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Meta-Analysis
. 2021 Oct 10;39(29):3293-3305.
doi: 10.1200/JCO.21.00535. Epub 2021 Jul 1.

Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis

Matteo Lambertini  1   2 , Eva Blondeaux  1   3 , Marco Bruzzone  4 , Marta Perachino  1   2 , Richard A Anderson  5 , Evandro de Azambuja  6 , Philip D Poorvu  7 , Hee Jeong Kim  8 , Cynthia Villarreal-Garza  9   10 , Barbara Pistilli  11 , Ines Vaz-Luis  11 , Cristina Saura  12 , Kathryn J Ruddy  13 , Maria Alice Franzoi  11 , Chiara Sertoli  1 , Marcello Ceppi  4 , Hatem A Azim Jr  9 , Frederic Amant  14   15 , Isabelle Demeestere  16 , Lucia Del Mastro  1   3 , Ann H Partridge  7 , Olivia Pagani  17 , Fedro A Peccatori  18
Affiliations
Meta-Analysis

Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis

Matteo Lambertini et al. J Clin Oncol. .

Abstract

Purpose: Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics.

Methods: A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models.

Results: Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy.

Conclusion: These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.

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Conflict of interest statement

Matteo LambertiniConsulting or Advisory Role: Roche, Novartis, Lilly, AstraZenecaSpeakers' Bureau: Theramex, Takeda, Roche, Lilly, Novartis, Pfizer, Sandoz Richard A. AndersonHonoraria: Merck, IBSAConsulting or Advisory Role: NeRRe Therapeutics, Roche Diagnostics, SojournixResearch Funding: Roche Diagnostics Evandro de AzambujaHonoraria: Roche/Genentech, SeaGen, Zodiac PharmaConsulting or Advisory Role: Roche/Genentech, Novartis, Libbs, Pierre FabreResearch Funding: Roche/Genentech, AstraZeneca, Servier/Pfizer, GlaxoSmithKline/NovartisTravel, Accommodations, Expenses: Roche/Genentech, GlaxoSmithKline Philip D. PoorvuOther Relationship: Medscape Cynthia Villarreal-GarzaConsulting or Advisory Role: Roche, Novartis, Pfizer, LillySpeakers' Bureau: Roche, Myriad Genetics, NovartisResearch Funding: AstraZeneca, RocheTravel, Accommodations, Expenses: Roche, MSD Oncology, Pfizer Barbara PistilliConsulting or Advisory Role: Puma Biotechnology, Pierre Fabre, Novartis, Myriad Genetics, AstraZenecaResearch Funding: Pfizer, Puma Biotechnology, Merus, Daiichi-SankyoTravel, Accommodations, Expenses: Pfizer, AstraZeneca, MSD Oncology, Novartis Ines Vaz-LuisHonoraria: AstraZeneca, Amgen, Pfizer Cristina SauraConsulting or Advisory Role: AstraZeneca, Daiichi Sankyo, Eisai, Exact Sciences, Roche, Exeter Pharmaceuticals, MediTech, Merck Sharp & Dohme, Novartis, Pfizer, Philips, Pierre Fabre, Puma Biotechnology, Sanofi/Aventis, SeaGen, ZymeworksResearch Funding: Genentech, AstraZeneca, Roche, Macrogenics, Novartis, Pfizer, Puma Biotechnology, Synthon, PiqurTravel, Accommodations, Expenses: Pfizer, Novartis, Roche, AstraZeneca, Genomic Health, Puma Biotechnology Kathryn J. RuddyResearch Funding: MedtronicPatents, Royalties, Other Intellectual Property: Spouse and Mayo Clinic have filed patents related to the application of artificial intelligence to the electrocardiogram for diagnosis and risk stratification, and Spouse and Mayo Clinic are involved in a potential equity or royalty relationship with AliveCor Hatem A. Azim JrEmployment: Innate PharmaStock and Other Ownership Interests: Innate PharmaHonoraria: NovartisConsulting or Advisory Role: DiaacurateSpeakers' Bureau: GlaxoSmithKlineTravel, Accommodations, Expenses: Novartis Frederic AmantConsulting or Advisory Role: Clovis Oncology, AstraZeneca, Samsung Bioepis Isabelle DemeestereConsulting or Advisory Role: RocheResearch Funding: Roche DiagnosticTravel, Accommodations, Expenses: Ferring Lucia Del MastroHonoraria: Roche, Novartis, Lilly, MSD OncologyConsulting or Advisory Role: Roche, Novartis, MSD, Pfizer, Ipsen, AstraZeneca, Genomic Health, Lilly, Seattle Genetics, Eisai, Pierre Fabre, Daiichi SankyoTravel, Accommodations, Expenses: Roche, Pfizer, Celgene Ann H. PartridgePatents, Royalties, Other Intellectual Property: I receive small royalty payments for coauthoring the breast cancer survivorship section of UpToDateTravel, Accommodations, Expenses: Novartis Olivia PaganiConsulting or Advisory Role: Pfizer, Roche, Novartis, Takeda, Lilly, Debiopharm Group Fedro A. PeccatoriConsulting or Advisory Role: Roche Molecular Diagnostics, IpsenNo other potential conflicts of interest were reported.

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