Association between the female survivors of childhood, adolescent, and young adult cancer and the adverse obstetric and feto-maternal outcomes: A systematic review and meta-analysis.
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OBJECTIVES: Potential to conceive after successful cancer therapy remains a major concern for young female survivors, as cancer and its associated treatments can negatively affect both maternal and fetal outcomes in future pregnancies. This study aims to determine the association between the female survivors of childhood, adolescent, and young adult cancer and the adverse obstetric and feto-maternal outcomes. METHOD: Literature search was done on PubMed, EMBASE, Scopus, and Web of Science to identify relevant studies. Literature published up to December 3, 2024, was included. Cancer survivors, with any type of cancer diagnosed during childhood, adolescence, or young adulthood (up to 39 years of age), were included. Studies reporting the comparative feto-maternal outcomes in pregnant women with and without any cancer history were included. Relevant studies were identified and screened, and duplicates were removed using NESTED Knowledge. Risk of bias was assessed using Newcastle-Ottawa Scale. The calculation of pooled estimates for outcomes using maximum likelihood estimators was carried out using a random effects model. R Studio was used to perform statistical analyses in accordance with accepted coding practices. Certainty in evidence was assessed by GRADE profile. RESULTS: Overall, 40 studies were eligible for inclusion, among which 37 were included in the meta-analysis. The pooled relative risk (RR) of the 15 studies reporting preterm births was 1.30 (95% confidence interval [CI]: 1.15, 1.47), significantly higher among the cancer survivors. Twelve studies had a pooled RR of 1.32 (95% CI: 1.09, 1.60) for gestational diabetes mellitus among the individuals with cancer history. Pooled RR was 1.13 (95% CI: 1.01, 1.27) for congenital anomalies, indicating a significantly higher risk among cancer survivors. Certainty of evidence was rated very low for all outcomes. CONCLUSION: Female cancer survivors have an increased risk of preterm birth, gestational diabetes mellitus, congenital anomalies, and caesarean delivery.