Pregnancy after cancer: Does timing of conception affect infant health?

Abstract

BACKGROUND:The objective of this retrospective cohort study was to determine whether women who conceive soon after treatment for cancer have higher risks of adverse pregnancy outcomes. METHODS: Vital records data were linked to cancer registry diagnosis and treatment information in 3 US states. Women who conceived their first pregnancy after diagnosis between ages 20 and 45 years with any invasive cancer or ductal carcinoma in situ were eligible. Log-binomial models were used to compare risks in cancer survivors who conceived in each interval to the risks in matched comparison births to women without cancer. RESULTS: Women who conceived ≤1 year after starting chemotherapy for any cancer had higher risks of preterm birth than comparison women (chemotherapy alone: relative risk [RR], 1.9; 95% confidence interval [CI], 1.3-2.7; chemotherapy with radiation: RR, 2.4; 95% CI, 1.6-3.6); women who conceived ≥1 year after starting chemotherapy without radiation or ≥2 years after chemotherapy with radiation did not. In analyses imputing the treatment end date for breast cancer survivors, those who conceived ≥1 year after finishing chemotherapy with or without radiation had no higher risks than women without cancer. The risk of preterm birth in cervical cancer survivors largely persisted but was somewhat lower in pregnancies conceived after the first year (for pregnancies conceived ≤1 year after diagnosis: RR, 3.5; 95% CI, 2.2-5.4; for pregnancies conceived >1 year after diagnosis: RR, 2.4; 95% CI, 1.6-3.5). CONCLUSIONS: In women who received chemotherapy, the higher risk of preterm birth was limited to those survivors who had short intervals between treatment and conception. Cancer 2018;124:4401-4407.

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

“…Similar results were observed among breast cancer survivors for both preterm birth (RR, 2.4; 95% CI, 1.4-4.0) and low birth weight (RR, 3.3; 95% CI, 1.9-5.8). 107 On the contrary, breast cancer patients who conceived between 12 to 24 months after treatment did not have higher risks of preterm birth (RR, 0.9; 95% CI, 0.4-2.0) or infants born small for gestational age (RR, 0.8; 95% CI, 0.3-1.8) than matched women without cancer. 107 Taken together (Table 5), these studies suggest that despite there is no optimal cut-off to plan a pregnancy following breast cancer diagnosis, attempts to conceptions should be postponed at least 12 months following chemotherapy completion.…”

“…107 On the contrary, breast cancer patients who conceived between 12 to 24 months after treatment did not have higher risks of preterm birth (RR, 0.9; 95% CI, 0.4-2.0) or infants born small for gestational age (RR, 0.8; 95% CI, 0.3-1.8) than matched women without cancer. 107 Taken together (Table 5), these studies suggest that despite there is no optimal cut-off to plan a pregnancy following breast cancer diagnosis, attempts to conceptions should be postponed at least 12 months following chemotherapy completion. A wash-out period of 3 and 7 months should be also considered following exposure to endocrine therapy and anti-HER2 biologic agents, respectively.…”

“…An additional important concern for early pregnancies following anticancer therapies is the potential adverse effects in terms of pregnancy outcomes. In 2018, Hartnett et al 107 investigated this issue retrospectively in a cohort of 4203 patients affected by different tumors, 754 of whom affected by breast cancer. It was observed a higher risk in preterm birth (RR, 1.9; 95% CI, 1.3-2.7) and low birth weight (RR, 2.0; 95% CI, 1.4-3.0) in the group of patients who conceived less than 12 months after chemotherapy completion.…”

Pregnancy and labour likelihood after breast cancer (a review)

“…Таким образом, был сделан вывод о необходимости наблюдения за пациентками минимум в течение 6 месяцев после постановки диагноза и до наступления беременности. Однако авторы также рекомендуют для женщин с более высоким риском рецидива рассмотреть отсрочку беременности на срок 5 лет и более [34].…”

Pregnancy after cancer: Timing is everything

“…In this issue of Cancer , Hartnett and colleagues seek to address this gap and build on the existing literature by evaluating fetal outcomes in a large population‐based sample of women with a history of cancer . They present an analysis of first subsequent pregnancy outcomes among women who were diagnosed with cancer between ages 20 and 45 years in 3 US states using cancer registry data linked to birth registries.…”