Maternal and neonatal outcomes of pregnancy-associated cancer by cancer type
4 affiliations
- 1Faculty of Medicine, Ternopil National Medical University
- 2Elanco Animal Health
- 3Liberty University
- 4Chao Family Comprehensive Cancer Center, University of California Irvine
Abstract
Background Pregnancy-associated cancer (PAC) is diagnosed in approximately 1 in 1,000 pregnancies, and its incidence is rising with delayed childbearing. While previous meta-analyses have established overall PAC-associated risks, the extent to which maternal and neonatal outcomes differ by cancer type remains poorly characterised. Methods We conducted an updated systematic review following PRISMA 2020 guidelines. MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched from inception to June 2026. We included observational studies (cohort, case-control, population-based registries) reporting maternal and neonatal outcomes stratified by cancer type. Systematic reviews were used for reference checking only and were not included as primary evidence sources. Study-level risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses were performed for overall outcomes, with narrative synthesis for cancer-specific analyses. The review was not prospectively registered; this is acknowledged as a limitation. Findings Primary studies (70,097,167 births, 59,190 PAC cases) were included. Women with PAC had significantly increased risks of preterm birth (RR 3.07, 95% CI 2.37–3.98; prediction interval 0.93–10.14; 16 studies; I² = 98%), venous thromboembolism (RR 6.76, 95% CI 5.08–8.99; 6 studies; I² = 0%), maternal death (RR 41.58, 95% CI 20.38–84.83; 3 studies; I² = 44%), and caesarean section (RR 1.58, 95% CI 1.31–1.89; 13 studies; I² = 98%). Neonatal risks included low birth weight (RR 1.84, 95% CI 1.69–2.01; 11 studies; I² = 95%) and low Apgar score (RR 1.36, 95% CI 1.20–1.56; 6 studies; I² = 0%). Among malignancy types with available data, colorectal, breast, and cervical cancers demonstrated higher reported risks of adverse outcomes within individual studies; however, direct comparisons between cancer types are not supported by the available evidence. The majority of preterm births were iatrogenic (up to 88% in the INCIP cohort). Chemotherapy after the first trimester was not associated with increased congenital malformations but was associated with lower birth weight. Interpretation Pregnancy-associated cancer substantially increases maternal and neonatal morbidity and mortality. The strongest evidence concerns overall PAC-associated outcomes. Cancer-type-specific evidence is based on narrative synthesis of within-study associations and should be considered exploratory. Multidisciplinary management, careful delivery timing, and thromboprophylaxis are important considerations, though clinical recommendations should be individualised. These findings should be interpreted cautiously given the observational nature of the evidence, substantial heterogeneity for some outcomes, and the absence of formal comparative analyses between cancer types.
Related
- Impact of Short-Term Fluoride Supplementation in Pregnancy on the Maternal Microbiome, Pregnancy, and Neonatal Outcomes: A Pilot Randomized Controlled Trial
- Uterine Fibroids in Pregnancy: Maternal, Obstetric, and Neonatal Outcomes in a Retrospective Cohort Study
- Early Adverse Neonatal Outcomes Among Women With Diabetes in Pregnancy in Uganda: Incidence, Distribution and Associated Factors in a Multicenter Prospective Cohort Study
- Adverse pregnancy outcomes associated with advanced maternal age among Libyan women: a cross-sectional study at Benghazi medical centre
- Opioid Analgesic Initiation During Pregnancy and the Risk of Adverse Maternal and Neonatal Outcomes: A Target Trial Emulation
BibTeX
@article{awosan2026maternal,
title = {{Maternal and neonatal outcomes of pregnancy-associated cancer by cancer type}},
author = {Wuraola Ruth Awosan and David Sokoyebomi Oluwafemi Abafi and Naa Komley Commey and Victor Lambongang and Oghenetanure Ryan Enaworu and Blessing Esohe Emokpae and Adaoma Anthonia Aghaduno},
journal = {Discover Public Health},
year = {2026},
month = oct,
doi = {10.1186/s12982-026-03034-2},
url = {https://doi.org/10.1186/s12982-026-03034-2},
note = {CC BY},
}
RIS
TY - JOUR
TI - Maternal and neonatal outcomes of pregnancy-associated cancer by cancer type
AU - Wuraola Ruth Awosan
AU - David Sokoyebomi Oluwafemi Abafi
AU - Naa Komley Commey
AU - Victor Lambongang
AU - Oghenetanure Ryan Enaworu
AU - Blessing Esohe Emokpae
AU - Adaoma Anthonia Aghaduno
PY - 2026
DA - 2026/10/25
JO - Discover Public Health
DO - 10.1186/s12982-026-03034-2
UR - https://doi.org/10.1186/s12982-026-03034-2
AB - Background Pregnancy-associated cancer (PAC) is diagnosed in approximately 1 in 1,000 pregnancies, and its incidence is rising with delayed childbearing. While previous meta-analyses have established overall PAC-associated risks, the extent to which maternal and neonatal outcomes differ by cancer type remains poorly characterised. Methods We conducted an updated systematic review following PRISMA 2020 guidelines. MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched from inception to June 2026. We included observational studies (cohort, case-control, population-based registries) reporting maternal and neonatal outcomes stratified by cancer type. Systematic reviews were used for reference checking only and were not included as primary evidence sources. Study-level risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses were performed for overall outcomes, with narrative synthesis for cancer-specific analyses. The review was not prospectively registered; this is acknowledged as a limitation. Findings Primary studies (70,097,167 births, 59,190 PAC cases) were included. Women with PAC had significantly increased risks of preterm birth (RR 3.07, 95% CI 2.37–3.98; prediction interval 0.93–10.14; 16 studies; I² = 98%), venous thromboembolism (RR 6.76, 95% CI 5.08–8.99; 6 studies; I² = 0%), maternal death (RR 41.58, 95% CI 20.38–84.83; 3 studies; I² = 44%), and caesarean section (RR 1.58, 95% CI 1.31–1.89; 13 studies; I² = 98%). Neonatal risks included low birth weight (RR 1.84, 95% CI 1.69–2.01; 11 studies; I² = 95%) and low Apgar score (RR 1.36, 95% CI 1.20–1.56; 6 studies; I² = 0%). Among malignancy types with available data, colorectal, breast, and cervical cancers demonstrated higher reported risks of adverse outcomes within individual studies; however, direct comparisons between cancer types are not supported by the available evidence. The majority of preterm births were iatrogenic (up to 88% in the INCIP cohort). Chemotherapy after the first trimester was not associated with increased congenital malformations but was associated with lower birth weight. Interpretation Pregnancy-associated cancer substantially increases maternal and neonatal morbidity and mortality. The strongest evidence concerns overall PAC-associated outcomes. Cancer-type-specific evidence is based on narrative synthesis of within-study associations and should be considered exploratory. Multidisciplinary management, careful delivery timing, and thromboprophylaxis are important considerations, though clinical recommendations should be individualised. These findings should be interpreted cautiously given the observational nature of the evidence, substantial heterogeneity for some outcomes, and the absence of formal comparative analyses between cancer types.
SN - 3005-0774
ER -