Perinatal complications in female survivors of cancer: a systematic review and meta-analysis.

Abstract Background Observational studies have suggested that perinatal outcomes are worse in offspring of cancer survivors. We conducted a systematic review and meta-analysis to examine the risks of perinatal complications in female cancer survivors diagnosed before the age of 40 years. Methods All published articles on pregnancy, perinatal or congenital risks in female cancer survivors were screened for eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results Twenty-two studies met the inclusion criteria. Meta-analysis indicates that offspring of cancer survivors are at increased risk of prematurity (relative risk [RR]: 1.56; 95% confidence interval [CI] 1.37–1.77) and low birth weight (RR 1.47; 95% CI 1.24–1.73) but not of being small for gestational age (RR 0.99; 95% CI 0.81–1.22). Cancer survivors have higher rates of elective (RR: 1.38; 95% CI 1.13–1.70) and emergency caesarean section (RR: 1.22; 95% CI 1.15–1.30) as well as assisted vaginal delivery (RR: 1.10; 95% CI 1.02–1.18) and are at increased risk of postpartum haemorrhage (RR: 1.18; 95% CI 1.02–1.36). The risk of congenital abnormalities also appears increased (RR 1.10; 95% CI 1.02–1.20), but this is likely to be an artefact of analysis. Although meta-analysis of the effects of radiotherapy was not possible for all outcomes, there was an increased risk of prematurity (RR 2.27; 95% CI 1.34–3.82) and consistent findings of low birth weight (RR 1.38–2.31). Risk of being small for gestational age was increased only after high uterine radiotherapy dosage. Conclusion The increased perinatal risks warrant a proactive approach from healthcare providers in both counselling and management of perinatal care for cancer survivors. Highlights • Pregnancy in survivors of cancer can carry risk to both mother and foetus. • The offspring of survivors of cancer are at risk of prematurity and low birth weight. • Offspring are not at risk of being small for gestational age or congenital abnormalities. • Abdominal radiotherapy is associated with increased risk of postpartum haemorrhage. • Elective and emergency caesarean section rates are higher in cancer survivors. [ABSTRACT FROM AUTHOR]