Impact of prior breast cancer on mode of delivery and pregnancy-associated disorders: a retrospective analysis of subsequent pregnancy outcomes

Obstetric and perinatal outcomes in women with previous breast cancer: a nationwide study of singleton births 1973-2017

STUDY QUESTION

What are the obstetric and perinatal outcomes in births to breast cancer survivors compared to women without previous breast cancer?

SUMMARY ANSWER

Women who conceived during the first 2 years following a breast cancer diagnosis had a higher risk for preterm birth, induced delivery, and cesarean section, while no increased risks were observed in births conceived later than 2 years after a breast cancer diagnosis.

WHAT IS KNOWN ALREADY

A recent meta-analysis found higher risks of cesarean section, preterm birth, low birthweight, and small for gestational age in pregnancies among breast cancer survivors. Less is known about rarer outcomes such as pre-eclampsia or congenital malformations.

STUDY DESIGN SIZE DURATION

We conducted a population-based matched cohort study including all breast cancer survivors who gave birth to singletons 1973-2017 in Sweden, identified through linkage between the Swedish Cancer Register, the Medical Birth Register, and the National Quality Register for Breast Cancer.

PARTICIPANTS/MATERIALS SETTINGS METHODS

Each birth following breast cancer (n = 926) was matched by maternal age at delivery, parity, and calendar year at delivery to 100 births in a comparator cohort of women (n = 92 490). Conditional logistic and multinomial regression models estimated relative risks (RR) with 95% CI. Subgroup analyses by time since diagnosis and type of treatment were performed.

MAIN RESULTS AND THE ROLE OF CHANCE

Previous breast cancer was associated with higher risks of induced delivery (RR; 1.3, 1.0-1.6), very preterm birth (RR; 1.8, 1.1-3.0), and planned preterm birth (RR; 1.6, 1.0-2.4). Women who conceived within 1 year after breast cancer diagnosis had higher risks of cesarean section (RR; 1.7, 1.0-2.7), very preterm birth (RR; 5.3, 1.9-14.8), and low birthweight (RR; 2.7, 1.4-5.2), while the risks of induced delivery (RR; 1.8, 1.1-2.9), moderately preterm birth (RR; 2.1, 1.2-3.7), and planned preterm birth (RR; 2.5, 1.1-5.7) were higher in women who conceived during the second year after diagnosis. Women who conceived later than 2 years after breast cancer diagnosis had similar obstetric risks to their comparators.

LIMITATIONS REASONS FOR CAUTION

As information on the end date of treatment was unavailable, the time between the date of diagnosis and conception was used as a proxy, which does not fully capture the effect of time since end of treatment. In addition, treatments and clinical recommendations have changed over the long study period, which may impact childbearing patterns in breast cancer survivors.

WIDER IMPLICATIONS OF THE FINDINGS

Risks of adverse obstetric outcomes in breast cancer survivors were confined to births conceived within 2 years of diagnosis. As family building holds significance for numerous young breast cancer patients, these findings are particularly important to inform both breast cancer survivors and clinicians about future reproductive outcomes.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the Swedish Cancer Society (grant number 22-2044 Pj A.L.V.J.), Karolinska Institutet Foundations (grant number: 2022-01696 F.E.L., 2022-01559 A.L.V.J.), and the Swedish Research Council (grant number: 2021-01657 A.L.V.J.). K.A.R.-W. is supported by grants from the Swedish Cancer Society (20 0170 F) and the Radiumhemmets Research Foundations for clinical researchers 2020-2026. The authors declare that they have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Pregnancy rate, maternal and neonatal outcomes among breast cancer survivors: A systematic review

AIM

This study investigated the pregnancy rate, maternal and neonatal outcomes, and breast cancer (BC) recurrence status after pregnancy among BC survivors.

DESIGN

A systematic review.

METHODS

Electronic databases such as PubMed, Web of Science [WOS], Scopus, ScienceDirect, Google Scholar, and Scientific Information Database were systematically searched. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Observational studies reported the pregnancy rate, maternal and neonatal outcomes among reproductive-aged BC survivors, and the recurrence status of BC after pregnancy were eligible to include in this study.

