Researchers have found an increased frequency of severe maternal morbidity and obstetric complications among women who received a diagnosis of a hematological malignancy during pregnancy.
Women diagnosed with pregnancy-associated hematological malignancies who received a diagnosis during pregnancy saw no significant survival difference when compared to women who received diagnoses after pregnancy, research has shown. However, researchers found an increased frequency of severe maternal morbidity and obstetric complications among women who received a diagnosis of a hematological malignancy during pregnancy.
Researchers, who published their findings in The Lancet Hematology, performed a nationwide observational cohort study drawing on data from the French National Healthcare Data System of all pregnancies in France ending between Jan. 1, 2012 and Dec. 31, 2022. Out of nearly 10 million pregnancies in almost 6 million women, 1,366 pregnancy-associated hematological malignancies were identified, 413 of which were during pregnancy and 953 of which were within 12 months of the end of pregnancy.
The five-year overall survival for women diagnosed during pregnancy was 91.2% versus 90.3% for those diagnosed post-pregnancy for all hematological malignancies combined. Specifically, those rates were:
Overall survival: the time a patient lives, regardless of disease status.
Pre-eclampsia: a condition involving high blood pressure during pregnancy.
Thrombosis: when a blood clot forms in a blood vessel.
Disseminated intravascular coagulation: abnormal clotting in the blood vessels.
Chorioamnionitis: when membranes surrounding the fetus and the amniotic fluid are infected by bacteria.
Of note, maternal morbidity was higher in the group of women who experienced hematological malignancies during pregnancies versus the reference group of women with pregnancies without diagnosis of hematological malignancy during pregnancy or in the following year. The most frequently observed morbidities were pre-eclampsia (4.3% of completed pregnancies in the hematological malignancy during pregnancy group versus2.1% of completed pregnancies in the reference group); malnutrition (4% versus 1.1%), thrombosis (1.8% versus 0.2%) and infections (12.8% versus 8.1%).
Likewise, severe maternal morbidity was more frequent in the hematological malignancy during pregnancy group, with rates of 26.2% in that group and 1.5% in the reference group, and with the most common severe maternal morbidities being transfusions of blood products (17.7% versus 0.4%), sepsis (6.4% versus 0.5%), acute respiratory distress syndrome (4% versus 0.1%) and disseminated intravascular coagulation (3.1% versus 0.2%).
Researchers stated that maternal morbidity rates were especially high for women with pregnancies associated with acute leukemia, myelodysplastic syndrome or chronic myelomonocytic leukemia, and aggressive B-cell non-Hodgkin lymphoma.
Researchers reported no increase in the frequency of stillbirths in the hematological malignancy during pregnancy group versus the reference group (0.6% versus 0.5%). But, there were more frequent cases of spontaneous preterm labor (13.7% versus 3.6%), induced preterm labor (18.3% versus 1.3%), chorioamnionitis (1.2% versus 0.4%), postpartum hemorrhage (10.1% versus 4.8%) and a caesarean section (41.8% versus 20.2%).
Furthermore, the mean gestational age in the hematological malignancy group was 36.1 weeks versus 39 weeks in the reference group and there were increases in very preterm (less than 32 weeks of pregnancy, 9.8% versus 1.2%) and preterm (32 to 36 weeks of pregnancy) deliveries (35.4% versus 5.4%). Specifically, obstetric complications were found to be high in pregnancies associated with acute leukemia or aggressive B-cell non-Hodgkin lymphoma.
“Our study highlights the complex management of hematological malignancy in pregnancy, requiring a multidisciplinary approach to balance maternal and fetal health,” researchers concluded in the study. “Our findings substantially contribute to the understanding of pregnancy-associated hematological malignancy, serving as a valuable resource for health-care providers. This information aids in treatment planning and supports women and family education.”
Reference:
“Maternal and obstetric outcomes in women with pregnancy-associated haematological malignancies: an observational nationwide cohort study” by Pierre Pinson et al., The Lancet Hematology.
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