Table 2.
Relative risk of developing a hypertensive disorder, diabetes mellitus, or anemia in pregnancy among female survivors of childhood cancer
| Characteristic | Maternal disorders related to pregnancy |
Other obstetric conditions |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hypertension complicating pregnancy* ICD10: O10-O11, O13-O16 |
Hypertension complicating pregnancy* (excluding preexisting hypertension) ICD10:O13-O16 |
Gestational diabetes mellitus*,† ICD10: O24.4 |
Anemia complicating pregnancy*,‡ ICD10: O99.0 |
|||||||||
| No. (%) | RR (95% CI) | P§ | No. (%) | RR (95% CI) | P§ | No. (%) | RR (95% CI) | P§ | No. (%) | RR (95% CI) | P§ | |
| General population | 1495 (6.0) | 1.00 (ref.) | 1013 (4.1) | 1.00 (ref.) | 390 (1.6) | 1.00 (ref.) | 1099 (4.4) | 1.00 (ref.) | ||||
| Female survivors‖ | 61 (7.1) | 1.23 (0.95 to 1.60) | .11 | 40 (4.7) | 1.18 (0.85 to 1.65) | .32 | 13 (1.5) | 0.91 (0.49 to 1.71) | .72 | 34 (4.0) | 0.88 (0.58 to 1.29) | .52 |
| Type of childhood cancer | ||||||||||||
| Leukemia | 81 (8.9) | 1.00 (ref.) | 51 (5.6) | 1.00 (ref.) | 18 (2.0) | 1.00 (ref.) | 52 (5.7) | 1.00 (ref.) | ||||
| Hodgkin lymphoma | 10 (6.5) | 0.62 (0.30 to 1.25) | .18 | 6 (3.9) | 0.61 (0.23 to 1.58) | .31 | 5 (3.3) | 1.33 (0.46 to 3.90) | .60 | 10 (6.5) | 1.12 (0.59 to 2.13) | .73 |
| Non-Hodgkin lymphoma | 13 (11.7) | 1.18 (0.62 to 2.25) | .61 | 9 (8.1) | 1.34 (0.61 to 2.98) | .47 | 4 (3.6) | 1.64 (0.49 to 5.56) | .42 | 8 (7.2) | 1.18 (0.56 to 2.51) | .66 |
| CNS tumor | 25 (7.4) | 0.83 (0.53 to 1.30) | .41 | 15 (4.5) | 0.81 (0.45 to 1.45) | .47 | 4 (1.2) | 0.60 (0.21 to 1.74) | .35 | 17 (5.1) | 0.86 (0.48 to 1.54) | .61 |
| Neuroblastoma | 17 (12.6) | 1.41 (0.80 to 2.48) | .24 | 13 (9.6) | 1.71 (0.90 to 3.23) | .10 | 2 (1.5) | 0.99 (0.23 to 4.32) | .99 | 4 (3.0) | 0.49 (0.18 to 1.32) | .16 |
| NH-retinoblastoma | 6 (4.2) | 0.50 (0.22 to 1.14) | .10 | 2 (1.4) | 0.27 (0.07 to 1.11) | .07 | 4 (2.8) | 1.24 (0.37 to 4.13) | .73 | 3 (2.1) | 0.38 (0.12 to 1.18) | .09 |
| H-retinoblastoma | 3 (5.2) | 0.66 (0.22 to 2.01) | .46 | 3 (5.2) | 1.05 (0.34 to 3.26) | .93 | 0 (0.0) | — | — | 3 (5.2) | 0.94 (0.30 to 2.91) | .91 |
| Wilms tumor | 61 (18.9) | 2.12 (1.52 to 2.97) | <.001 | 44 (13.7) | 2.38 (1.56 to 3.64) | <.001 | 8 (2.5) | 1.27 (0.49 to 3.25) | .62 | 21 (6.5) | 1.15 (0.70 to 1.89) | .57 |
| Bone tumor | 9 (6.2) | 0.64 (0.31 to 1.33) | .23 | 7 (4.8) | 0.76 (0.32 to 1.81) | .53 | 1 (0.7) | 0.39 (0.05 to 2.91) | .36 | 7 (4.8) | 0.82 (0.32 to 2.06) | .67 |
| Soft-tissue sarcoma | 16 (8.6) | 0.93 (0.53 to 1.64) | .80 | 12 (6.5) | 1.13 (0.58 to 2.18) | .72 | 5 (2.7) | 1.11 (0.30 to 4.01) | .88 | 10 (5.4) | 0.95 (0.47 to 1.93) | .88 |
| Other | 21 (7.5) | 0.85 (0.52 to 1.40) | .54 | 14 (5.0) | 0.91 (0.49 to 1.67) | .76 | 5 (1.8) | 0.83 (0.30 to 2.34) | .73 | 8 (2.9) | 0.51 (0.24 to 1.06) | .07 |
