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. 2024 Apr;103(4):729-739.
doi: 10.1111/aogs.14530. Epub 2023 Mar 13.

Pregnancy-associated gynecological cancer in New South Wales, Australia 1994-2013: A population-based historical cohort study

Penelope Fotheringham  1   2 , Nadom Safi  1   2 , Zhouyang Li  1   2 , Antoinette Anazodo  3 , Marc Remond  1   2 , Andrew Hayen  4 , David Currow  5 , David Roder  6 , Nada Hamad  7 , Michael Nicholl  8 , Adrienne Gordon  8 , Jane Frawley  4 , Elizabeth A Sullivan  1   2
Affiliations

Pregnancy-associated gynecological cancer in New South Wales, Australia 1994-2013: A population-based historical cohort study

Penelope Fotheringham et al. Acta Obstet Gynecol Scand. 2024 Apr.

Abstract

Introduction: Pregnancy-associated gynecological cancer (PAGC) refers to cancers of the ovary, uterus, fallopian tube, cervix, vagina, and vulva diagnosed during pregnancy or within 12 months postpartum. We aimed to describe the incidence of, and perinatal outcomes associated with, invasive pregnancy-associated gynecological cancer.

Material and methods: We conducted a population-based historical cohort study using linked data from New South Wales, Australia. We included all women who gave birth between 1994 and 2013, with a follow-up period extending to September 30, 2018. Three groups were analyzed: a gestational PAGC group (women diagnosed during pregnancy), a postpartum PAGC group (women diagnosed within 1 year of giving birth), and a control group (women with control diagnosis during pregnancy or within 1 year of giving birth). We used generalized estimation equations to compare perinatal outcomes between study groups.

Results: There were 1 786 137 deliveries during the study period; 70 women were diagnosed with gestational PAGC and 191 with postpartum PAGC. The incidence of PAGC was 14.6/100 000 deliveries and did not change during the study period. Women with gestational PAGC (adjusted odds ratio [aAOR] 6.81, 95% confidence interval [CI] 2.97-15.62) and with postpartum PAGC (aOR 2.65, 95% CI 1.25-5.61) had significantly increased odds of a severe maternal morbidity outcome compared with the control group. Babies born to women with gestational PAGC were more likely to be born preterm (aOR 3.11, 95% CI 1.47-6.59) and were at increased odds of severe neonatal complications (aOR 3.47, 95% CI 1.45-8.31) compared with babies born to women without PAC.

Conclusions: The incidence of PAGC has not increased over time perhaps reflecting, in part, the effectiveness of cervical screening and early impacts of human papillomavirus vaccination programs in Australia. The higher rate of preterm birth among the gestational PAGC group is associated with adverse outcomes in babies born to these women.

Keywords: cancer in pregnancy; gynecological cancer; iatrogenic prematurity; maternal outcome; neonatal outcome; perinatal outcome.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Crude incidence of pregnancy‐associated gynecological cancer.
FIGURE 2
FIGURE 2
Overall survival for gestational and postpartum groups.
See this image and copyright information in PMC

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