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Maternal and neonatal outcomes in pregnancies following colorectal cancer

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Abstract

Background

The risks of adverse obstetric outcomes among young women survivors of colorectal cancer (CRC) are uncertain.

Methods

This Western Australian, whole-jurisdictional linked-data, retrospective cohort study compared maternal and neonatal outcomes of first postcancer pregnancies among women CRC survivors against randomly selected pregnancies of women with no cancer history. Logistic regression models were used to investigate a range of adverse outcomes independently associated with CRC and its surgical and adjunctive treatments.

Results

Among 627,762 deliveries during the study period (1983–2007), 232 were first pregnancies following CRC. Whether following laparoscopic or open cancer surgery, these pregnancies were independently associated with a significantly increased risk of antepartum hemorrhage [odds ratios (ORs): 1.25; 2.13 for the respective procedures], postpartum hemorrhage (ORs: 1.61; 3.31), Cesarean delivery (ORs: 2.42; 4.24), infant low Apgar score (ORs: 1.32; 2.64), need for neonatal resuscitation (ORs: 1.49; 3.20), and special care admission (ORs: 1.42; 2.87). A history of open (but not laparoscopic) cancer surgery was associated with increased risk of gastrointestinal obstruction during pregnancy (OR 1.17) and prolonged postpartum hospitalization (OR 3.11). Neither was significantly associated with perinatal death. Among women with previous CRC, rectal (versus colonic) malignancy was independently associated with a significantly higher risk of overall maternal and neonatal adverse outcomes (ORs: 3.73 and 2.73, respectively), as was radiotherapy (ORs: 4.24 and 2.81, respectively). Chemotherapy was independently associated with a marginally but significantly higher risk of overall maternal but not neonatal outcomes (ORs: 1.11; 0.98). Open versus laparoscopic cancer surgery was associated with a significantly higher risk of antepartum and postpartum hemorrhage, low Apgar score, need for neonatal resuscitation, and neonatal special care admission.

Conclusions

Previous CRCs, particularly rectal and radiation-treated tumors, appear to confer an increased likelihood of adverse outcomes in subsequent pregnancies. Laparoscopic technique for CRC surgery may reduce adverse gestational outcomes.

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Acknowledgments

The authors thank the Western Australian Data Linkage Branch for their assistance and provision of data. This work was supported by the Cancer Council Western Australia and The University of Western Australia.

Disclosure

Authors F.H., G.P., J.W., G.M., D.P., K.E. and R.B. have no conflicts of interest or financial ties to disclose. J.M. holds an unrestrictive education grant from Covidien.

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Authors and Affiliations

  1. School of Population Health, Centre for Health Services Research, The University of Western Australia, Crawley, Australia

    Fatima Haggar & David Preen

  2. The Ottawa Hospital Research Institute, University of Ottawa, 737 Parkdale Ave, Suite 326, Ottawa, ON K1Y 1J8, Canada

    Fatima Haggar, Guillaume Martel, Robin Boushey & Joseph Mamazza

  3. Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT, USA

    Gavin Pereira

  4. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Subiaco, Australia

    Gavin Pereira & Kristjana Einarsdottir

  5. Combined Universities Centre for Rural Health, The University of Western Australia, Nedlands, Australia

    John Woods

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  1. Fatima Haggar
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Correspondence to Fatima Haggar.

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Haggar, F., Pereira, G., Preen, D. et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc 27, 2327–2336 (2013). https://doi.org/10.1007/s00464-012-2774-6

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