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Maternal Comorbidity and Adverse Perinatal Outcomes in Female Adolescent and Young Adult Cancer Survivors: a Cohort Study
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  • Milli Desai,
  • Beth Zhou,
  • Vinit Nalawade,
  • Cynthia Gyamfi-Bannerman,
  • Nina Veeravalli,
  • Henry Henk,
  • James Murphy,
  • Brian Whitcomb,
  • H. Irene Su
Milli Desai
University of California San Diego

Corresponding Author:[email protected]

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Beth Zhou
University of California San Diego
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Vinit Nalawade
University of California San Diego
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Cynthia Gyamfi-Bannerman
University of California San Diego Health Sciences
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Nina Veeravalli
Optum Health LLC
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Henry Henk
Optum Health LLC
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James Murphy
University of California San Diego
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Brian Whitcomb
University of Massachusetts Amherst
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H. Irene Su
University of California San Diego
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Abstract

Objectives: To evaluate risks of preterm birth and severe maternal morbidity (SMM) in female adolescent and young adult cancer survivors; assess maternal comorbidity as a potential mechanism; determine whether associations differ by use of assisted reproductive technology (ART). Design: Retrospective cohort Setting: Privately insured females in the U.S. Sample: Female with live births from 2000 to 2019 within OptumLabs®, a U.S. administrative health claims dataset Methods: Log-binomial regression models estimated relative risks of preterm birth and SMM by cancer status and tested for effect modification. Causal mediation analysis based on a counterfactual approach evaluated the proportions explained by maternal comorbidity. Main Outcome Measures: SMM, preterm birth Results: Among 46,064 cancer survivors, 2,440 singleton births, 214 multiple births, and 2,590 linked newborns occurred after cancer. In singleton births, preterm birth incidence was 14.8% in cancer survivors versus 12.4% in females without cancer (aRR 1.19, 95%CI 1.06-1.34); SMM incidence was 3.9% in cancer survivors versus 2.4% in females without cancer (aRR 1.44, 95%CI 1.13-1.83). Cancer survivors had more maternal comorbidities before and during pregnancy; 26% of the association between cancer and preterm birth and 30% of the association between cancer and SMM was mediated by maternal comorbidities. Associations between cancer and outcomes did not differ between ART and non-ART births. Conclusion: Preterm birth and SMM risks were modestly increased after cancer. Significant proportions of elevated risks may be due to increased comorbidities. Prevention and treatment of comorbidities provides an opportunity to improve perinatal outcomes among cancer survivors.
22 May 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
27 May 2022Submission Checks Completed
27 May 2022Assigned to Editor
29 May 2022Reviewer(s) Assigned
22 Aug 2022Review(s) Completed, Editorial Evaluation Pending
15 Sep 2022Editorial Decision: Revise Minor
02 Oct 20221st Revision Received
07 Oct 2022Submission Checks Completed
07 Oct 2022Assigned to Editor
07 Oct 2022Review(s) Completed, Editorial Evaluation Pending
25 Oct 2022Editorial Decision: Accept