Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
Am J Obstet Gynecol. 2023 Sep;229(3):324.e1-324.e7. doi: 10.1016/j.ajog.2023.06.008. Epub 2023 Jun 7.
Individuals with cancer during pregnancy are a medically complex patient population that is anticipated to grow. A better understanding of this population and patterns of risk at time of delivery would offer an opportunity for providers to mitigate maternal morbidity.
This study aimed to estimate the prevalence in the United States of concurrent cancer diagnoses at time of delivery by cancer type and associated maternal morbidity and mortality.
Using the National Inpatient Sample, we identified delivery-associated hospitalizations between 2007 and 2018. Concurrent cancer diagnoses were classified using the Clinical Classifications Software. Main outcomes included severe maternal morbidity, as defined by the Centers for Disease Control and Prevention indicators, and mortality during delivery hospitalization. We calculated adjusted rates for cancer diagnosis at time of delivery and adjusted odds ratios of severe maternal morbidity and maternal death during hospitalization using survey-weighted multivariable logistic regression models.
In this sample of 9,418,761 delivery-associated hospitalizations, 63 per 100,000 deliveries had a concurrent cancer diagnosis (95% confidence interval, 60-66; national weighted estimate, 46,654,042). The most common cancer types were breast cancer (8.4 per 100,000 deliveries), leukemia (8.4 per 100,000 deliveries), Hodgkin lymphoma (7.4 per 100,000 deliveries), non-Hodgkin lymphoma (5.4 per 100,000 deliveries), and thyroid cancer (4.0 per 100,000 deliveries). Patients with cancer were at significantly higher risk for any severe maternal morbidity (adjusted odds ratio, 5.25; 95% confidence interval, 4.73-5.83) and maternal death (adjusted odds ratio, 67.5; 95% confidence interval, 45.1-101.4). Risks of hysterectomy (adjusted odds ratio, 16.92; 95% confidence interval, 13.96-20.52), acute respiratory distress (adjusted odds ratio, 12.76; 95% confidence interval, 9.92-16.42), sepsis (adjusted odds ratio, 11.91; 95% confidence interval, 8.68-16.32), and embolism (adjusted odds ratio, 11.12; 95% confidence interval, 6.94-17.82) were particularly heightened among patients with cancer. Patients with leukemia, specifically, had the highest risk of adverse maternal outcomes (adjusted rate, 113 per 1000 deliveries; 95% confidence interval, 91-135 per 1000) when evaluating risk by cancer type.
Patients with cancer are at markedly increased risk of maternal morbidity and all-cause mortality during delivery-associated hospitalization. Risk is distributed unevenly within this population, with certain cancer types carrying unique risks for specific morbidity events.
患有癌症的孕妇是一个医疗复杂的患者群体，预计这一群体还会增加。更好地了解这一人群以及分娩时的风险模式将为提供者提供机会，以降低产妇发病率。
本研究旨在按癌症类型估计美国分娩时同时诊断癌症的患病率，以及相关的产妇发病率和死亡率。
我们使用国家住院患者样本，确定了 2007 年至 2018 年期间与分娩相关的住院治疗。使用临床分类软件对同时诊断的癌症进行分类。主要结果包括疾病控制和预防中心指标定义的严重产妇发病率和分娩住院期间的死亡率。我们使用基于调查权重的多变量逻辑回归模型计算了分娩时癌症诊断的调整率以及严重产妇发病率和住院期间产妇死亡的调整比值比。
在这项 9418761 例与分娩相关的住院治疗样本中，每 100000 例分娩中有 63 例（95%置信区间，60-66；全国加权估计值为 46654042）同时诊断出癌症。最常见的癌症类型是乳腺癌（每 100000 例分娩中有 8.4 例）、白血病（每 100000 例分娩中有 8.4 例）、霍奇金淋巴瘤（每 100000 例分娩中有 7.4 例）、非霍奇金淋巴瘤（每 100000 例分娩中有 5.4 例）和甲状腺癌（每 100000 例分娩中有 4.0 例）。患有癌症的患者发生任何严重产妇发病率的风险显著更高（调整比值比，5.25；95%置信区间，4.73-5.83）和产妇死亡（调整比值比，67.5；95%置信区间，45.1-101.4）。子宫切除术（调整比值比，16.92；95%置信区间，13.96-20.52）、急性呼吸窘迫（调整比值比，12.76；95%置信区间，9.92-16.42）、败血症（调整比值比，11.91；95%置信区间，8.68-16.32）和栓塞（调整比值比，11.12；95%置信区间，6.94-17.82）的风险特别高。特别是患有白血病的患者，当按癌症类型评估风险时，其不良产妇结局的风险最高（调整率，每 1000 例分娩中有 113 例；95%置信区间，每 1000 例分娩中有 91-135 例）。
患有癌症的孕妇在分娩相关住院期间发生产妇发病率和全因死亡率的风险显著增加。该人群中的风险分布不均，某些癌症类型对特定发病率事件具有独特的风险。
