Cancer
Maternal mortality after adolescent and young adult cancer: a population-based study Caitlin Murphy* Caitlin Murphy Andrea Betts Jennifer Wang Philip Lupo L. Aubree Shay Marlyn Allicock Sandi Pruitt
Background: Adolescents and young adults with a history of cancer (AYAs) have excess risk of adverse birth outcomes, including cesarean delivery and preterm birth. Maternal mortality in this population has not been well-described. To address this gap, we examined maternal mortality in a diverse, population-based sample of AYAs.
Methods: We identified female AYAs diagnosed with cancer at age 15-39 years from January 1, 1995 to December 31, 2015 using data from the Texas Cancer Registry. These data were linked to live birth and fetal death certificates through December 31, 2016 to identify births after diagnosis, excluding births to AYAs diagnosed during pregnancy. We defined maternal mortality as any death within one year of delivery and estimated risk using a Poisson model with robust standard errors.
Results: There were 11,263 births to 8,333 female AYAs after diagnosis. AYAs were commonly diagnosed with thyroid (28.4%), lymphoma (13.2%), and breast (11.2%) cancers; 8.7% were non-Hispanic Black and 29.3% were Hispanic. Mean time from diagnosis to first post-diagnosis birth was 4.3 years (SD=3.0), and mean maternal age at first post-diagnosis birth was 31.0 years (SD=5.5). Risk of maternal mortality was 0.69% (95% CI 0.55%, 0.87%), ranging from 0.03% (95% CI 0.01%, 0.09%) for AYAs with thyroid cancer to 1.51% (95% CI 0.94%, 2.42%) and 1.53% (95% CI 0.64%, 3.67%) for AYAs with breast and gastrointestinal cancer, respectively. Risk also differed by race/ethnicity. For example, non-Hispanic Black (RR 3.38, 95% CI 1.86, 6.17) and Hispanic (RR 1.75, 95% CI 1.05, 2.89) AYAs had higher risk compared to non-Hispanic White AYAs.
Conclusions: Risk of maternal mortality in AYAs is low – less than 1%. However, we observed striking differences in maternal mortality by race/ethnicity, adding to overwhelming evidence on maternal and reproductive health inequities. Additional work is needed to identify mechanisms of disparities and strategies to improve birth equity for AYAs.