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Cancer survivorship and risk of pregnancy complications, adverse obstetric outcomes, and maternal morbidities in female adolescents and young adults: a nationwide population-based study from Taiwan

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Abstract

Background

Cancer treatment in female adolescent and young adult (AYA) cancer survivors (i.e., those diagnosed between 15 and 39 years of age) may adversely affect multiple bodily functions, including the reproductive system.

Methods

We initially assembled a retrospective, nationwide population-based cohort study by linking data from two nationwide Taiwanese data sets. We subsequently identified first pregnancies and singleton births to AYA cancer survivors (2004–2018) and select AYA without a previous cancer diagnosis matched to AYA cancer survivors for maternal age and infant birth year.

Results

The study cohort consisted of 5151 and 51,503 births to AYA cancer survivors and matched AYA without a previous cancer diagnosis, respectively. The odds for overall pregnancy complications (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01–1.18) and overall adverse obstetric outcomes (OR, 1.07; 95% CI, 1.01–1.13) were significantly increased in survivors compared with matched AYA without a previous cancer diagnosis. Specifically, cancer survivorship was associated with an increased risk of preterm labour, labour induction, and threatened abortion or threatened labour requiring hospitalisation.

Conclusions

AYA cancer survivors are at increased risk for pregnancy complications and adverse obstetric outcomes. Efforts to integrate individualised care into clinical guidelines for preconception and prenatal care should be thoroughly explored.

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Data availability

This study used data from the Taiwan Nation Health Insurance Database and the Taiwan Birth Reporting System. A data usage license was obtained from Taiwan Health and Welfare Data Science Center. Data are available at https://dep.mohw.gov.tw/DOS/np-2497-113.html with permission of the Taiwan Health and Welfare Data Science Center.

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Acknowledgements

The authors thank the statistical assistance and the support of the Maintenance Project of the Center for Artificial Intelligence in Medicine (Grant CLRPG3H0014) at the Chang Gung Memorial Hospital. We wish to acknowledge their invaluable help in study design and monitoring, data analysis, and interpretation. The first author expresses his appreciation to Dr. Ji-Hong Hong for inspiring this research effort.

Funding

This work was financially supported by the Chang Gung Memorial Hospital (project CMRPG3I0103). Support was also received from the University of Nottingham for the provision of methodological assistance. The funders had no role in study design, data collection and analysis, the decision to publish or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Wei-Heng Kao & Chun-Chieh Wang

  2. Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Wei-Heng Kao & Yi-Fang Chuang

  3. Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chang-Fu Kuo

  4. Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK

    Chang-Fu Kuo

  5. Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chia-Chun Chang

  6. Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Taipei, Taiwan

    Yu-Cheng Liu

  7. Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Jun-Te Hsu

  8. Department of General Surgery, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Jun-Te Hsu

  9. Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan

    Yi-Fang Chuang

  10. International Health Program, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Yi-Fang Chuang

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  1. Wei-Heng Kao
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Contributions

WHK: study concept and design; literature review; acquisition, analysis, or interpretation of the data; and drafting of the manuscript. CFK: study concept and design; acquisition, analysis or interpretation of the data. CCC: study concept and design; acquisition, analysis or interpretation of the data. YCL: acquisition, analysis, or interpretation of the data and drafting of the manuscript. CCW: study concept and design; acquisition, analysis or interpretation of the data. JTH: acquisition, analysis or interpretation of the data and drafting of the manuscript. YJC: literature review; acquisition, analysis, or interpretation of data and drafting of the manuscript. YFC: literature review; acquisition, analysis or interpretation of data; drafting of the manuscript and study supervision.

Corresponding author

Correspondence to Yi-Fang Chuang.

Ethics declarations

Competing interests

The authors, WHK, CFK, CCC, YCL, CCW, JTH and YJC, declare no competing interests.

Ethics approval and consent to participate

The study protocol was approved by the Ethics Committee of the Chung Gung Medical Foundation Institutional Review Board (No. 202201203B0). The requirement for written patient informed consent was waived due to the study design.

Consent for publication

This study contained no individual person’s data.

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Kao, WH., Kuo, CF., Chang, CC. et al. Cancer survivorship and risk of pregnancy complications, adverse obstetric outcomes, and maternal morbidities in female adolescents and young adults: a nationwide population-based study from Taiwan. Br J Cancer 129, 503–510 (2023). https://doi.org/10.1038/s41416-023-02333-8

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