title: Adverse obstetric and perinatal outcomes following treatment of adolescent and young adult cancer: a population-based cohort study.
abstract: OBJECTIVE
  To investigate obstetric and perinatal outcomes among female survivors of adolescent and young adult (AYA) cancers and their offspring.
  
  
  METHODS
  Using multivariate analysis of statewide linked data, outcomes of all first completed pregnancies (n = 1894) in female survivors of AYA cancer diagnosed in Western Australia during the period 1982-2007 were compared with those among females with no cancer history. Comparison pregnancies were matched by maternal age-group, parity and year of delivery.
  
  
  RESULTS
  Compared with the non-cancer group, female survivors of AYA cancer had an increased risk of threatened abortion (adjusted relative risk 2.09, 95% confidence interval 1.51-2.74), gestational diabetes (2.65, 2.08-3.57), pre-eclampsia (1.32, 1.04-1.87), post-partum hemorrhage (2.83, 1.92-4.67), cesarean delivery (2.62, 2.22-3.04), and maternal postpartum hospitalization>5 days (3.01, 1.72-5.58), but no excess risk of threatened preterm delivery, antepartum hemorrhage, premature rupture of membranes, failure of labor to progress or retained placenta. Their offspring had an increased risk of premature birth (<37 weeks: 1.68, 1.21-2.08), low birth weight (<2500 g: 1.51, 1.23-2.12), fetal growth restriction (3.27, 2.45-4.56), and neonatal distress indicated by low Apgar score (<7) at 1 minute (2.83, 2.28-3.56), need for resuscitation (1.66, 1.27-2.19) or special care nursery admission (1.44, 1.13-1.78). Congenital abnormalities and perinatal deaths (intrauterine or ≤7 days of birth) were not increased among offspring of survivors.
  
  
  CONCLUSIONS
  Female survivors of AYA cancer have moderate excess risks of adverse obstetric and perinatal outcomes arising from subsequent pregnancies that may require additional surveillance or intervention.
authors.affiliation: The Department of Surgery, The Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Canada; Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia.
authors.forename: Fatima A
authors.initials: FA
authors.lastname: Haggar
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Subiaco, Australia; Center for Perinatal Pediatric and Environmental Epidemiology, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Gavin
authors.initials: G
authors.lastname: Pereira
authors.affiliation: Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Preen
authors.affiliation: Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia.
authors.forename: C D'Arcy
authors.initials: CD
authors.lastname: Holman
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Subiaco, Australia.
authors.forename: Kristjana
authors.initials: K
authors.lastname: Einarsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D066264:Datasets as Topic; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D063868:Patient Outcome Assessment; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D011252:Pregnancy Complications, Neoplastic; D012306:Risk; D055815:Young Adult