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Objective: Cancer diagnosed during pregnancy poses unique challenges to both patients and healthcare providers. While advances in oncology and maternal-fetal medicine have improved the management of this complex condition, there remains a need for comprehensive research on the risks and outcomes associated with cancer during pregnancy. We aimed to investigate the risk of adverse pregnancy outcomes and fetal malformations in patients diagnosed with cancer during pregnancy. Methods: Among a cohort of 1,985,678 women who underwent deliveries between 2015 and 2022, we applied exclusion criteria that removed individuals diagnosed with cancer in the year preceding their pregnancies and cases involving multiple pregnancy. Consequently, the final cohort for analysis consisted of 1,839,651 women. Results: A total of 6,884 subjects were diagnosed with cancer during pregnancy, among whom 956 cases were associated with congenital malformations, while 5,928 served as controls. Our analysis revealed a significantly increased risk of congenital malformations in women diagnosed with cancer during pregnancy compared to the control group (p<0.001). After adjusting for maternal age, pre-pregnancy hypertension, prepregnancy diabetes, gestational diabetes, and child sex, we found that the risk of congenital malformation increased by 1.59-fold (95% confidence interval [CI]=1.21-2.08) for breast cancer, 1.47-fold (95% CI=1.31-1.66) for ovarian cancer, and 2.88-fold (95% CI=1.21-6.84) for gastric cancer. Conclusion: This comprehensive analysis has important implications for clinical decision-making, patient counseling, and the development of strategies to optimize maternal and fetal outcomes in cancer during pregnancy. [ABSTRACT FROM AUTHOR]