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  • 2022-RA-598-ESGO Prognostic factors for adverse obstetric outcomes in pregnant cancer patients an update on 2174 cases registered in the INCIP registry

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Fertility/Pregnancy
2022-RA-598-ESGO Prognostic factors for adverse obstetric outcomes in pregnant cancer patients an update on 2174 cases registered in the INCIP registry
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  1. Charlotte Maggen1,
  2. Joosje Heimovaara2,
  3. Kristel van Calsteren3,
  4. Elyce Cardonick4,
  5. Annouschka Laenen5,
  6. Roman G Shmakov6,
  7. Vera Wolters7,
  8. Mina Mhallem Gziri8,
  9. Christianne Lok7,
  10. Evgeniya Polushkina6,
  11. Jeroen Blommaert2,
  12. Michael Halaska9,
  13. Robert Fruscio10,
  14. Alvaro Cabrera-Garcia11,
  15. Ingrid A Boere12,
  16. Ingrid A Boere13,
  17. Petronella Ottevanger14,
  18. Giovanna Scarfone15,
  19. Jorine de Haan16 and
  20. Frédéric Amant3
  1. 1Obstetrics and perinatal medicine, UZ Brussels, Jette, Belgium
  2. 2KU Leuven, Leuven, Belgium
  3. 3University Hospitals of Leuven, Leuven, Belgium
  4. 4Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, NJ, USA, Camden, NJ
  5. 5Statistics, KU Leuven, Leuven, Belgium
  6. 6National Medical Research Centre for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia, Moscow, Russian Federation
  7. 7Department of Gynecology, Antoni van Leeuwenhoek – Netherlands Cancer Institute, Amsterdam, The Netherlands, Amsterdam, Netherlands
  8. 8Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium, Sint-Lambrechts-Woluwe, Belgium
  9. 9Faculty Hospital Kralovske, Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic, Prague, Czech Republic
  10. 10Clinic of Obstetrics and Gynecology, University of Milan – Bicocca, San Gerardo Hospital, Monza, Italy, Milan, Italy
  11. 11Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) ‘ Reference clinic for hemato-oncological diseases during pregnancy CREHER’ Estado de México, México, Mexico, Mexico
  12. 12Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands., Rotterdam, Netherlands
  13. 13Department of Obstetrics and Gynecology, University of Turin, Città della Salute e della Scienza, Sant’Anna Hospital, via Ventimiglia 1, 10126, Turin, Italy., Turin, Italy
  14. 14Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands., Nijmegen, Netherlands
  15. 15Gynecological Oncology Unit, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico, Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy., Milan, Italy
  16. 16Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Amsterdam, Netherlands

Abstract

Introduction/Background Following the increasing evidence on fetal safety, over time more pregnant women are receiving cancer treatment, including chemotherapy, in order to safeguard maternal prognosis. To evaluate current clinical practice obstetric and neonatal outcomes of women registered by the International Network on Cancer, Infertility and Pregnancy (INCIP) were assessed.

Abstract 2022-RA-598-ESGO Figure 1
Abstract 2022-RA-598-ESGO Figure 1

Distribution of cancer types and cancer stages at diagnosis by cancer type (n=2174)

Abstract 2022-RA-598-ESGO Figure 2
Abstract 2022-RA-598-ESGO Figure 2

Evolution in oncological management (A), obstetric outcome (B) and obstetric and neonatal complications © in pregnant cancer patients over 25 years (1996–2021)

Methodology Women with a primary or recurrent invasive cancer during pregnancy or women who were pregnant while receiving invasive cancer treatment between 1996 and 2021 were selected from the INCIP database. Descriptive statistics on oncological diagnosis, stage, antenatal treatment, obstetric and neonatal outcomes, and reported complications was performed. Proportions of events were estimated per 5-year time period with 95% confidence intervals using logistic regression models. A logistic regression model was used to explore the relationship between cancer stage and type, antenatal treatment and obstetric outcome [preterm premature rupture of membranes (PPROM), (planned or spontaneous) preterm delivery, small for gestational age (SGA), other obstetric or medical complications, admission in the neonatal intensive care unit (NICU)], pregnancy loss (miscarriages and stillbirths) and maternal death. Multiple imputation was used to deal with missing data.

Results In the pregnant cancer population (n=2174), preterm delivery(47%), delivery by cesarean section (45%), planned delivery(65%), SGA(27%), maternal death (2%) and NICU admission (33%) are common. Over time, more women received antenatal chemotherapy(p<0.001), associated with an increase in SGA(p=0.07), spontaneous preterm delivery(p=0.009) and medical complications (p=0.002), and a decrease in elective preterm delivery(p<0.001), NICU admission (p=0.044) and neonatal complications(p<0.001). Most important prognostic factors for adverse outcomes were hematological cancers [maternal death OR 8.0,95%CI(2.7–23.5), p<0.001], metastatic disease [maternal death OR 7.0,95%CI(3.7–13.4),p<0.001, pregnancy loss OR 2.2,95%CI(1.5–3.2),p<0.001] and antenatal chemotherapy [PPROM OR 2.6,95%CI(1.9–3.5),p<0.001, SGA OR 1.6,95%CI(1.3–2.1),p<0.001, other obstetric complications OR 1.6,95%CI(1.2–2.2),p=0.003].

Conclusion Antenatal chemotherapy will put a pregnancy at risk of complications and pregnant cancer patients should be managed in high risk obstetric units.

https://doi.org/10.1136/ijgc-2022-ESGO.370

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