Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review

Abstract

Background The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years. Objectives Synthesise published literature on the relationship between HL and maternal and perinatal outcomes. Search strategy Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand‐searching reference lists. Selection criteria Two reviewers independently reviewed titles, abstracts and full‐text articles. Published studies containing original data were eligible. Data Collection and Analysis Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta‐analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Main results Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9–3.1, and aOR 1.84, 95% CI 0.81–4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65–1.51, and aOR 6.74, 95% CI 0.52–88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55–1.10, and aOR 0.38, 95% CI 0.05–2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05–1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97–21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%–80% vs 4%, 95% CI 4%–5%, respectively). The GRADE certainty of findings ranged from low to very low. Conclusions Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

“…These findings correspond to the literature data, which have shown that, in general, the diagnosis of most cancer types during pregnancy or lactation (except melanoma, breast and ovarian cancers) does not increase the risk of cause‐specific death 28 . Moreover, as with most common malignancies diagnosed during pregnancy, studies indicate that the rates of adverse pregnancy outcomes are similar in women with a Hodgkin lymphoma and those in the general pregnant population 29,30 . In addition, no significant increase in maternal morbidity or mortality was registered if ovarian malignancies complicated pregnancy 31 …”

“…28 Moreover, as with most common malignancies diagnosed during pregnancy, studies indicate that the rates of adverse pregnancy outcomes are similar in women with a Hodgkin lymphoma and those in the general pregnant population. 29,30 In addition, no significant increase in maternal morbidity or mortality was registered if ovarian malignancies complicated pregnancy. 31 Studies conducted in the previous decade have reported an increased risk for induced abortion, stillbirth, preterm birth, growth restrictions, neonatal intensive care unit admission, and neonatal death in pregnancies complicated by cancer.…”

Use of the GRADE system in systematic reviews

“…Dear Dr. Papageorghiou, We would like to take this opportunity to respond to the letter authored by Shen et al 1 in relation to our recently published paper. 2 We thank the authors for their interest in our paper and their comments regarding the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.…”

“…Dear Dr. Papageorghiou, We read with great interest the systematic review by Houlihan et al 1 examining whether a previous or current diagnosis of Hodgkin lymphoma (HL) is associated with adverse maternal and perinatal outcomes. They included 33 observational studies (18 case series and 15 cohort studies) and concluded that there were no increased rates of most adverse pregnancy outcomes among women with a current or previous diagnosis of HL compared with the general pregnant population, and that the studies had a low to very low quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.…”

Authors' reply

“…Dear Dr. Papageorghiou, We would like to take this opportunity to respond to the letter authored by Shen et al 1 in relation to our recently published paper. 2 We thank the authors for their interest in our paper and their comments regarding the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.…”