.7; 95%CI: 2.6-5.3).There was also a slightly increased odds of miscarriage (OR=1.6; 95%CI: 1.2-2.1) among these women. Partners of male survivors exhibited no significantly increased odds of untoward pregnancy outcomes, other than that chemotherapy was associated with an increase in abortion among their partners (OR=2.3; 95%CI:1.6-3.2).

Conclusion

Female survivors of childhood cancer who have had their reproductive organs irradiated are at risk for delivering preterm and for producing low birth weight offspring. There are no strong indications of an increased risk of untoward pregnancy outcomes for partners of male survivors. The increased risk of abortion among partners of male survivors treated with chemotherapy is biologically not plausible and likely to be a chance finding. This large-scale population-based study confirms findings from previous smaller and non-population based studies.

Objectives

One of the principal uncertainties in predicting the risk of untoward pregnancy outcomes among survivors of childhood cancer arises from the fact that most previous studies either lacked sufficient statistical power or were non-population based, which may have hindered accurate or valid quantification of risks. We used data from a large-scale population-based study to quantify the risk of untoward pregnancy outcomes in survivors of childhood cancer in relation to aspects of childhood cancer and its treatment.

Method

A questionnaire including questions inquiring about pregnancy outcomes of the survivor or their partner was completed by 10,477 survivors. A total of 6887 singleton pregnancies were reported. Logistic regression models were used to calculate odds ratios (ORs) for various untoward pregnancy outcomes by type of childhood cancer, whether initial treatment involved radiotherapy and/or chemotherapy, and whether the reproductive organs had been exposed to high-dose radiation.

Results

Female survivors with reproductive organs previously exposed to high-dose radiation had a significantly increased odds of delivering preterm (OR=2.7; 95%CI:1.9-3.8) and producing offspring with a low birth weight (OR=3.7; 95%CI: 2.6-5.3).There was also a slightly increased odds of miscarriage (OR=1.6; 95%CI: 1.2-2.1) among these women. Partners of male survivors exhibited no significantly increased odds of untoward pregnancy outcomes, other than that chemotherapy was associated with an increase in abortion among their partners (OR=2.3; 95%CI:1.6-3.2).

Conclusion

Female survivors of childhood cancer who have had their reproductive organs irradiated are at risk for delivering preterm and for producing low birth weight offspring. There are no strong indications of an increased risk of untoward pregnancy outcomes for partners of male survivors. The increased risk of abortion among partners of male survivors treated with chemotherapy is biologically not plausible and likely to be a chance finding. This large-scale population-based study confirms findings from previous smaller and non-population based studies.