Risk for maternal death higher in pregnancies complicated due to cancer
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Risks for severe maternal morbidity and mortality appeared higher among pregnancies complicated by cancer, according to study results in a research letter published in JAMA Oncology.
Rationale and methods
“To date, little data have examined the association between cancer and maternal morbidity and mortality. Not only is the incidence of cancer in women of reproductive age increasing, but as treatment improves, women with cancer are living longer,” Koji Matsuo, MD, PhD, researcher in the division of gynecologic oncology in the department of obstetrics and gynecology at Keck School of Medicine of the University of Southern California, and colleagues wrote.
“In addition, there has been an increased focus on fertility preservation in both men and women of reproductive age with cancer,” they added. “The objective of this cohort study was to examine nationwide trends and characteristics of severe maternal morbidity and mortality among pregnant women with cancer in the U.S.”
Researchers used data from the National Inpatient Sample database to conduct a population-based retrospective cohort study that included 14,648,135 individuals (median age, 29 years; 50.4% white) with cancer and without cancer.
They used a multivariable binary logistic regression model to first examine patient, hospital and pregnancy characteristics associated with cancer. Researchers then examined severe maternal morbidity as defined by the CDC and mortality during the index admission for delivery among those with cancer. They performed propensity score analysis with inverse probability of treatment weighting to account for the effects of clinical and demographic characteristics on cancer.
Key findings
Results showed a prevalence rate of pregnancy with cancer of 69.3 per 100,000 deliveries, which increased from 64.5 to 73.4 between 2016 and 2019, for a relative increase of 13.8% (P < .001).
Breast cancer was the most common cancer type, followed by lymphoma, leukemia and gynecologic cancers. Researchers observed an increase throughout time in the prevalence of skin, soft tissue, breast and oral cavity/pharyngeal cancers.
The most common factors associated with cancer included patient characteristics of advanced age, more recent year of delivery, white race, obesity, smoking, preexisting hypertension and chemotherapy exposure, as well as pregnancy characteristics of early preterm delivery and cesarean delivery.
After researchers adjusted for potential mediators between cancer and adverse outcomes, they found patients with cancer more likely to experience severe maternal morbidity (97.4 per 1,000 deliveries vs. 17.3 per 1,000 deliveries; adjusted OR = 3.63; 95% CI, 3.42-3.84) and death during the index hospital stay for delivery (2.2 per 1,000 deliveries vs. < 0.1 per 1,000 deliveries; adjusted OR = 13.34; 95% CI, 8.72-20.39).
They noted similar associations for sepsis, ventilation and hysterectomy.
Limitations
Study limitations included a lack information on cancer stage, anticancer treatment and disease status at the time of delivery, an inability to perform cancer type-specific analyses owing to limited sample size, and ascertainment bias. In addition, the database researchers used did not include cause of death, oncologic outcomes, neonatal outcomes and information after discharge.
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