Pregnancy associated cancer, timing of birth and clinical decision making-a NSW data linkage study.

Safi, N; Li, Z; Anazodo, A; Remond, M; Hayen, A; Currow, D; Roder, D; Hamad, N; Nicholl, M; Gordon, A; Frawley, J; Fotheringham, P; Sullivan, E

Pregnancy associated cancer, timing of birth and clinical decision making-a NSW data linkage study.

Safi, N

Li, Z Anazodo, A Remond, M Hayen, A

Currow, D

Roder, D Hamad, N Nicholl, M Gordon, A Frawley, J

Fotheringham, P Sullivan, E

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Publisher:: Springer Nature
Publication Type:: Journal Article
Citation:: BMC Pregnancy Childbirth, 2023, 23, (1), pp. 105
Issue Date:: 2023-02-09

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Field	Value	Language
dc.contributor.author	Safi, N https://orcid.org/0000-0001-8473-0980
dc.contributor.author	Li, Z
dc.contributor.author	Anazodo, A
dc.contributor.author	Remond, M
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030
dc.contributor.author	Currow, D https://orcid.org/0000-0003-1988-1250
dc.contributor.author	Roder, D
dc.contributor.author	Hamad, N
dc.contributor.author	Nicholl, M
dc.contributor.author	Gordon, A
dc.contributor.author	Frawley, J https://orcid.org/0000-0001-6037-0140
dc.contributor.author	Fotheringham, P
dc.contributor.author	Sullivan, E https://orcid.org/0000-0002-8718-2753
dc.date.accessioned	2023-05-11T08:33:55Z
dc.date.available	2023-01-06
dc.date.available	2023-05-11T08:33:55Z
dc.date.issued	2023-02-09
dc.identifier.citation	BMC Pregnancy Childbirth, 2023, 23, (1), pp. 105
dc.identifier.issn	1471-2393
dc.identifier.issn	1471-2393
dc.identifier.uri	http://hdl.handle.net/10453/170318
dc.description.abstract	BACKGROUND: The incidence of pregnancy-associated cancer (PAC), comprising cancer diagnosed during pregnancy or within one year postpartum, is increasing. We investigated the obstetric management and outcomes of women with PAC and their babies. METHODS: A population-based observational study of all women who gave birth between 1994 and 2013 in New South Wales, Australia. Women were stratified into three groups: those diagnosed during pregnancy (gestational cancer group), those diagnosed within one year of giving birth (postpartum cancer group), and a no-PAC group. Generalized estimating equations were used to examine the association between PAC and adverse maternal and neonatal outcomes. RESULTS: One million seven hundred eighty-eight thousand four hundred fifty-onepregnancies were included-601 women (614 babies) were in the gestational cancer group, 1772 women (1816 babies) in the postpartum cancer group, and 1,786,078 women (1,813,292 babies) in the no-PAC group. The overall crude incidence of PAC was 132.7/100,000 women giving birth. The incidence of PAC increased significantly over the twenty-year study period from 93.5/100,000 in 1994 to 162.5/100,000 in 2013 (2.7% increase per year, 95% CI 1.9 - 3.4%, p-value < 0.001). This increase was independent of maternal age. The odds of serious maternal complications (such as acute abdomen, acute renal failure, and hysterectomy) were significantly higher in the gestational cancer group (adjusted odds ratio (AOR) 5.07, 95% CI 3.72 - 6.90) and the postpartum cancer group (AOR 1.55, 95% CI 1.16 - 2.09). There was no increased risk of perinatal mortality in babies born to women with PAC. However, babies of women with gestational cancer (AOR 8.96, 95% CI 6.96 - 11.53) or postpartum cancer (AOR 1.36, 95% CI 1.05 - 1.81) were more likely to be planned preterm birth. Furthermore, babies of women with gestational cancer had increased odds of a severe neonatal adverse outcome (AOR 3.13, 95% CI 2.52 - 4.35). CONCLUSION: Women with PAC are more likely to have serious maternal complications. While their babies are not at increased risk of perinatal mortality, they are more likely to experience poorer perinatal outcomes associated with preterm birth. The higher rate of birth intervention among women with gestational cancers reflects the complexity of clinical decision-making in this context.
dc.format	Electronic
dc.language	eng
dc.publisher	Springer Nature
dc.relation	The Cancer Council NSWAPP1141231
dc.relation.ispartof	BMC Pregnancy Childbirth
dc.relation.isbasedon	10.1186/s12884-023-05359-1
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1110 Nursing, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.subject.mesh	Pregnancy
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Premature Birth
dc.subject.mesh	Parturition
dc.subject.mesh	Maternal Age
dc.subject.mesh	Perinatal Death
dc.subject.mesh	Neoplasms
dc.subject.mesh	Clinical Decision-Making
dc.subject.mesh	Pregnancy Outcome
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Premature Birth
dc.subject.mesh	Pregnancy Outcome
dc.subject.mesh	Maternal Age
dc.subject.mesh	Pregnancy
dc.subject.mesh	Parturition
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Female
dc.subject.mesh	Perinatal Death
dc.subject.mesh	Clinical Decision-Making
dc.subject.mesh	Pregnancy
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Premature Birth
dc.subject.mesh	Parturition
dc.subject.mesh	Maternal Age
dc.subject.mesh	Perinatal Death
dc.subject.mesh	Neoplasms
dc.subject.mesh	Clinical Decision-Making
dc.subject.mesh	Pregnancy Outcome
dc.title	Pregnancy associated cancer, timing of birth and clinical decision making-a NSW data linkage study.
dc.type	Journal Article
utslib.citation.volume	23
utslib.location.activity	England
utslib.for	1110 Nursing
utslib.for	1114 Paediatrics and Reproductive Medicine
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	open_access	*
dc.date.updated	2023-05-11T08:33:51Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	23
utslib.citation.issue	1

