Table 5.
Relative risk of developing specific complications of labor and delivery among female survivors of childhood cancer
| Characteristic | Complications of labor and delivery |
Delivery |
Supervision of high-risk pregnancy* ICD10: Z35 |
||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Perineal laceration*,† ICD10: O70 |
Postpartum hemorrhage* ICD10: O72 |
Elective cesarean section*,† |
Emergency cesarean section*,† |
||||||||||||
| No. (%) | RR (95% CI) | P‡ | No. (%) | RR (95% CI) | P‡ | No. (%) | RR (95% CI) | P‡ | No. (%) | RR (95% CI) | P‡ | No. (%) | RR (95% CI) | P‡ | |
| General population | 9229 (40.7) | 1.00 (ref.) | 2179 (8.7) | 1.00 (ref.) | 2249 (10.4) | 1.00 (ref.) | 3174 (14.0) | 1.00 (ref.) | 999 (4.0) | 1.00 (ref.) | |||||
| Female survivors§ | 313 (41.7) | 0.99 (0.89 to 1.10) | .75 | 82 (9.5) | 1.08 (0.93 to 1.28) | .46 | 109 (14.7) | 1.39 (1.16 to 1.70) | <.001 | 119 (15.8) | 1.08 (0.91 to 1.27) | .21 | 41 (4.8) | 1.19 (0.85 to 1.64) | .32 |
| Type of childhood cancer | |||||||||||||||
| Leukemia | 307 (38.4) | 1.00 (ref.) | 93 (10.2) | 1.00 (ref.) | 116 (15.2) | 1.00 (ref.) | 148 (18.6) | 1.00 (ref.) | 34 (3.7) | 1.00 (ref.) | |||||
| Hodgkin lymphoma | 63 (45.3) | 1.16 (0.94 to 1.43) | .17 | 18 (11.8) | 1.03 (0.62 to 1.69) | .92 | 14 (10.3) | 0.59 (0.32 to 1.08) | .09 | 17 (12.2) | 0.59 (0.36 to 0.97) | .04 | 8 (5.2) | 0.97 (0.44 to 2.18) | .95 |
| Non-Hodgkin lymphoma | 30 (31.9) | 0.81 (0.59 to 1.11) | .19 | 10 (9.0) | 0.79 (0.37 to 1.69) | .55 | 17 (18.7) | 1.09 (0.64 to 1.84) | .75 | 20 (21.3) | 1.03 (0.67 to 1.60) | .88 | 4 (3.6) | 0.88 (0.33 to 2.39) | .80 |
| CNS tumor | 109 (39.1) | 1.03 (0.86 to 1.24) | .79 | 33 (9.8) | 0.87 (0.59 to 1.28) | .47 | 57 (20.1) | 1.22 (0.90 to 1.65) | .20 | 51 (18.3) | 0.90 (0.67 to 1.22) | .51 | 12 (3.6) | 0.77 (0.40 to 1.47) | .43 |
| Neuroblastoma | 43 (38.4) | 1.04 (0.80 to 1.34) | .80 | 17 (12.6) | 1.27 (0.75 to 2.16) | .37 | 23 (18.7) | 1.20 (0.74 to 1.96) | .46 | 12 (10.7) | 0.64 (0.37 to 1.11) | .11 | 5 (3.7) | 1.04 (0.39 to 2.72) | .94 |
| NH-retinoblastoma | 53 (40.5) | 1.09 (0.86 to 1.39) | .50 | 14 (9.8) | 0.89 (0.52 to 1.53) | .68 | 12 (9.8) | 0.71 (0.41 to 1.22) | .21 | 21 (16.0) | 0.78 (0.50 to 1.21) | .26 | 7 (4.9) | 0.93 (0.41 to 2.12) | .86 |
| H-retinoblastoma | 26 (50.0) | 1.28 (0.88 to 1.86) | .20 | 6 (10.3) | 1.00 (0.46 to 2.17) | .99 | 6 (11.5) | 0.77 (0.33 to 1.83) | .55 | 6 (11.5) | 0.68 (0.31 to 1.46) | .32 | 1 (1.7) | 0.37 (0.05 to 2.72) | .33 |
| Wilms tumor | 102 (38.2) | 0.99 (0.81 to 1.21) | .91 | 41 (12.7) | 1.23 (0.86 to 1.76) | .26 | 55 (20.0) | 1.23 (0.88 to 1.73) | .22 | 47 (17.6) | 0.97 (0.71 to 1.31) | .83 | 16 (5.0) | 1.18 (0.62 to 2.26) | .61 |
| Bone tumor | 46 (39.7) | 1.01 (0.78 to 1.30) | .96 | 10 (6.9) | 0.63 (0.34 to 1.17) | .14 | 29 (22.5) | 1.52 (1.05 to 2.20) | .03 | 16 (13.8) | 0.77 (0.47 to 1.26) | .30 | 5 (3.4) | 0.86 (0.35 to 2.13) | .75 |
| Soft-tissue sarcoma | 52 (32.7) | 0.85 (0.65 to 1.11) | .21 | 18 (9.7) | 0.87 (0.54 to 1.42) | .58 | 26 (17.2) | 1.07 (0.70 to 1.63) | .76 | 33 (20.9) | 1.04 (0.73 to 1.50) | .81 | 8 (4.3) | 0.89 (0.40 to 1.99) | .78 |
| Other | 95 (38.8) | 1.00 (0.82 to 1.21) | .93 | 21 (7.5) | 0.69 (0.45 to 1.08) | .10 | 35 (14.7) | 0.87 (0.58 to 1.29) | .48 | 42 (17.1) | 0.89 (0.64 to 1.24) | .48 | 14 (5.0) | 1.12 (0.60 to 2.09) | .72 |
