Maternal and neonatal outcomes in pregnancies following colorectal cancer.
BACKGROUND
The risks of adverse obstetric outcomes among young women survivors of colorectal cancer (CRC) are uncertain.


METHODS
This Western Australian, whole-jurisdictional linked-data, retrospective cohort study compared maternal and neonatal outcomes of first postcancer pregnancies among women CRC survivors against randomly selected pregnancies of women with no cancer history. Logistic regression models were used to investigate a range of adverse outcomes independently associated with CRC and its surgical and adjunctive treatments.


RESULTS
Among 627,762 deliveries during the study period (1983-2007), 232 were first pregnancies following CRC. Whether following laparoscopic or open cancer surgery, these pregnancies were independently associated with a significantly increased risk of antepartum hemorrhage [odds ratios (ORs): 1.25; 2.13 for the respective procedures], postpartum hemorrhage (ORs: 1.61; 3.31), Cesarean delivery (ORs: 2.42; 4.24), infant low Apgar score (ORs: 1.32; 2.64), need for neonatal resuscitation (ORs: 1.49; 3.20), and special care admission (ORs: 1.42; 2.87). A history of open (but not laparoscopic) cancer surgery was associated with increased risk of gastrointestinal obstruction during pregnancy (OR 1.17) and prolonged postpartum hospitalization (OR 3.11). Neither was significantly associated with perinatal death. Among women with previous CRC, rectal (versus colonic) malignancy was independently associated with a significantly higher risk of overall maternal and neonatal adverse outcomes (ORs: 3.73 and 2.73, respectively), as was radiotherapy (ORs: 4.24 and 2.81, respectively). Chemotherapy was independently associated with a marginally but significantly higher risk of overall maternal but not neonatal outcomes (ORs: 1.11; 0.98). Open versus laparoscopic cancer surgery was associated with a significantly higher risk of antepartum and postpartum hemorrhage, low Apgar score, need for neonatal resuscitation, and neonatal special care admission.


CONCLUSIONS
Previous CRCs, particularly rectal and radiation-treated tumors, appear to confer an increased likelihood of adverse outcomes in subsequent pregnancies. Laparoscopic technique for CRC surgery may reduce adverse gestational outcomes.
School of Population Health, Centre for Health Services Research, The University of Western Australia, Crawley, Australia. fhaggar@toh.on.ca
Fatima
F
Haggar
Gavin
G
Pereira
David
D
Preen
John
J
Woods
Guillaume
G
Martel
Robin
R
Boushey
Joseph
J
Mamazza
Kristjana
K
Einarsdottir
D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017741:Survivors