Abstract:

BACKGROUND: The incidence of pregnancy-associated cancer (PAC), comprising cancer diagnosed during pregnancy or within one year postpartum, is increasing. We investigated the obstetric management and outcomes of women with PAC and their babies. METHODS: A population-based observational study of all women who gave birth between 1994 and 2013 in New South Wales, Australia. Women were stratified into three groups: those diagnosed during pregnancy (gestational cancer group), those diagnosed within one year of giving birth (postpartum cancer group), and a no-PAC group. Generalized estimating equations were used to examine the association between PAC and adverse maternal and neonatal outcomes. RESULTS: One million seven hundred eighty-eight thousand four hundred fifty-onepregnancies were included-601 women (614 babies) were in the gestational cancer group, 1772 women (1816 babies) in the postpartum cancer group, and 1,786,078 women (1,813,292 babies) in the no-PAC group. The overall crude incidence of PAC was 132.7/100,000 women giving birth. The incidence of PAC increased significantly over the twenty-year study period from 93.5/100,000 in 1994 to 162.5/100,000 in 2013 (2.7% increase per year, 95% CI 1.9 - 3.4%, p-value < 0.001). This increase was independent of maternal age. The odds of serious maternal complications (such as acute abdomen, acute renal failure, and hysterectomy) were significantly higher in the gestational cancer group (adjusted odds ratio (AOR) 5.07, 95% CI 3.72 - 6.90) and the postpartum cancer group (AOR 1.55, 95% CI 1.16 - 2.09). There was no increased risk of perinatal mortality in babies born to women with PAC. However, babies of women with gestational cancer (AOR 8.96, 95% CI 6.96 - 11.53) or postpartum cancer (AOR 1.36, 95% CI 1.05 - 1.81) were more likely to be planned preterm birth. Furthermore, babies of women with gestational cancer had increased odds of a severe neonatal adverse outcome (AOR 3.13, 95% CI 2.52 - 4.35). CONCLUSION: Women with PAC are more likely to have serious maternal complications. While their babies are not at increased risk of perinatal mortality, they are more likely to experience poorer perinatal outcomes associated with preterm birth. The higher rate of birth intervention among women with gestational cancers reflects the complexity of clinical decision-making in this context.

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http://hdl.handle.net/10453/170318