Pregnancy and neonatal outcomes among women with early-onset colorectal cancer: a nationwide case-control study

Yin Cao; Stephanie Zhao; Tomas S Bexelius; Jonas Söderling; Mengyao Shi; Bjorn Roelstraete; Barbara B Warner; Olof Stephansson; Jonas F Ludvigsson

doi:10.1016/j.eclinm.2023.101963

Pregnancy and neonatal outcomes among women with early-onset colorectal cancer: a nationwide case-control study

EClinicalMedicine. 2023 Apr 13:59:101963. doi: 10.1016/j.eclinm.2023.101963. eCollection 2023 May.

Authors

Yin Cao^{1

2

3}, Stephanie Zhao⁴, Tomas S Bexelius^{5

6}, Jonas Söderling^{7

8}, Mengyao Shi¹, Bjorn Roelstraete⁸, Barbara B Warner⁹, Olof Stephansson^{7

10}, Jonas F Ludvigsson^{8

11

12}

Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
² Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
³ Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁴ School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁵ Department of Women's and Children's Health, Childhood Cancer Research Unit and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Paediatric Oncology, Astrid Lindgren Children Hospital, Stockholm, Sweden.
⁷ Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
⁸ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁹ Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA.
¹⁰ Division of Women's Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden.
¹¹ Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
¹² Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.

Abstract

Background: Early-onset colorectal cancer has risen worldwide, leaving more women with colorectal cancer at reproductive ages. We aimed to investigate the risk of adverse pregnancy and neonatal outcomes among women with early-onset colorectal cancer.

Methods: We conducted a nationwide, matched case-control study of maternal/pregnancy outcomes including pre-eclampsia and Cesarean delivery (C-section) as well as neonatal outcomes including preterm birth among 207 births in women with early-onset colorectal cancer (ages 18-49) and 1019 births in women without colorectal cancer in Sweden (1992-2019). Early-onset colorectal cancer cases were identified through the Cancer Register, and outcome data were retrieved through linkage to Medical Birth Register and National Patient Register. Using conditional logistic regression, we estimated multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Findings: Between Jan 1, 1992, and Dec 31, 2019, women with early-onset colorectal cancer who gave birth had increased odds of pre-eclampsia (7.2% vs 3.2%; OR = 2.52, 95%CI = 1.25-5.08), any C-section (24.6% vs 19.4%; OR = 1.43, 95%CI = 1.00-2.06), particularly emergency C-section (17.4% vs 10.5%; OR = 1.79, 95%CI = 1.17-2.75), after adjustment for maternal education level, country of birth, body mass index and smoking in early pregnancy, and comorbidities. Maternal history of early-onset colorectal cancer was also associated with offspring preterm birth (12.1% vs 5.2%; OR = 2.31, 95%CI = 1.34-3.99), delineated as spontaneous (OR = 1.06, 95%CI = 0.47-2.39) or medically-indicated preterm birth (OR = 4.48, 95%CI = 2.05-9.79). There was no increased risk of congenital malformation or small for gestational age birth.

Interpretation: In this population-based study, maternal history of early-onset colorectal cancer was associated with risk of both adverse pregnancy (pre-eclampsia, C-section) and neonatal outcomes (preterm birth).

Funding: US National Institutes of Health, Swedish Society of Medicine, Swedish Cancer Foundation.

Keywords: Colorectal cancer; Early-onset; Neonatal; Pregnancy.