Pregnancy Outcomes in Females after Treatment for Childhood Cancer

Abstract

This Ontario province-wide cohort study was conducted to compare the risk of adverse pregnancy outcomes in female childhood cancer survivors who received abdominal-pelvic radiation and/or chemotherapy with alkylating agents with the risk among those who were treated by non-sterilizing alkylating agents with the risk among those who were treated by non-sterilizing surgery only. Females in Ontario, Canada, diagnosed in 1964-1988 before age 20 with a histologically confirmed malignancy and who had survived for at least 5 years, attained age 18, and were alive at the time of study, were identified through the Ontario Cancer Registry. We ascertained pregnancy outcomes by a telephone-administered questionnaire. Treatment data were abstracted from medical records for 830 subjects 18-49 years of age, the analysis comprised 340 survivors who had one or more pregnancies after treatment. There was no evidence of an increased risk of having a spontaneous abortion or an infant with a birth defect. Survivors receiving abdominal-pelvic radiation were more likely to have a low birth weight infant (odds ratio estimate [OR] = 3.64; 95% confidence interval [CI] = 1.33-9.96), a premature low birth weight infant (OR = 3.29; 95% CI = 0.97-11.1), or an infant who died in the perinatal period (OR = 2.41; 95% CI = 0.50-11.5), compared with those receiving surgery. Risks of perinatal death and having a low birth weight infant increased with dose of radiotherapy directed to the abdomen.

Exposure to radiation therapy is associated with female reproductive health among childhood cancer survivors: a meta-analysis study

“…The included studies were published between 1999 and 2014, and all of them were cohort studies [4,[6][7][8][9][10][11][12][13][14][15][16][17][18]. A total of 10,717 women with radiation therapy and 11,128 women without radiation therapy from 13 studies were evaluated [4, 6-15, 17, 18].…”

“…In fertility factors, 5 studies were described about infertility [6,9.12,14, 18], 2 studies were based on AMH values [4,17], 2 studies on AOF [10,16], 3 studies on stillbirth or neonatal death [7,8,13], 2 studies on spontaneous abortion [7,12], 2 studies on congenital anomaly [7,15], 2 studies on low birth weight [7,11] and 1 study on preterm birth [11]. In radiation therapy methods, 4 studies were performed in radiation therapy without specific description [10,12,16,2], 2 studies on abd-pelvic radiation [6,7], 2 studies on ovarian radiation [8,15] and each of the 6 last studies were performed on pelvic radiation [4], abdominal or total body radiation [17], hypothalamic or pituitary radiation [14], nasopharyngeal radium irradiation [9], uterus radiation [11], uterus and ovarian radiation [13].…”

“…Infertility Among the 5 included studies that identified the relationship between radiotherapy and infertility [6][7][8][9][10], the study-specific RRs for infertility range were from 1.20 to 1.54. The pooled RR (exposed to radiotherapy vs. non-exposed) for infertility was 1.28 (95 % CI was 1.16-1.42) with low heterogeneity (I 2 =24.9 %) (Fig.…”

“…Abortion Two studies demonstrated the relationship between radiotherapy and spontaneous abortion [7,12] and the studyspecific RRs for spontaneous abortion range were from 0.99 to 1.44. The pooled RR (exposed to radiotherapy vs. nonexposed) for spontaneous abortion was 1.20 (95 % CI was 0.83-1.73) with significantly heterogeneity (I 2 = 46.5 %) (Fig.…”

“…Stillbirth Three studies described radiotherapy associated with stillbirth or neonatal death [7,8,13], the study-specific RRs for stillbirth or neonatal death range were from 1.16 to 1.59. The pooled RR (exposed to radiotherapy vs. non-exposed) for stillbirth or neonatal death was 1.19 (95 % CI was 1.02-1.39) with significantly heterogeneity (I 2 =0.0 %) (Fig.…”