Cancer Causes & Control

, Volume 30, Issue 6, pp 651–661 | Cite as

Obstetrical and infant outcomes among women with neoplasms during pregnancy

  • Xin Niu
  • Christopher I. Li
  • Beth A. MuellerEmail author
Original Paper



One in 1,000 pregnancies is complicated by malignancies. Prevalence is greater for benign neoplasms. Adverse outcomes among women with malignancies have been reported. Less is known of postpartum outcomes for infants, or outcomes among women with benign neoplasms.


We conducted a population-based cohort study using Washington State-linked vital-hospital discharge records. Women with neoplasms (707 malignant; 13,156 benign) with deliveries in 1987–2012 were identified, and a randomly selected comparison cohort. Obstetrical/infant outcomes and rehospitalization < 2 years post-delivery were compared separately for each group by multivariable regressions to estimate risk ratios (RR) and 95% confidence intervals (CI).


Women with either condition had increased anemia, cesarean, and preterm delivery; their infants were more often < 2,500 g or jaundiced. Women with benign conditions had increased gestational diabetes (RR = 1.20; 95% CI 1.12–1.28) and preeclampsia (RR = 1.27; 95% CI 1.18–1.36); their infants had increased malformations (RR = 1.29; 95% CI 1.19–1.38). Women with neoplasms more often were hospitalized seven or more days or rehospitalized; their infants’ hospitalizations were also longer.


Malignant and benign neoplasms were associated with several adverse outcomes. Reasons for relationships of benign neoplasms with gestational diabetes, preeclampsia, and congenital malformations merit further study.


Cancer Pregnancy-related cancer Pregnancy outcomes Infant outcomes 



We would like to acknowledge the Washington State Department of Health for data access and Mr. Bill O’Brien for programming and file management.

Compliance with ethical standard

Conflicts of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10552_2019_1167_MOESM1_ESM.docx (42 kb)
Fig. S1. Identification of women included in study—Supplementary material 1 (DOCX 42 kb)
10552_2019_1167_MOESM2_ESM.docx (31 kb)
Supplementary material 2 (DOCX 31 kb)


