ESPEYB17 9. Oncology and Chronic Disease Fertility-Related Issues (7 abstracts)
9.2. Pregnancy, time to pregnancy and obstetric outcomes among female childhood cancer survivors: Results of the DCOG LATER-VEVO study
Van Dijk M , van Leeuwen FE , Overbeek A , Lambalk CB , van den Heuvel-Eibrink MM , van Dorp W , Tissing WJ , Kremer LC , Loonen JJ , Versluys B , Bresters D , Ronckers CM , van der Pal HJ , Beerendonk CCM , Kaspers GJL , van Dulmen-den Broeder E & van den Berg MH
To read the full abstract: J Cancer Res Clin Oncol. 2020 Jun;146(6):1451–1462. marloes.vandijk@amsterdamumc.nl
Chemo- and radiotherapy administered during childhood may compromise female reproductive function leading to premature depletion of the ovarian follicle pool. Childhood cancer survivors (CCS) women who pursue pregnancy may experience a lengthening of the time required to become pregnant (time to pregnancy: TTP), similar to that seen in aged mothers. This retrospective study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating long-term fertility among Dutch female CCS. Data were collected by questionnaires. The study included CCS sisters and a random sample of women from the general population as controls.
Among the subgroup of CCS women who ever pursued pregnancy, the chance of becoming pregnant was significantly lower than in normal women. Overall TTP was 1.1 times longer for CCS women compared to controls and it was significantly longer in survivors of tumours of central nervous system (CNS) and kidney. Frequency of adverse obstetric outcomes (miscarriage, still birth, or induced abortion) was not different in CCS and controls, but CCS had an increased risks of preterm delivery and caesarean section. Lower abdominal/pelvic radiotherapy was strongly associated with adverse obstetric outcomes.
This is one of the first studies analysing TTP and adverse obstetric outcomes in CCS using a large, nationwide register. Strengths of the study include the evaluation of the chance of becoming pregnant among women who actually pursued pregnancy, the inclusion of a large control group, and the availability of detailed information about previous cancer treatment. On the other hand, data were collected by a questionnaire and only 63% of the invited CCS and 49% of the controls completed this, clearly limiting the value of the results. Moreover, the proportion of CCS women treated with chemotherapy-only was significantly higher among participants compared to non-participants. This may indicate that the more aggressively treated CCS were not included. Consequently, the reported risks of adverse obstetric outcomes may be an underestimation of the actual risk. TTP analyses are valid only for CCS who were able to conceive and ignore women who pursued but failed to achieve pregnancy. Finally, the analyses were not corrected for individual factors negatively affecting pregnancy outcome, such as BMI, smoking behavior, and menstrual cycle characteristics.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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