title: Delivery of a very low birth weight infant and increased maternal risk of cancer and death: a population study with 16 years of follow-up.
abstract: BACKGROUND
  Pregnancy complications represent sentinel events for women's future health. We investigated whether delivery of a very low birth weight (VLBW) infant is associated with increased maternal risk for future incidence of maternal cancer and death.
  
  
  METHODS
  This is a population-based cohort study of linked Israeli Ministry of Health datasets between 1995 and 2011. Women delivering a live singleton <1,500 g infant (VLBW group) were compared with women delivering a live singleton, 3,000-3,500 g (control). The first pregnancy eligible for entry into the study, the "index pregnancy," reflected exposure status for each participant. Primary outcomes were maternal cancer and death. Cancer diagnoses were further classified by primary site. Cox regression models adjusted for follow-up period and maternal characteristics at index pregnancy: Age at delivery, ethnicity, years of education, marital status, and previous cancer afforded calculation of hazard ratios (HR) and 95% confidence intervals (CI).
  
  
  RESULTS
  During the study period, 982,091 mothers with 2,243,736 live births were identified; of these, 13,773 births were VLBW eligible for inclusion in the study and 448,743 births were controls. Groups differed significantly by average follow-up and all maternal characteristics evaluated. Overall rate of cancers and death was significantly increased for VLBW women compared to controls: 18.4 versus 15.7% and 7.3 versus 3.2%, both p < 0.0001. The Cox model adjusted for maternal characteristics showed significantly increased risk of cancer (all sites) in the VLBW women: HR 1.18 (95% CI 1.02-1.37) and for death: HR 2.13 (95% CI 1.68-2.71), and an increased combined risk of both outcomes: HR 1.4 (95% CI 1.23-1.59).
  
  
  CONCLUSIONS
  The delivery of a VLBW newborn is an independent lifetime risk factor for subsequent maternal cancers and death. These women may benefit from targeted cancer screening and counseling.
authors: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, 12 Bayit Street, 91031, Jerusalem, Israel. sorina@szmc.org.il.
authors: Sorina
authors: S
authors: Grisaru-Granovsky
authors: Department of Health Information and Computer Services, Ministry of Health, Jerusalem, Israel.
authors: Ethel Sherry
authors: ES
authors: Gordon
authors: Department of Health Information and Computer Services, Ministry of Health, Jerusalem, Israel.
authors: Ziona
authors: Z
authors: Haklai
authors: Department of Neonatology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, Jerusalem, Israel.
authors: Michael S
authors: MS
authors: Schimmel
authors: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, 12 Bayit Street, 91031, Jerusalem, Israel.
authors: Lior
authors: L
authors: Drukker
authors: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, 12 Bayit Street, 91031, Jerusalem, Israel.
authors: Arnon
authors: A
authors: Samueloff
authors: Israel Center for Disease Control, Ministry of Health, Jerusalem, Israel.
authors: Lital
authors: L
authors: Keinan-Boker
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008423:Maternal Age; D008875:Middle Aged; D009035:Mothers; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012306:Risk; D018571:Sentinel Surveillance
keywords: Cancer; Death; Maternal outcome; Preterm birth; Very low birth weight