Assessment of Severe Maternal Morbidity and Mortality in Pregnancies Complicated by Cancer in the US

Matsuo, Koji; Klar, Maximilian; Youssefzadeh, Ariane C.; Mandelbaum, Rachel S.; Roman, Lynda D.; Ouzounian, Joseph G.; Wright, Jason D.

doi:10.1001/jamaoncol.2022.1795

Cited by 18 publications

(19 citation statements)

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“…The strength of recommendations for malignancy investigation varies after atypical noninvasive prenatal screening results, 9 but our study and other recent publications 13,30–33 support investigation for malignancy in all patients. Currently, there are no national society guidelines in the United States for maternal malignancy investigation in patients with suspicious prenatal cell-free DNA screening results, and optimal management strategy remains unclear.…”

Section: Discussionsupporting

confidence: 57%

“…The most common type of cancer identified by SNP-based noninvasive prenatal screening was lymphoma, followed by breast and colorectal cancer, findings that are consistent with existing noninvasive prenatal screening studies. 30 Of note, two of the patients in our cohort had an active cancer diagnosis at the time of noninvasive prenatal screening.…”

Section: Discussionmentioning

confidence: 95%

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Maternal Malignancy After Atypical Findings on Single-Nucleotide Polymorphism–Based Prenatal Cell-Free DNA Screening

Goldring

Trotter

Meltzer

et al. 2023

Obstetrics &Amp; Gynecology

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To evaluate the incidence and clinical outcomes of cell-free DNA results suspicious for maternal malignancy on prenatal cell-free DNA screening with single-nucleotide polymorphism (SNP)-based technology. METHODS:This retrospective cohort study included data from SNP-based, noninvasive prenatal screening samples from a commercial laboratory from January 2015 to October 2021. Maternal plasma was screened for trisomy 21, 18, and 13; monosomy X; and triploidy. Cases were considered suspicious for maternal malignancy if retrospective bioinformatics and visual inspection of the SNP plot were suggestive of multiple maternal copy number variants across at least two of the tested chromosomes. Clinical follow-up on patients was obtained by contacting individual referring clinician offices by telephone, facsimile, or email.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 95%

Maternal Malignancy After Atypical Findings on Single-Nucleotide Polymorphism–Based Prenatal Cell-Free DNA Screening

Goldring

Trotter

Meltzer

et al. 2023

Obstetrics &Amp; Gynecology

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“…Identification of these covariates was based on the Diagnosis-Related Group, ICD-10-CM, and ICD-10 Procedure Coding System codes (eTable 1 in Supplement 1). The covariates were grouped similarly in prior studies …”

