In-Hospital Complications in Pregnant Women With Current or Historical Cancer Diagnoses

Abstract

Objective
To assess the temporal trends, patient characteristics and comorbidities, and in-hospital cardiovascular and obstetric complications and outcomes of pregnant women with current or historical cancer diagnosis at the time of admission for delivery.

Patients and Methods
We analysed delivery hospitalisations with or without current or historical cancer between January 1, 2004 and December 31, 2014 from the United States National Inpatient Sample database.

Results
We included 43,132,097 delivery hospitalisations with no cancer, 39,118 with current cancer and 67,336 with historical diagnosis of cancer. The five most common types of current cancer were haematological, thyroid, cervical, skin and breast cancer. Women with current and historical cancer were older (29 and 32 vs. 27 years) and incurred higher hospital costs ($4,131 and $4,078 vs. $3,521), compared to women without cancer. Most of the cancer types were associated with preterm birth (haematological: adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.35-1.62; cervical: aOR 1.47, 95% CI 1.32-1.63; breast: aOR 1.93, 95% CI 1.72-2.16). Current haematological cancer was associated with the highest risk of peripartum cardiomyopathy (aOR 12.19, 95% CI 7.75-19.19), all-cause mortality (aOR 6.50, 95% CI 2.22-19.07), arrhythmia (aOR 3.82, 95% CI 2.04-7.15) and postpartum haemorrhage (aOR 1.31, 95% CI 1.11-1.54). Having current or historical cancer diagnosis did not confer additional risk for stillbirth; however metastases increased the risk of maternal mortality and preterm birth.

Conclusion
Women with current or historical diagnosis of cancer at delivery have more comorbidities compared to women without cancer. Clinicians should communicate the risks of multi-system complications to this complex patient group.