title: Lifestyle, distress, and pregnancy outcomes in the Childhood Cancer Survivor Study cohort.
abstract: OBJECTIVE
  To evaluate associations between prepregnancy lifestyle factors, psychologic distress and adverse pregnancy outcomes among female survivors of childhood cancer.
  
  
  METHODS
  We examined pregnancies of 1192 female participants from the Childhood Cancer Survivor Study. Generalized linear models, adjusted for age at diagnosis, age at pregnancy, parity, and education were used to calculate the odds ratio (OR) and confidence interval (CI) for associations between prepregnancy inactivity, overweight or obese status, smoking status, risky drinking, psychologic distress and pregnancy outcomes. Interactions between lifestyle factors, psychologic distress, type of cancer and cancer treatment were assessed in multivariable models.
  
  
  RESULTS
  The median age of study participants at the beginning of pregnancy was 28 years (range, 14-45). Among 1858 reported pregnancies, there were 1300 singleton live births (310 were preterm), 21 stillbirths, 397 miscarriages, and 140 medical abortions. Prepregnancy physical inactivity, risky drinking, distress, and depression were not associated with any pregnancy outcomes. Compared with those who had never smoked, survivors with >5 pack-years smoking history had a higher risk for miscarriage among those treated with >2.5 Gray (Gy) uterine radiation (OR, 53.9; 95% CI, 2.2-1326.1) than among those treated with ≤2.5 Gy uterine radiation (OR, 1.9; 95% CI, 1.2-3.0). There was a significant interaction between smoking and uterine radiation (Pinteraction = .01).
  
  
  CONCLUSIONS
  Although most lifestyle factors and psychologic distress were not predictive of adverse pregnancy outcomes, the risk for miscarriage was significantly increased among survivors exposed to >2.5 Gy uterine radiation who had a history of smoking.
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors: Prasad L
authors: PL
authors: Gawade
authors: Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Kevin C
authors: KC
authors: Oeffinger
authors: Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Charles A
authors: CA
authors: Sklar
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors: Daniel M
authors: DM
authors: Green
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors: Kevin R
authors: KR
authors: Krull
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN; Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN.
authors: Wassim
authors: W
authors: Chemaitilly
authors: M. D. Anderson Cancer Center, Houston, TX.
authors: Marilyn
authors: M
authors: Stovall
authors: Fred Hutchinson Cancer Research Center, Seattle, WA.
authors: Wendy
authors: W
authors: Leisenring
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors: Gregory T
authors: GT
authors: Armstrong
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors: Leslie L
authors: LL
authors: Robison
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN. Electronic address: kiri.ness@stjude.org.
authors: Kirsten K
authors: KK
authors: Ness
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009369:Neoplasms; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D017741:Survivors; D055815:Young Adult
keywords: childhood cancer survivors; lifestyle; pregnancy; smoking; uterine radiation