Section: Methodsmentioning

confidence: 99%

Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy

et al. 2023

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ImportanceUnhoused status is a substantial problem in the US. Pregnancy characteristics and maternal outcomes of individuals experiencing homelessness are currently under active investigation to optimize health outcomes for this population.ObjectiveTo assess the trends, characteristics, and maternal outcomes associated with unhoused status in pregnancy.Design, Setting, and ParticipantsThis cross-sectional study analyzed data from the Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample. The study population included hospitalizations for vaginal and cesarean deliveries from January 1, 2016, to December 31, 2020. Unhoused status of these patients was identified from use of International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code Z59.0. Statistical analysis was conducted from December 2022 to June 2023.Main Outcomes and MeasuresPrimary outcomes were (1) temporal trends; (2) patient and pregnancy characteristics associated with unhoused status, which were assessed with a multivariable logistic regression model; (3) delivery outcomes, including severe maternal morbidity (SMM) and mortality at delivery, which used the Centers for Disease Control and Prevention definition for SMM indicators and were assessed with a propensity score–adjusted model; and (4) choice of long-acting reversible contraception method and surgical sterilization at delivery.ResultsA total of 18 076 440 hospital deliveries were included, of which 18 970 involved pregnant patients who were experiencing homelessness at the time of delivery, for a prevalence rate of 104.9 per 100 000 hospital deliveries. These patients had a median (IQR) age of 29 (25-33) years. The prevalence of unhoused patients increased by 72.1% over a 5-year period from 76.1 in 2016 to 131.0 in 2020 per 100 000 deliveries (P for trend &lt; .001). This association remained independent in multivariable analysis. In addition, (1) substance use disorder (tobacco, illicit drugs, and alcohol use disorder), (2) mental health conditions (schizophrenia, bipolar, depressive, and anxiety disorders, including suicidal ideation and past suicide attempt), (3) infectious diseases (hepatitis, gonorrhea, syphilis, herpes, and COVID-19), (4) patient characteristics (Black and Native American race and ethnicity, younger and older age, low or unknown household income, obesity, pregestational hypertension, pregestational diabetes, and asthma), and (5) pregnancy characteristics (prior uterine scar, excess weight gain during pregnancy, and preeclampsia) were associated with unhoused status in pregnancy. Unhoused status was associated with extreme preterm delivery (&lt;28-week gestation: 34.3 vs 10.8 per 1000 deliveries; adjusted odds ratio [AOR], 2.76 [95% CI, 2.55-2.99]); SMM at in-hospital delivery (any morbidity: 53.8 vs 17.7 per 1000 deliveries; AOR, 2.30 [95% CI, 2.15-2.45]); and in-hospital mortality (0.8 vs &lt;0.1 per 1000 deliveries; AOR, 10.17 [95% CI, 6.10-16.94]), including case fatality risk after SMM (1.5% vs 0.3%; AOR, 4.46 [95% CI, 2.67-7.45]). Individual morbidity indicators associated with unhoused status included cardiac arrest (AOR, 12.43; 95% CI, 8.66-17.85), cardiac rhythm conversion (AOR, 6.62; 95% CI, 3.98-11.01), ventilation (AOR, 6.24; 95% CI, 5.03-7.74), and sepsis (AOR, 5.37; 95% CI, 4.53-6.36).Conclusions and RelevanceResults of this national cross-sectional study suggest that unhoused status in pregnancy gradually increased in the US during the 5-year study period and that pregnant patients with unhoused status were a high-risk pregnancy group.

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“…In the previous analysis, patient demographics, pregnancy characteristics, and severe maternal morbidity and mortality at delivery were evaluated among pregnant women with malignancy. The details of analysis development and the principal findings were described in the primary study report 11 …”

Section: Methodsmentioning

confidence: 99%

“…The current study was a pre-planned secondary analysis of a previously organized data set that examined the clinical characteristics and outcomes of pregnancy and delivery with malignancy in the NIS program between January 2016 and December 2019. 11 In the previous analysis, patient demographics, pregnancy characteristics, and severe maternal morbidity and mortality at delivery were evaluated among pregnant women with malignancy. The details of analysis development and the principal findings were described in the primary study report.…”

Section: Study Populationmentioning

confidence: 99%

Prevalence of anxiety and depressive disorders in pregnant women with malignancy

Matsuo

Duval

Youssefzadeh

et al. 2022

Intl J Gynecology & Obste

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Malignancy during pregnancy is a rare clinical entity, complicating approximately 1 in 1000 to 1 in 2000 pregnancies overall. [1][2][3] Previous studies related to pregnancy with malignancy primarily focused on optimizing anti-cancer treatment during pregnancy and examining the fetal effects of such therapy, 1,2,4 and limited data are available regarding the psychological effect of malignancy among pregnant women. For instance, a 2019 systematic review identified only a few studies that reported the psychological aspects of pregnant women with malignancy, 5-9 and these previous investigations have been limited by their small heterogeneous study size. [5][6][7][8][9] The risk of psychological comorbidities such as anxiety or depressive disorder is likely higher as pregnant women who have cancer face two major life events: a life-threatening cancer diagnosis and the pregnancy itself. [6][7][8][9] These two life events are conflicting for the patients, and a challenging and devastating event such as cancer during pregnancy can trigger fear, guilt, and anxiety in the patient. 4 Given the rarity of pregnancy with malignancy, a large-scale analysis of psychological comorbidities can provide valuable clinical

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Assessment of Severe Maternal Morbidity and Mortality in Pregnancies Complicated by Cancer in the US

Abstract: This cohort study examines nationwide trends and characteristics of severe maternal morbidity and mortality among pregnant women with cancer in the US.

Cited by 18 publications

References 5 publications

Maternal Malignancy After Atypical Findings on Single-Nucleotide Polymorphism–Based Prenatal Cell-Free DNA Screening

Maternal Malignancy After Atypical Findings on Single-Nucleotide Polymorphism–Based Prenatal Cell-Free DNA Screening

Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy

Prevalence of anxiety and depressive disorders in pregnant women with malignancy

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