  1. 1.
    Mathews TJ, Hamilton BE (2016) Mean age of mothers is on the rise: United States, 2000-2014. In: NCHS data brief, 2016. pp 1–8Google Scholar
  2. 2.
    American Cancer Society Cancer Facts & Figures 2012. In: American Cancer Society, 2012. p 68Google Scholar
  3. 3.
    Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, Young J (2012) Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG 119(13):1572–1582. CrossRefGoogle Scholar
  4. 4.
    Koren G, Lishner M (2011) Cancer in pregnancy and lactation: the motherisk guide. Cambridge University Press, Cambridge, pp 1–211. CrossRefGoogle Scholar
  5. 5.
    Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, Melisko ME, Cedars MI, Rosen MP (2012) Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer 118:1710–1717. CrossRefGoogle Scholar
  6. 6.
    Braems G, Denys H, De Wever O, Cocquyt V, Van den Broecke R (2011) Use of tamoxifen before and during pregnancy. Oncologist 16:1547–1551. CrossRefGoogle Scholar
  7. 7.
    Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5(5):283–291CrossRefGoogle Scholar
  8. 8.
    Kal HB, Struikmans H (2005) Radiotherapy during pregnancy: fact and fiction. Lancet Oncol 6:328CrossRefGoogle Scholar
  9. 9.
    Loibl S, Han SN, von Minckwitz G, Bontenbal M, Ring A, Giermek J, Fehm T, Van Calsteren K, Linn SC, Schlehe B, Gziri MM, Westenend PJ, Müller V, Heyns L, Rack B, Van Calster B, Harbeck N, Lenhard M, Halaska MJ, Kaufmann M, Nekljudova V, Amant F (2012) Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 13:887–896. CrossRefGoogle Scholar
  10. 10.
    Daras M, Cone C, Peters KB (2014) Tumor progression and transformation of low-grade glial tumors associated with pregnancy. J Neurooncol 116:113–117. CrossRefGoogle Scholar
  11. 11.
    Cardonick E, Usmani A, Ghaffar S (2010) Perinatal outcomes of a pregnancy complicated by cancer, including neonatal follow-up after in utero exposure to chemotherapy: results of an international registry. Am J Clin Oncol 33:221–228. Google Scholar
  12. 12.
    Selig BP, Furr JR, Huey RW, Moran C, Alluri VN, Medders GR, Mumm CD, Hallford HG, Mulvihill JJ (2012) Cancer chemotherapeutic agents as human teratogens. Birth Defects Res A Clin Mol Teratol 94(8):626–650. CrossRefGoogle Scholar
  13. 13.
    Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE (2009) Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol (New York) 113(3):630–635CrossRefGoogle Scholar
  14. 14.
    Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS, Pinn VW, Dixon D (2014) Proceedings from the Third National Institutes of Health International Congress on advances in uterine leiomyoma research: comprehensive review, conference summary and future recommendations. Hum Reprod Update 20(3):309–333CrossRefGoogle Scholar
  15. 15.
    Schiff MA, Doody DR, Crane DA, Mueller BA (2017) Pregnancy outcomes among deaf women in Washington State, 1987-2012. Obstet Gynecol 130(5):953–960. CrossRefGoogle Scholar
  16. 16.
    Lydon-Rochelle MT, Holt VL, Cardenas V, Nelson JC, Easterling TR, Gardella C, Callaghan WM (2005) The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol 193(1):125–134. CrossRefGoogle Scholar
  17. 17.
    Kleinman LC, Norton EC (2009) What’s the Risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression. Health Serv Res 44(1):288–302. CrossRefGoogle Scholar
  18. 18.
    Shavers VL, Lynch CF, Burmeister LF (2002) Racial differences in factors that influence the willingness to participate in medical research studies. Ann Epidemiol 12(4):248–256. CrossRefGoogle Scholar
  19. 19.
    Oh SS, Galanter J, Thakur N, Pino-Yanes M, Barcelo NE, White MJ, de Bruin DM, Greenblatt RM, Bibbins-Domingo K, Wu AH, Borrell LN, Gunter C, Powe NR, Burchard EG (2015) Diversity in clinical and biomedical research: a promise yet to be fulfilled. PLoS Med 12(12):e1001918. CrossRefGoogle Scholar
  20. 20.
    Moran BJ, Yano H, Al Zahir N, Farquharson M (2007) Conflicting priorities in surgical intervention for cancer in pregnancy. Lancet Oncol 8:536–544. CrossRefGoogle Scholar
  21. 21.
    Hartnett KP, Ward KC, Kramer MR, Lash TL, Mertens AC, Spencer JB, Fothergill A, Howards PP (2017) The risk of preterm birth and growth restriction in pregnancy after cancer. Int J Cancer. Google Scholar
  22. 22.
    Lu D, Ludvigsson JF, Smedby KE, Fall K, Valdimarsdóttir U, Cnattingius S, Fang F (2017) Maternal cancer during pregnancy and risks of stillbirth and infant mortality. J Clin Oncol 35:1522–1529. CrossRefGoogle Scholar
  23. 23.
    Lam SJ, Best S, Kumar S (2014) The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol 211:e391–e395. CrossRefGoogle Scholar
  24. 24.
    Ciavattini A, Clemente N, Delli Carpini G, Di Giuseppe J, Giannubilo SR, Tranquilli AL (2014) Number and size of uterine fibroids and obstetric outcomes. J Matern-Fetal Neonatal Med. Google Scholar
  25. 25.
    Puri K, Famuyide AO, Erwin PJ, Stewart EA, Laughlin-Tommaso SK (2014) Submucosal fibroids and the relation to heavy menstrual bleeding and anemia. Am J Obstet Gynecol 210(1):38e31–38e37. CrossRefGoogle Scholar
  26. 26.
    Wartko PD, Beck TL, Reed SD, Mueller BA, Hawes SE (2017) Association of endometrial hyperplasia and cancer with a history of gestational diabetes. Cancer Causes Control 28(8):819–828. CrossRefGoogle Scholar
  27. 27.
    Roberts WE, Fulp KS, Morrison MJC, Martin JN (1999) The impact of leiomyomas on pregnancy. Aust N Z J Obstet Gynaecol 39(1):43–47. CrossRefGoogle Scholar
