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Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality
Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden; University of Nottingham, Nottingham, United Kingdom; Columbia University College of Physicians and Surgeons, New York NY, United States .ORCID iD: 0000-0003-1024-5602
Karolinska University Hospital, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-3649-2639
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2017 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 35, no 14, 1522-1529 p., JCO2016699439Article in journal (Refereed) Published
Abstract [en]

Purpose: To examine whether maternal cancer during pregnancy is associated with increased risks of stillbirth and infant mortality.

Methods: On the basis of nationwide health registers, we conducted a study of 3,947,215 singleton births in Sweden from 1973 through 2012. Exposure was defined as maternal cancer diagnosed during pregnancy (number of births = 984) or during the year after pregnancy (number of births = 2,723). We calculated incidence rate ratios (IRRs) for stillbirth and infant mortality, comparing exposed births to unexposed births. Small-for-gestational-age (SGA) and preterm births were examined as secondary outcomes.

Results: Maternal cancer diagnosed during pregnancy was positively associated with stillbirth (IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as SGA (IRR, 4.9; 95% CI, 2.2 to 11.0), and with preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Positive associations of maternal cancer diagnosed during pregnancy or the year after pregnancy were noted for both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality.

Conclusion: Maternal cancer during pregnancy is associated with increased risks of rare but fatal outcomes, including stillbirth and neonatal mortality. This may be due to conditions associated with fetal growth restriction and iatrogenic preterm birth. Careful monitoring of fetal growth and cautious decision making on preterm delivery should therefore be reinforced.

Place, publisher, year, edition, pages
American Society of Clinical Oncology , 2017. Vol. 35, no 14, 1522-1529 p., JCO2016699439
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-57334DOI: 10.1200/JCO.2016.69.9439ISI: 000400811200007PubMedID: 28384079Scopus ID: 2-s2.0-85019131648OAI: oai:DiVA.org:oru-57334DiVA: diva2:1103530
Funder
Swedish Cancer Society, CAN 2014/417Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0498Swedish Society for Medical Research (SSMF)
Note

Funding agencies:

Karolinska Institutet (KI)

Karolinska Institutet Research Associate Award

Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2017-09-18Bibliographically approved

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