There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for all types of cancers combined. The aim of this study was to quantify deficits in birth rates and risks of obstetric complications for female survivors of 17 specific types of adolescent and young adult cancer. The Teenage and Young Adult Cancer Survivor Study (TYACSS)—a retrospective, population-based cohort of 200 945 5-year survivors of cancer diagnosed at age 15–39 years from England and Wales—was linked to the English Hospital Episode Statistics (HES) database from April 1, 1997, to March 31, 2022. The cohort included 17 different types of adolescent and young adult cancers. We ascertained 27 specific obstetric complications through HES among 96 947 women in the TYACSS cohort. Observed and expected numbers for births and obstetric complications were compared between the study cohort and the general population of England to identify survivors of adolescent and young adult cancer at a heighted risk of birth deficits and obstetric complications relative to the general population. Between April 1, 1997, and March 31, 2022, 21 437 births were observed among 13 886 female survivors of adolescent and young adult cancer from England, which was lower than expected (observed-to-expected ratio: 0·68, 95% CI 0·67–0·69). Other survivors of genitourinary, cervical, and breast cancer had under 50% of expected births. Focusing on more common (observed ≥100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥1·25), survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labour, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta praevia, and antepartum haemorrhage. Survivors of leukaemia were at risk of preterm delivery, obstructed labour, postpartum haemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded an observed-to-expected ratio of 1·25 or greater. Survivors of cervical cancer and leukaemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer. Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences.

中文翻译：

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英国青少年和青年癌症女性幸存者的不良产科结局风险 (TYACSS)：一项基于人群的回顾性队列研究


关于青少年和年轻成人癌症幸存者产科并发症风险的数据有限，之前的大多数研究仅报告所有类型癌症的综合风险。本研究的目的是量化 17 种特定类型的青少年和年轻人癌症的女性幸存者的出生率缺陷和产科并发症风险。青少年和年轻人癌症幸存者研究 (TYACSS) 是一项基于人群的回顾性队列，由 200945 名来自英格兰和威尔士 15-39 岁的癌症 5 年幸存者组成，与英国医院发病统计数据 (HES) 相关联）数据库从1997年4月1日到2022年3月31日。该队列包括17种不同类型的青少年和年轻人癌症。我们通过 HES 在 TYACSS 队列中的 96 947 名女性中确定了 27 种特定的产科并发症。将研究队列与英格兰普通人群之间的出生和产科并发症的观察和预期数字进行比较，以确定相对于普通人群而言，出生缺陷和产科并发症风险较高的青少年和年轻人癌症幸存者。 1997年4月1日至2022年3月31日期间，英国13 886名青少年癌症女性幸存者中观察到21 437名新生儿出生，低于预期（观察与预期比率：0·68，95% CI 0·67–0·69）。其他泌尿生殖癌、宫颈癌和乳腺癌的幸存者的出生率低于预期出生率的 50%。 关注至少中度过量（观察与预期比率≥1·25）的更常见（观察≥100）产科并发症，宫颈癌幸存者面临胎儿先露异常、难产、羊水和胎膜增多的风险疾病、胎膜早破、早产、胎盘疾病（包括前置胎盘）和产前出血。白血病幸存者面临早产、难产、产后出血和胎盘滞留的风险。所有其他特定癌症的幸存者出现的产科并发症不超过两种，且观察与预期的比率超过 1·25 或更高。宫颈癌和白血病的幸存者面临多种严重产科并发症的风险；因此，任何怀孕都应被视为高风险，并将受益于产科医生主导的产前护理。尽管观察到所有 17 种不同类型的青少年和年轻人癌症的出生率均存在缺陷，但我们为几乎所有青少年和年轻人癌症的幸存者提供了关于他们几乎所有产科并发症风险的保证。我们的研究结果为制定与青少年和年轻成人癌症女性幸存者产科风险咨询和监测相关的临床指南提供了证据。英国癌症儿童协会、脑肿瘤慈善机构和医学科学院。