| Pheterogeneity‡ | .59 | .46 | .10 | .50 | .99 | ||||||||||
| Treated with radiotherapy | |||||||||||||||
| No | 313 (41.7) | 1.00 (ref.) | 82 (9.5) | 1.00 (ref.) | 109 (14.7) | 1.00 (ref.) | 119 (15.8) | 1.00 (ref.) | 41 (4.8) | 1.00 (ref.) | |||||
| Brain | 296 (38.3) | 0.91 (0.80 to 1.05) | .21 | 93 (10.3) | 1.14 (0.85 to 1.53) | .37 | 129 (17.0) | 1.15 (0.90 to 1.49) | .27 | 138 (17.9) | 1.21 (0.95 to 1.53) | .12 | 32 (3.6) | 0.88 (0.55 to 1.40) | .58 |
| Other (nonbrain/abdominal) | 78 (39.0) | 0.94 (0.76 to 1.15) | .55 | 23 (10.0) | 0.98 (0.62 to 1.55) | .93 | 31 (15.7) | 0.90 (0.59 to 1.37) | .63 | 33 (16.5) | 0.97 (0.67 to 1.40) | .87 | 12 (5.2) | 0.95 (0.49 to 1.84) | .88 |
| Abdominal | 97 (37.3) | 0.88 (0.72 to 1.07) | .20 | 41 (12.6) | 1.33 (0.93 to 1.89) | .12 | 66 (24.4) | 1.46 (1.07 to 1.99) | .02 | 56 (21.5) | 1.35 (1.00 to 1.83) | .05 | 17 (5.2) | 1.04 (0.58 to 1.87) | .90 |
| Abdominal non-Wilms | 35 (36.5) | 0.83 (0.61 to 1.13) | .23 | 15 (12.6) | 1.25 (0.75 to 2.07) | .39 | 23 (24.0) | 1.36 (0.87 to 2.13) | .18 | 23 (24.0) | 1.36 (0.87 to 2.11) | .17 | 6 (5.0) | 0.82 (0.33 to 2.07) | .68 |
| Abdominal Wilms only | 62 (37.8) | 0.90 (0.70 to 1.14) | .37 | 26 (12.6) | 1.37 (0.89 to 2.10) | .15 | 43 (24.7) | 1.46 (1.01 to 2.11) | .05 | 33 (20.1) | 1.32 (0.92 to 1.89) | .13 | 11 (5.3) | 1.16 (0.58 to 2.33) | .68 |
| No radiotherapy Wilms only | 34 (40.5) | 0.98 (0.71 to 1.35) | .90 | 11 (11.5) | 1.37 (0.74 to 2.53) | .31 | 12 (14.1) | 1.10 (0.57 to 2.12) | .78 | 11 (13.1) | 1.06 (0.59 to 1.90) | .85 | 5 (5.2) | 1.39 (0.43 to 4.50) | .58 |
| Pheterogeneity‡ | .49 | .42 | .07 | .14 | .94 | ||||||||||
| Age at diagnosis, y | |||||||||||||||
| 0–4 | 427 (37.9) | 1.00 (ref.) | 132 (10.0) | 1.00 (ref.) | 189 (16.8) | 1.00 (ref.) | 1.00 (ref.) | 51 (3.9) | 1.00 (ref.) | ||||||
| 5–9 | 277 (40.4) | 1.01 (0.86 to 1.18) | .93 | 83 (10.6) | 1.13 (0.81 to 1.58) | .47 | 96 (14.4) | 0.79 (0.60 to 1.05) | .11 | 111 (16.3) | 0.92 (0.70 to 1.21) | .57 | 21 (2.7) | 0.69 (0.38 to 1.25) | .22 |
| 10–14 | 220 (37.8) | 0.96 (0.80 to 1.16) | .69 | 66 (9.6) | 1.08 (0.71 to 1.63) | .73 | 105 (18.3) | 0.85 (0.61 to 1.19) | .35 | 113 (19.4) | 1.15 (0.84 to 1.56) | .36 | 42 (6.1) | 1.30 (0.78 to 2.17) | .31 |
| Ptrend‡ | .73 | .65 | .26 | .46 | .35 | ||||||||||
| Decade of diagnosis | |||||||||||||||
| <1980 | 276 (40.2) | 1.00 (ref.) | 91 (10.7) | 1.00 (ref.) | 162 (22.3) | 1.00 (ref.) | 120 (17.5) | 1.00 (ref.) | 45 (5.3) | 1.00 (ref.) | |||||
| 1980–1984 | 277 (39.2) | 1.03 (0.87 to 1.23) | .72 | 82 (10.1) | 0.89 (0.63 to 1.27) | .52 | 103 (15.1) | 0.70 (0.52 to 0.94) | .02 | 127 (18.0) | 1.12 (0.84 to 1.50) | .43 | 38 (4.7) | 1.35 (0.78 to 2.32) | .28 |
| 1985–1991 | 333 (37.7) | 1.06 (0.87 to 1.31) | .55 | 97 (9.8) | 0.88 (0.59 to 1.34) | .56 | 108 (12.7) | 0.58 (0.40 to 0.83) | <.001 | 140 (15.9) | 0.92 (0.64 to 1.31) | .64 | 30 (3.0) | 1.21 (0.65 to 2.26) | .54 |
| Ptrend‡ | .54 | .59 | .004 | .52 | .52 | ||||||||||
*
Adjusted for maternal age and parity. CNS = central nervous system; H = heritable; ICD = International Classification of Diseases, version 10; NH = nonheritable; RR = relative risk.
†
Compared with vaginal delivery.
‡
P value based on two-sided Wald test.
§
Relates to all female survivors not treated with any radiotherapy.