  28. 28.
    Coronado GD, Marshall LM, Schwartz SM (2000) Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 95(5):764–769. Google Scholar
  29. 29.
    Santamaria X, Taylor H (2014) MicroRNA and gynecological reproductive diseases. Fertil Steril 101(6):1545–1551CrossRefGoogle Scholar
  30. 30.
    Li J, Chen Z, Zhou X, Shi S, Qi H, Baker PN, Zhang H (2016) Imbalance between proliferation and apoptosis—related impaired GPR30 expression is involved in preeclampsia. Cell Tissue Res 366(2):499–508. CrossRefGoogle Scholar
  31. 31.
    Boardman JP (2008) Preterm birth: causes, consequences and prevention. J Obstet Gynaecol 28:559. CrossRefGoogle Scholar
  32. 32.
    Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW (2013) Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ (Clinical research ed) 346:f3443. Google Scholar
  33. 33.
    Murthy RK, Theriault RL, Barnett CM, Hodge S, Ramirez MM, Milbourne A, Rimes SA, Hortobagyi GN, Valero V, Litton JK (2014) Outcomes of children exposed in utero to chemotherapy for breast cancer. Breast Cancer Res 16:500. CrossRefGoogle Scholar
  34. 34.
    Egbe AC (2015) Birth defects in the newborn population: race and ethnicity. Pediatr Neonatol 56:183–188. CrossRefGoogle Scholar
  35. 35.
    Salani R, Billingsley CC, Crafton SM (2014) Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol 211(1):7–14. CrossRefGoogle Scholar
  36. 36.
    Vila-Vives JM, Hidalgo-Mora JJ, Soler I, Rubio J, Quiroga R, Perales A (2012) Fetal arthrogryposis secondary to a giant maternal uterine leiomyoma. Case Rep Obstet Gynecol 2012:726732. Google Scholar
  37. 37.
    Katz L, Levy A, Wiznitzer A, Sheiner E (2010) Pregnancy outcome of patients with dermoid and other benign ovarian cysts. Arch Gynecol Obstet 281:811–815. CrossRefGoogle Scholar
  38. 38.
    Amant F, Vandenbroucke T, Verheecke M, Fumagalli M, Halaska MJ, Boere I, Han S, Gziri MM, Peccatori F, Rob L, Lok C, Witteveen P, Voigt JU, Naulaers G, Vallaeys L, Van den Heuvel F, Lagae L, Mertens L, Claes L, Van Calsteren K, International Network on Cancer I, Pregnancy (2015) Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med 373(19):1824–1834. CrossRefGoogle Scholar
  39. 39.
    Wang PS, Walker AM, Tsuang MT, Orav EJ, Levin R, Avorn J (2001) Finding incident breast cancer cases through US claims data and a state cancer registry. Cancer Causes Control 12(3):257–265CrossRefGoogle Scholar
  40. 40.
    McGeechan K, Kricker A, Armstrong B, Stubbs J (1998) Evaluation of linked cancer registry and hospital records of breast cancer. Aust N Z J Pub Health 22(7):765–770. CrossRefGoogle Scholar
  41. 41.
    Solin LJ, Legorreta A, Schultz DJ, Levin HA, Zatz S, Goodman RL (1994) Analysis of a claims database for the identification of patients with carcinoma of the breast. J Med Syst 18(1):23–32. CrossRefGoogle Scholar
  42. 42.
    Baldi I, Vicari P, Di Cuonzo D, Zanetti R, Pagano E, Rosato R, Sacerdote C, Segnan N, Merletti F, Ciccone G (2008) A high positive predictive value algorithm using hospital administrative data identified incident cancer cases. J Clin Epidemiol 61(4):373–379. CrossRefGoogle Scholar
  43. 43.
    Wang PS, Walker AM, Tsuang MT, Orav EJ, Levin R, Avorn JJ (2001) Finding incident breast cancer cases through US claims data and a state cancer registry. Cancer Causes Control 12(3):257–265. CrossRefGoogle Scholar
  44. 44.
    Yasmeen S, Romano PS, Schembri ME, Keyzer JM, Gilbert WM (2006) Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am J Obstet Gynecol 194(4):992–1001. CrossRefGoogle Scholar
  45. 45.
    Roohan PJ, Josberger RE, Acar J, Dabir P, Feder HM, Gagliano PJ (2003) Validation of birth certificate data in New York State. J Commun Health 28(5):335–346CrossRefGoogle Scholar
  46. 46.
    DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE (2002) Reliability of birth certificate data: a multi-hospital comparison to medical records information. Matern Child Health J 6(3):169–179CrossRefGoogle Scholar
  47. 47.
    Martin JA, Wilson EC, Osterman MJ, Saadi EW, Sutton SR, Hamilton BE (2013) Assessing the quality of medical and health data from the 2003 birth certificate revision: results from two states. Natl Vital Stat Rep 62(2):1–19Google Scholar
  48. 48.
    Zollinger TW, Przybylski MJ, Gamache RE (2006) Reliability of Indiana birth certificate data compared to medical records. Ann Epidemiol 16(1):1–10. CrossRefGoogle Scholar
  49. 49.
    Andrade SE, Scott PE, Davis RL, Li D-K, Getahun D, Cheetham TC, Raebel MA, Toh S, Dublin S, Pawloski PA, Hammad TA, Beaton SJ, Smith DH, Dashevsky I, Haffenreffer K, Cooper WO (2013) Validity of health plan and birth certificate data for pregnancy research. Pharmacoepidemiol Drug Saf 22(1):7–15. CrossRefGoogle Scholar
  50. 50.
    Lydon-Rochelle MT, Holt VL, Nelson JC, Cárdenas V, Gardella C, Easterling TR, Callaghan WM (2005) Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatr Perinat Epidemiol 19(6):460–471CrossRefGoogle Scholar
  51. 51.
    Cooper WO, Hernandez-Diaz S, Gideon P, Dyer SM, Hall K, Dudley J, Cevasco M, Thompson AB, Ray WA (2008) Positive predictive value of computerized records for major congenital malformations. Pharmacoepidemiol Drug Saf 17(5):455–460. CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of EpidemiologyUniversity of Washington (UW)SeattleUSA
  2. 2.Public Health Sciences DivisionFred Hutchinson Cancer Research Center (FHCRC)SeattleUSA

Personalised recommendations