Advances in cancer treatment mean there are more long-term survivors than ever before. But it begs the question: Are women who get diagnosed as adolescents or young adults at higher risk of giving birth to babies with health problems?
Not only does the cancer itself wreak havoc on the body, but so do the treatments. Research published in JAMA Oncology shows that women diagnosed between the ages of 15 and 39 do have a greater risk of giving birth to pre-term and low-birth weight babies. They are also more likely to need cesarean (C-section) deliveries.
“The higher prevalence of these outcomes was most pronounced among births to mothers diagnosed with cancer during pregnancy, with a more modest increase among those with a longer interval between diagnosis and birth,” the authors wrote. “Elevations in preterm birth persisted when cesarean deliveries and/or induced labor were excluded, suggesting an increase in spontaneous pre-term deliveries in adolescent and young adult cancer survivors.”
The researchers, from the University of North Carolina at Chapel Hill, analyzed the North Carolina Central Cancer Registry and state birth certificate files to arrive at their conclusions. The data included 2,598 births to female adolescent and young adult cancer survivors and almost 13,000 births to women without a cancer diagnosis as controls.
Previous studies conducted in Australia have produced similar conclusions. “In our study, the large sample size allowed us to stratify by the length of time between a woman’s cancer diagnosis and her first post-diagnosis birth,” the authors wrote.
“Our results suggest that the increased prevalence of preterm birth and low-birth weight may be most concentrated among births to adolescent and young adult cancer survivors diagnosed during pregnancy, some of whom may deliver early to begin treatment,” they wrote.
The authors hypothesized that long-term effects of cancer treatments may be to blame. “In all cancer site groups combined, both preterm birth and low-birth weight were more common among births to women treated with chemotherapy,” the authors wrote.
“This may be partly explained by cardiovascular or pulmonary impairments due to chemotherapy, which may impact blood volume regulation and adversely affect pregnancy outcomes. Treatment with radiation, in the absence of chemotherapy, did not appear to be strongly associated with these outcomes,” they wrote.
According to the National Comprehensive Cancer Center Network’s website, “there are no official guidelines determining the length of time to wait after cancer treatment before attempting pregnancy.”
“There are generally three factors for a woman to consider,” said Joanne Frankel Kevin of Memorial Sloan Kettering Cancer Center in New York. “These include making sure that (1) eggs that have been exposed to chemotherapy or radiation and may have been damaged are no longer in her body, (2) she is fully recovered from her treatment and its effects, and (3) she has been ‘cleared’ by her oncologist because an acceptable period of time has passed in which she is not likely to have a recurrence.”
The authors of the JAMA Oncology paper said they hope their findings “inform reproductive counseling of female adolescent and young adult cancer survivors.”