Pregnant Women With Previous or Current Cancer Diagnoses May Experience More Complications During Delivery

Pregnant women with current or previous cancer diagnoses were more likely to have comorbidities than pregnant women without cancer. Although there are disparities between cancers, certain types, such as hematologic cancer, were associated with higher death rates and more in-hospital complications.

The findings, which were published in Mayo Clinic Proceedings, also demonstrated that women with current or historical cancer were older and had more costly hospital visits, compared to women without cancer.

“Women who have been diagnosed with cancer either during pregnancy or before they have completed child-bearing need appropriate counseling so they can make informed choices,” the study authors wrote. “However, because of limited clinical experience and expertise, management of cancer in pregnancy remains a challenge for clinicians and the expectant mothers and their families.”

The researchers aimed to assess the chronological trends, comorbidities and in-hospital cardiovascular/obstetric complications and outcomes of pregnant women with a current or historical cancer diagnosis during the time they were admitted for delivery. To do so, they analyzed hospital discharge data from the U.S. National Inpatient Sample (NIS) database ranging from 2004 to 2014.

There were a total of 43,238,551 delivery hospitalization episodes included in the analysis. Researchers identified an increase over time in the prevalence of women being admitted with a historical cancer diagnosis (from .12% in 2004 to .22% in 2014). There was also a small increase in women with a current cancer diagnosis (.07% to .12%).

Women with current and historical cancer diagnoses had a higher prevalence of most comorbidities, which included previous heart attacks (0.09% current and 0.07% historical vs 0.01% without diagnosis), heart failure (0.31% current and 0.23% historical vs 0.05% without diagnosis) and previous stroke (0.14% current and 0.15% historical vs 0.03% without diagnosis). They were also more likely to be smokers (12.54% current and 9.29% historical) compared with women without cancer (6.08%).

Maternal complications and outcomes were most prevalent in women with a current cancer diagnosis compared with women with a historical diagnosis or with no diagnosis. The complications included mortality, acute kidney injury and stroke. Outcomes (also higher in the current cancer group) were preterm birth and post-partum hemorrhage.

The most common current cancer diagnosis among the pregnant women were lymphoma and leukemia, followed by thyroid and cervical. Among the women with historical diagnoses, thyroid was the most common cancer type. The maternal complications were most prevalent in women with lymphoma and leukemia.

“In pregnant patients, it is pertinent to be aware of maternal and neonatal risks associated with current and historical cancer diagnosis so these can be monitored,” the authors wrote. “…Clinicians should communicate the risks of multisystem complications to these complex patients.”

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