Perinatal complications in female survivors of cancer: a systematic review and meta-analysis

Background: Observational studies have suggested that perinatal outcomes are worse in offspring of cancer survivors. We conducted a systematic review and meta-analysis to examine the risks of perinatal complications in female cancer survivors diagnosed before the age of 40 years. Methods: All published articles on pregnancy, perinatal or congenital risks in female cancer survivors were screened for eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results: Twenty-two studies met the inclusion criteria. Meta-analysis indicates that offspring of cancer survivors are at increased risk of prematurity (relative risk [RR]: 1.56; 95% confidence interval [CI] 1.37–1.77) and low birth weight (RR 1.47; 95% CI 1.24–1.73) but not of being small for gestational age (RR 0.99; 95% CI 0.81–1.22). Cancer survivors have higher rates of elective (RR: 1.38; 95% CI 1.13–1.70) and emergency caesarean section (RR: 1.22; 95% CI 1.15–1.30) as well as assisted vaginal delivery (RR: 1.10; 95% CI 1.02–1.18) and are at increased risk of postpartum haemorrhage (RR: 1.18; 95% CI 1.02–1.36). The risk of congenital abnormalities also appears increased (RR 1.10; 95% CI 1.02–1.20), but this is likely to be an artefact of analysis. Although meta-analysis of the effects of radiotherapy was not possible for all outcomes, there was an increased risk of prematurity (RR 2.27; 95% CI 1.34–3.82) and consistent findings of low birth weight (RR 1.38–2.31). Risk of being small for gestational age was increased only after high uterine radiotherapy dosage. Conclusion: The increased perinatal risks warrant a proactive approach from healthcare providers in both counselling and management of perinatal care for cancer survivors.