Increased maternal morbidity observed in pregnant women with hematologic malignancy, reports research

A new study published in The Lancet Haematology showed that pregnant women with hematologic malignancies were more likely to experience severe maternal morbidity and obstetric difficulties.

With occurrences ranging from 4.0 to 15.8 instances per 100,000 pregnancies, hematological malignancy during pregnancy is an uncommon but clinically relevant event. There are significant problems in both diagnosis and treatment due to this unusual combination of cancer and pregnancy. Due to the rarity of pregnancy-associated hematological malignancy, there are little data to inform treatment decisions. In order to assess the overall survival, incidence, maternal morbidity, and mortality of women with pregnancy-associated hematological malignancies, Pierre Pinson and colleagues carried out this study.

This research was carried out as a countrywide observational cohort analysis by utilizing the French National Healthcare Data System (SNDS), a health-care administrative database that includes up to 99% of the French population. They considered all pregnancies in France that ended between January 1, 2012 and December 31, 2022. The pregnancies with outpatient terminations or losses, as well as those who had a history of hematological malignancies prior to pregnancy, were excluded.

A Cox proportional hazards simulation was employed to assess overall survival, defined as the time from diagnosis of hematological malignancy until death or completion of the study follow-up, in the hematological malignancy while pregnant group versus the hematological malignancy post-pregnancy group. Births were categorized as extremely preterm (<32 weeks), preterm (32-36 weeks), and term (≥37 weeks) and compared between the hematological malignancy during pregnancy group and the reference group. Confounder correction was performed using inverse probability weighting (IPW), which included maternal age (categorized), socioeconomic status, comorbidities, as well as year of delivery.

The corrected odds of any serious maternal complications during hematologic cancer-associated pregnancies were approximately 23 times higher than those in the general population, and the risk of preterm delivery was nearly 12 times greater. However, after roughly 6 years of median follow-up, there was no difference in overall survival (OS) between women diagnosed with hematologic malignancy during or after pregnancy. The 5-year OS rates were 91.2% and 90.3%, respectively.

The hematological malignancies during pregnancy are a difficult scenario, with a significant risk of maternal and obstetric problems. And so, it is vital that these women get treatment in highly specialist facilities that have the personnel and technological resources to handle both hematological and maternal problems. Overall, there was no discernible difference in overall survival between women who have been diagnosed with hematological malignancies while pregnant and those who were not.

Reference:

Pinson, P., Boussaid, I., Decroocq, J., Chouchana, L., Birsen, G., Barrois, M., Tsatsaris, V., Godeberge, C., Zerbit, J., Burroni, B., Pene, F., Huynh, L., Charlier, C., Tamburini, J., Beeker, N., Collier, M., Bouscary, D., Treluyer, J. M., & Birsen, R. (2024). Maternal and obstetric outcomes in women with pregnancy-associated haematological malignancies: an observational nationwide cohort study. In The Lancet Haematology. Elsevier BV. https://doi.org/10.1016/s2352-3026(24)00288-6