Pregnant women diagnosed with cancer experience adverse birth outcomes

Adolescent and young adult women diagnosed with cancer while pregnant are more likely to have adverse birth outcomes, according to a study by researchers with UTHealth Houston.

The study was published recently in the online version of the Journal of the National Cancer Institute.

“There is a small but growing number of young women who find themselves in this terrible situation — where they are diagnosed with cancer while pregnant,” said Andrea Betts, PhD, MPH, first author on the study and researcher at UTHealth Houston School of Public Health. “We wanted to look at what happens to the infants of these women and how they are impacted.”

Using data from the Texas Cancer Registry, Texas vital records, and the Texas Birth Defects Registry over a 15-year period, researchers were able to examine birth outcomes of nearly 1,300 adolescent and young adult women who were diagnosed with cancer during their pregnancies. They discovered that infants born to these women had a higher prevalence of low birth weight, very preterm and preterm birth, cesarean delivery, and low Apgar score — an indicator of newborn health — compared to women without cancer. These infants were also more likely to have birth defects involving the heart or circulatory system, although these were rare. 

Preterm birth is a leading cause of infant morbidity and mortality. In the study, infants born to women with cancer were three to four times more likely to be born prematurely and to be low birthweight, and nearly five times more likely to be born very prematurely (before 32 weeks).

“Being diagnosed with cancer during pregnancy forces women to make difficult decisions. They must balance and weigh the possible risks to their child with risks to themselves of a delayed or different course of treatment,” said Betts. “In some cases, they may have to decide whether they should continue their pregnancy, delay their own treatment and risk their cancer progressing, or deliver early to start cancer treatment and risk health complications for their child.”

Treatment for women diagnosed with cancer during pregnancy varies depending upon the type of cancer, stage of cancer, and the gestational age of the fetus. According to Betts, some chemotherapy is considered safe for pregnant women during the second and third trimesters, but not the first. Radiation therapy is not safe during pregnancy.

“Women need to be front and center when making decisions that impact their own health and their pregnancies. Oncologists and OB-GYNs should work together to counsel women and help them make the best evidence-based decision for them,” Betts said.

Additional UTHealth Houston School of Public Health authors included senior author Caitlin C. Murphy, PhD, MPH; L. Aubree Shay, PhD, MSSW; and Marlyn A. Allicock, PhD, MPH. Other authors included Philip J. Lupo, PhD, MPH, with Baylor College of Medicine; Sandi L. Pruitt, PhD, MPH, with The University of Texas Southwestern Medical Center; Michael E. Roth, MD, with The University of Texas MD Anderson Cancer Center; and Barbara A. Cohn, PhD, with the Child Health and Development Studies at the Public Health Institute in Berkeley, California.

Betts, Murphy, Shay, and Allicock are part of a team of investigators in the Adolescent and Young Adult Scholarship, Training, and Research (AYA STAR) Lab that formed at UTHealth Houston School of Public Health in 2020. Their expertise includes behavioral sciences, intervention development, epidemiology, program evaluation, and health disparities.

The research was supported by the U.S. Department of Defense (CA181215) and a training fellowship from UTHealth Houston (TL1 TR003169).

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