| Pheterogeneity§ | <.001 | <.001 | .93 | .47 | ||||||||
| Treated with radiotherapy | ||||||||||||
| No | 61 (7.1) | 1.00 (ref.) | 40 (4.7) | 1.00 (ref.) | 13 (1.5) | 1.00 (ref.) | 34 (4.0) | 1.00 (ref.) | ||||
| Brain | 82 (9.1) | 1.25 (0.89 to 1.76) | .20 | 49 (5.4) | 1.17 (0.75 to 1.82) | .49 | 19 (2.1) | 1.61 (0.72 to 3.59) | .24 | 49 (5.4) | 1.39 (0.89 to 2.18) | .15 |
| Other (nonbrain/abdominal) | 22 (9.5) | 1.28 (0.76 to 2.14) | .36 | 18 (7.8) | 1.64 (0.89 to 3.02) | .11 | 5 (2.2) | 1.61 (0.55 to 4.67) | .38 | 5 (2.2) | 0.57 (0.22 to 1.44) | .23 |
| Abdominal | 59 (18.1) | 2.43 (1.70 to 3.47) | <.001 | 42 (12.9) | 2.69 (1.72 to 4.22) | <.001 | 16 (4.9) | 3.35 (1.41 to 7.93) | .01 | 27 (8.3) | 2.10 (1.27 to 3.46) | .004 |
| Abdominal non-Wilms | 10 (8.4) | 1.09 (0.52 to 2.28) | .81 | 7 (5.9) | 1.17 (0.48 to 2.83) | .73 | 8 (6.7) | 4.27 (1.54 to 11.83) | .01 | 11 (9.2) | 2.25 (1.13 to 4.49) | .02 |
| Abdominal Wilms only | 49 (23.7) | 3.29 (2.29 to 4.71) | <.001 | 35 (16.9) | 3.59 (2.27 to 5.68) | <.001 | 8 (3.9) | 2.73 (1.00 to 7.62) | .05 | 16 (7.7) | 2.00 (1.13 to 3.57) | .02 |
| No radiotherapy Wilms only | 9 (9.4) | 1.36 (0.68 to 2.71) | .38 | 7 (7.3) | 1.60 (0.70 to 3.64) | .26 | 0 (0.0) | — | — | 4 (4.2) | 1.05 (0.36 to 3.12) | .93 |
| Pheterogeneity§ | <.001 | <.001 | .23 | .01 | ||||||||
| Age at diagnosis, y | ||||||||||||
| 0–4 | 136 (10.3) | 1.00 (ref.) | 93 (7.1) | 1.00 (ref.) | 31 (2.4) | 1.00 (ref.) | 74 (5.6) | 1.00 (ref.) | ||||
| 5–9 | 70 (9.0) | 0.96 (0.69 to 1.34) | .83 | 46 (5.9) | 0.86 (0.56 to 1.32) | .48 | 13 (1.7) | 0.61 (0.28 to 1.34) | .22 | 40 (5.1) | 0.75 (0.46 to 1.24) | .27 |
| 10–14 | 56 (8.2) | 1.06 (0.68 to 1.64) | .78 | 37 (5.4) | 1.03 (0.60 to 1.79) | .91 | 12 (1.7) | 0.81 (0.36 to 1.80) | .61 | 29 (4.2) | 0.67 (0.38 to 1.19) | .17 |
| Ptrend§ | .85 | .94 | .54 | .15 | ||||||||
| Decade of diagnosis | ||||||||||||
| <1980 | 86 (10.1) | 1.00 (ref.) | 54 (6.4) | 1.00 (ref.) | 14 (1.7) | 1.00 (ref.) | 49 (5.8) | 1.00 (ref.) | ||||
| 1980–1984 | 73 (9.0) | 1.00 (0.70 to 1.43) | .99 | 50 (6.2) | 1.06 (0.67 to 1.67) | .80 | 19 (2.3) | 1.53 (0.61 to 3.83) | .36 | 41 (5.1) | 0.82 (0.50 to 1.36) | .44 |
| 1985–1991 | 92 (9.3) | 1.05 (0.66 to 1.66) | .85 | 65 (6.6) | 1.16 (0.66 to 2.03) | .60 | 19 (1.9) | 1.34 (0.49 to 3.64) | .56 | 48 (4.8) | 0.76 (0.41 to 1.41) | .39 |
| Ptrend§ | .84 | .59 | .66 | .41 | ||||||||
*
Adjusted for maternal age and parity. CNS = central nervous system; H = heritable; ICD = International Classification of Diseases, version 10; NH = nonheritable; RR = relative risk.
†
Excludes preexisting diabetes mellitus (ICD 10: O24.0-O24.3) and unspecified whether preexisting or gestational diabetes (ICD 10: O24.9).
‡
Anemia complicating pregnancy, childbirth, and the puerperium.
§
P value based on two-sided Wald test.
‖
Relates to all female survivors not treated with any radiotherapy.