Obstetric and Neonatal Outcomes With Cancer Diagnosed During Pregnancy

Key Points

  • Use of antenatal treatment and likelihood of live birth increased over time.
  • Chemotherapy was associated with higher risk of being small for gestational age and NICU admission. 

As reported by de Haan et al in The Lancet Oncology, data from the International Network on Cancer, Infertility and Pregnancy (INCIP) registry indicate that use of chemotherapy during pregnancy has increased over a 20-year period, and that infants exposed to antenatal chemotherapy may be more likely to develop complications, such as being small for gestational age and requiring admission to the neonatal intensive care unit (NICU).

Study Details

The study involved INCIP data on 1,170 women from 37 sites in 16 counties who were diagnosed with primary invasive cancer during pregnancy between January 1996 and November 2016.   

Pregnancy Outcomes

Of the 1,170 women, 779 (67%) received cancer treatment during pregnancy. Breast cancer (39%) was the most common diagnosis. The likelihood of receiving cancer treatment during pregnancy increased every 5 years (relative risk [RR] = 1.10, 95% confidence interval [CI] = 1.05–1.15), primarily reflecting increased use of chemotherapy (RR = 1.31, 95% CI = 1.20–1.43).

Among 1,089 singleton pregnancies, 955 (88%) resulted in live birth; among 887 pregnancies with available data, 430 (48%) ended preterm. For each 5-year period, there was an increased likelihood of live birth (RR = 1.04, 95% CI = 1.01–1.06) and reduced likelihood of iatrogenic preterm deliveries (RR = 0.91, 95% CI = 0.84–0.98).

Neonatal Outcomes

A relationship was observed between platinum-based chemotherapy and small for gestational age status (odds ratio [OR] = 3.12, 95% CI = 1.45–6.70) and between taxane chemotherapy and NICU admission (OR = 2.37, 95% CI = 1.31–4.28). Compared with breast cancer, NICU admission was most likely in cases of gastrointestinal cancer (OR = 7·13, 95% CI = 2.86–17.7) and least likely in cases of thyroid cancers (OR = 0.14, 95% CI = 0.02–0.90). Abdominal or cervical surgery was associated with a reduced likelihood of NICU admission (OR = 0.30, 95% CI = 0.17–0.55).

The investigators concluded, “Over the years, the proportion of patients with cancer during pregnancy who received antenatal treatment increased, especially treatment with chemotherapy. Our data indicate that babies exposed to antenatal chemotherapy might be more likely to develop complications, specifically small for gestational age and NICU admission, than babies not exposed. We therefore recommend involving hospitals with obstetric high-care units in the management of these patients.”

The study was funded by Research Foundation—Flanders, European Research Council, Charles University, and Ministry of Health of the Czech Republic. 

Frédéric Amant, PhD, of the Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek—Netherlands Cancer Institute, is the corresponding author for The Lancet Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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