Abstract
Background: Observational studies have suggested that perinatal outcomes are worse in offspring of cancer survivors. We conducted a systematic review and meta-analysis to examine the risks of perinatal complications in female cancer survivors diagnosed before the age of 40 years.
Methods: All published articles on pregnancy, perinatal or congenital risks in female cancer survivors were screened for eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
Results: Twenty-two studies met the inclusion criteria. Meta-analysis indicates that offspring of cancer survivors are at increased risk of prematurity (relative risk [RR]: 1.56; 95% confidence interval [CI] 1.37–1.77) and low birth weight (RR 1.47; 95% CI 1.24–1.73) but not of being small for gestational age (RR 0.99; 95% CI 0.81–1.22). Cancer survivors have higher rates of elective (RR: 1.38; 95% CI 1.13–1.70) and emergency caesarean section (RR: 1.22; 95% CI 1.15–1.30) as well as assisted vaginal delivery (RR: 1.10; 95% CI 1.02–1.18) and are at increased risk of postpartum haemorrhage (RR: 1.18; 95% CI 1.02–1.36). The risk of congenital abnormalities also appears increased (RR 1.10; 95% CI 1.02–1.20), but this is likely to be an artefact of analysis. Although meta-analysis of the effects of radiotherapy was not possible for all outcomes, there was an increased risk of prematurity (RR 2.27; 95% CI 1.34–3.82) and consistent findings of low birth weight (RR 1.38–2.31). Risk of being small for gestational age was increased only after high uterine radiotherapy dosage.
Conclusion: The increased perinatal risks warrant a proactive approach from healthcare providers in both counselling and management of perinatal care for cancer survivors.
Methods: All published articles on pregnancy, perinatal or congenital risks in female cancer survivors were screened for eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
Results: Twenty-two studies met the inclusion criteria. Meta-analysis indicates that offspring of cancer survivors are at increased risk of prematurity (relative risk [RR]: 1.56; 95% confidence interval [CI] 1.37–1.77) and low birth weight (RR 1.47; 95% CI 1.24–1.73) but not of being small for gestational age (RR 0.99; 95% CI 0.81–1.22). Cancer survivors have higher rates of elective (RR: 1.38; 95% CI 1.13–1.70) and emergency caesarean section (RR: 1.22; 95% CI 1.15–1.30) as well as assisted vaginal delivery (RR: 1.10; 95% CI 1.02–1.18) and are at increased risk of postpartum haemorrhage (RR: 1.18; 95% CI 1.02–1.36). The risk of congenital abnormalities also appears increased (RR 1.10; 95% CI 1.02–1.20), but this is likely to be an artefact of analysis. Although meta-analysis of the effects of radiotherapy was not possible for all outcomes, there was an increased risk of prematurity (RR 2.27; 95% CI 1.34–3.82) and consistent findings of low birth weight (RR 1.38–2.31). Risk of being small for gestational age was increased only after high uterine radiotherapy dosage.
Conclusion: The increased perinatal risks warrant a proactive approach from healthcare providers in both counselling and management of perinatal care for cancer survivors.
| Original language | English |
|---|---|
| Pages (from-to) | 126-137 |
| Journal | European Journal of Cancer |
| Volume | 111 |
| Early online date | 5 Mar 2019 |
| DOIs | |
| Publication status | Published - Apr 2019 |
Keywords
- Cancer survivors
- Perinatal risk
- Premature delivery
- Postpartum haemorrhage
- Low birth weight
- Congenital abnormalities
Access to Document
- van-der-Kooi-2019-Perinatal-complications-EJC-AAM
Copyright 2019 Published by Elsevier Ltd. This work has been made available online in accordance with the publisher's policies. This is the author created accepted version manuscript following peer review and as such may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1016/j.ejca.2019.01.104