The risk of preterm birth among women with a history of leukemia or lymphoma

Abstract

Objective

Leukemia and lymphoma are top cancers affecting children, adolescents and young adults with high five-year survival rates. Late effects of these cancers are a concern in reproductive-age patients, including pregnancy outcomes such as preterm birth. Our study aimed to evaluate whether diagnosis of leukemia or lymphoma prior to pregnancy was associated with preterm birth (<37 weeks gestation).

Methods

We conducted a cross-sectional study using a population-based dataset from California with linked birth certificates to hospital discharge records and an Iowa-based sample that linked birth certificates to Surveillance, Epidemiology, and End Results (SEER) cancer registry data. Preterm birth was defined using birth certificates. We ascertained history of leukemia and lymphoma using discharge diagnosis data in California and SEER registry in Iowa.

Results

Prevalence of preterm birth in California and Iowa was 14.6% and 12.0%, respectively, in women with a history of leukemia/lymphoma compared to 7.8% and 8.2%, respectively, in women without a cancer history. After adjusting for maternal age, race, education, smoking, and plurality, Women with history of leukemia/lymphoma were at an increased risk of having a preterm birth in California (odds ratio (OR) 1.89; 95% confidence interval (CI) 1.56–2.28) and Iowa (OR 1.61; 95% CI 1.10–2.37) compared to those with no cancer history.

Conclusion

In both California and Iowa, women with a history of leukemia or lymphoma were at increased risk for preterm birth. This suggests the importance of counseling with a history of leukemia/lymphoma prior to pregnancy and increased monitoring of women during pregnancy.

Keywords:

• Preterm birth
• leukemia
• lymphoma
• gestational age
• premature

Acknowledgements

The authors express our sincere thanks to Dr. Paul Romitti and his team at the Iowa Registry for Congenital and Inherited Disorders (IRCID)/Iowa vital records for their assistance with the linkage to the birth certificate data. The authors also like to express our gratitude to Jason Brubaker at the Iowa Cancer Registry for his assistance on providing the SEER Registry data and for linkage with the birth certificate data in Iowa. This research is supported by the National Cancer Institute (P30 CA086862-18S6). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Disclosure statement

This research is supported by the National Cancer Institute under Grant number P30 CA086862-18S6. Dr. Kelli Ryckman and Dr. Sonia Anand received the grant during the conduct of the study. Additionally, Dr. Ryckman has a patent for Serum Screening and Lipid Markers Predicting Preterm Birth pending. All other authors report no conflict of interest.

Author contributions

Sonia T. Anand: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing; Elizabeth A. Chrischilles: Conceptualization, Project administration, Supervision, Writing – review & editing; Rebecca J. Baer: Data curation, Writing – review and editing; Mary E. Charlton: Conceptualization, Writing – review and editing; Patrick J. Breheny: Conceptualization, Writing – review and editing; William W. Terry: Conceptualization, Writing – review and editing; Monica R. McLemore: Writing – review and editing; Deborah A. Karasek: Writing – review and editing; Laura L. Jelliffe-Pawlowski: Writing – review and editing; Kelli K. Ryckman: Conceptualization, Funding acquisition, Project administration, Supervision, Writing – review & editing.