de Haan J, et al. - This study reports the oncological management and obstetric and neonatal outcomes of patients registered in International Network on Cancer, Infertility and Pregnancy (INCIP) and treated in the past 20 years. Furthermore, links between cancer type or treatment modality and obstetric and neonatal outcomes were also assessed herein. Findings indicated an increase in the proportion of patients with cancer during pregnancy who received antenatal treatment, over the years, particularly treatment with chemotherapy. As per observations, complications, specifically small for gestational age and neonatal intensive care unit (NICU) admission, might be more likely to develop in babies exposed to antenatal chemotherapy, as compared with babies not exposed. Hence, involving hospitals with obstetric high-care units in the management of these patients was recommended.

Methods

• Pregnant patients with cancer registered from all 37 centres (from 16 countries) participating in the INCIP registry, were included in this descriptive cohort study.
• Researchers, retrospectively and prospectively, gathered oncological, obstetric, and neonatal outcome data of consecutive patients diagnosed with primary invasive cancer during pregnancy between Jan 1, 1996, and Nov 1, 2016.
• Using log-binomial regression, they analysed changes over time in categorical patient characteristics, outcomes, and treatment methods.
• Furthermore, multiple logistic regression were used to analyse preterm, prelabour rupture of membranes (PPROM) or preterm contractions, small for gestational age, and admission to the neonatal intensive care unit (NICU).

Results

• This analysis included a total of 1170 patients and 779 (67%) received treatment during pregnancy.
• Data reported that breast cancer was the most common malignant disease (462 [39%]).
• Researchers noted that every 5 years, the likelihood of receiving treatment during pregnancy increased (relative risk [RR] 1.10, 95% CI 1.05–1.15), primarily associated with an increase of chemotherapeutic treatment (1.31, 1.20–1.43).
• Findings demonstrated that overall, 955 (88%) of 1089 singleton pregnancies ended in a livebirth, of which 430 (48%) of 887 pregnancies ended preterm.
• More livebirths (RR 1.04, 95% CI 1.01–1.06) and fewer iatrogenic preterm deliveries (0.91, 0.84–0.98) were observed each 5 years.
• Researchers also observed a link between platinum-based chemotherapy and small for gestational age (odds ratio [OR] 3.12, 95% CI 1.45–6.70), and between taxane chemotherapy and NICU admission (OR 2.37, 95% CI 1.31–4.28).
• Data reported that NICU admission seemed to depend on cancer type, with gastrointestinal cancers having highest risk (OR 7.13, 95% CI 2.86–17.7) and thyroid cancers having lowest risk (0.14, 0.02–0.90) when compared with breast cancer.
• Unexpectedly, abdominal or cervical surgery was found to be associated with a reduced likelihood of NICU admission (OR 0.30, 95% CI 0.17–0.55).
• In addition, other links between treatment or cancer type and outcomes were less clear.