RESULTS

Of the 29 included studies, 13 studies were prospective cohorts or prospective multicenter or population-based cohorts, 14 studies were retrospective cohort or retrospective population-based cohort studies, and two studies were cross-sectional retrospective surveys or population-based descriptive studies. This systematic review showed that the pregnancy rate was estimated at 3.1%-48.5% among BC survivors who attempted to conceive. The most prevalent maternal outcomes of pregnancy were miscarriage (1.8%-33.3%) and induced abortion (5.0%-44%) as well as preterm birth (PTB) or very PTB (1.2%-21.1%), and twin birth (1.1%-38.8%) were the most prevalent neonatal outcomes occurring among BC survivors, respectively. In addition, most of the included studies indicated that pregnancy had no adverse effect on the status of BC recurrence among survivors. Surviving women can be encouraged and receive a carefully multidisciplinary approach regarding healthy pregnancy. No Patient or Public Contribution.

Reproductive Health Outcomes among Adolescent and Young Adult Cancer Patients: A Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis (SRMA) aimed to synthesize the current literature on the impacts of adolescent and young adult (AYA, ages 15–39 years) cancer on reproductive health outcomes. Methods: EMBASE and Medline were searched from 1 January 2000 to 26 January 2022 for observational studies that included individuals with AYA cancer and controls which evaluated reproductive health outcomes. We used random effects models and 95% confidence intervals to obtain pooled measures of associations between AYA cancer, cancer treatment, and reproductive health outcomes. Results: The search identified 8625 articles; 21 were included. 62 reproductive outcomes were assessed and classified according to a sex-based framework as fetal/neonatal (n = 26), maternal (n = 11), fetal/neonatal-maternal (n = 23), and maternal-paternal (n = 2). Meta-analyses of crude estimates showed significant associations between AYA cancer and outcomes including preterm birth (pooled odds ratio [pOR] 1.31; 95% CI: 1.22, 1.42), gestational diabetes (pOR 1.43; 95% CI: 1.03, 1.99), and fertility treatment (pOR 2.66; 95% CI 1.71, 4.11). We also found higher odds of preterm birth (pOR 1.65; 95% CI: 1.21, 2.26) and low APGAR score at birth (pOR 2.03; 95% CI: 1.32, 3.13) among AYA cancer patients who received radiation compared to controls. Conclusions: Our SRMA quantified impacts of AYA cancers and treatments on several reproductive health outcomes.

Obstetric complications at time of delivery amongst breast cancer survivors: A population-based cohort study

PURPOSE

Our aim was to determine whether breast cancer survivors are at increased risk of obstetric and maternal complications at time of delivery.

METHODS

The USA 'National Inpatient Sample' database was queried for hospitalizations associated with deliveries, between 2015 and 2018. The incidence of maternal and fetal complications was compared between women with, and without, a personal history of breast cancer.

RESULTS

Of the 2,103,216 birth related admissions, 617 (0.03%) of the women were breast cancer survivors, with the proportion increasing over time (from 0.02% in 2015 to 0.04% in 2018). Breast cancer survivors had a higher socioeconomic status (p < 0.001) and were significantly older compared to other mothers (34 vs. 28 years, p < 0.001). Additionally, they were more likely to suffer from preexisting chronic diseases including cardiopulmonary disease and diabetes mellitus, and had a higher incidence of multiple gestation (4.4% vs. 1.6%) [OR 2.7, 95% CI 1.9-4.0, p < 0.001]. The incidence of acute adverse events at time of delivery including fetal distress, preterm labor, cesarean section and maternal infection was higher amongst the breast cancer survivors. On multivariate analysis age, ethnic group, comorbidities, multiple gestations, and a previous breast cancer diagnosis, but not cancer treatment, were associated with an increased risk of an obstetric adverse event.

CONCLUSION

Breast cancer survivors have more comorbidities and are at increased risk of acute obstetrical complications at time of delivery. Further studies are required to validate these findings, and evaluate the ability of interventions to improve obstetrical outcomes amongst breast cancer survivors.

Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis

PURPOSE

Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics.

METHODS

A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models.

RESULTS

Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy.

CONCLUSION

These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.

Time to Pregnancy, Obstetrical and Neonatal Outcomes after Breast Cancer: A Study from the Maternity Network for Young Breast Cancer Patients

Although an increasing number of young breast cancer (BC) patients have a pregnancy desire after BC, the time necessary to obtain a pregnancy after treatment and subsequent outcomes remain unknown. We aimed to determine the time to evolutive pregnancy in a cohort of BC survivors and subsequent obstetrical and neonatal outcomes. We analyzed BC patients treated at Institut Curie from 2005-2017, aged 18-43 years old (y.o.) at diagnosis having at least one subsequent pregnancy. 133 patients were included, representing 197 pregnancies. Mean age at BC diagnosis was 32.8 y.o. and at pregnancy beginning was 36.8 y.o. 71% pregnancies were planned, 18% unplanned and 86% spontaneous. 64% pregnancies resulted in live birth (n = 131). Median time from BC diagnosis to pregnancy beginning was 48 months and was significantly associated with endocrine therapy (p < 0.001). Median time to pregnancy was 4.3 months. Median time to evolutive pregnancy 5.6 months. In multivariate analysis, menstrual cycles before pregnancy remained significantly associated with time to pregnancy and endocrine therapy with time evolutive to pregnancy. None of the BC treatments (chemotherapy/endocrine therapy/trastuzumab) was significantly associated with obstetrical nor neonatal outcomes, that seemed comparable to global population. Our findings provide reassuring data for pregnancy counseling both in terms of delay and outcome.

Obstetrical outcomes in women with history of breast cancer: a systematic review and meta-analysis

PURPOSE

Potential risk of adverse obstetrical outcomes has been shown among breast cancer survivors. Therefore, the aim of this systematic review and meta-analysis was to evaluate the relationship between history of breast cancer (BC) and obstetrical outcomes.

METHODS

PubMed, EMBASE, and Medline were searched from the inception of each database to April 2019. Selection criteria included prospective and retrospective cohort studies of BC pregnant survivors. The meta-analysis was performed by computing odds ratios (ORs) using both fixed and random-effects models. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale and the review was registered with PROSPERO number CRD42019127716.

RESULTS

Four studies, including 1466 cases of BC survivors and 6,912,485 controls, were included. Compared with controls, a higher incidence of obstetrical complication was found in women with history of BC. The incidence of preterm birth (PTB) in the study group was 11.05% compared with 7.79% in the control group (1.68, 95% confidence interval 1.43-1.99). Breast cancer history was also associated with low birth weight (LBW) (study group: 9.26% vs. control group: 5.54%, 1.88, CI 95% 1.55-2.27), cesarean section (CS) (study group: 19.76% vs. control group 10.81%, 1.78, CI 95% 1.39-2.27), intrauterine fetal death (IUFD) (study group: 0.004% vs. control group 0.36%, of 1.25 CI 95% 0.36-4.35), and fetal anomalies (study group: 5.8% vs. control group: 4.26%, 1.45 CI 95% 1.01-2.09).

CONCLUSIONS

History of BC was associated with adverse obstetrical outcomes.

Fertility preservation in breast cancer patients

Breast cancer is the most commonly diagnosed cancer in women. As long-term survival rates have improved, there has been a concurrent increase in quality of life considerations, of which fertility preservation is of utmost importance. A number of fertility preservation options are available to women diagnosed with breast cancer, including administration of a GnRH agonist during chemotherapy in an attempt to minimize ovarian damage, oocyte or embryo cryopreservation prior to the administration of chemotherapy, in vitro maturation of oocytes or ovarian tissue cryopreservation. The safety of pregnancy after a diagnosis of breast cancer has been confirmed in numerous studies.

Diagnoses of suspected cancer in otolaryngology practices in Germany

The aim of this study was to estimate the prevalence of suspected head and neck cancer (HNC) diagnoses made by otolaryngologists in a population with subsequently confirmed cancer diagnoses in Germany. This study included patients with an initial documentation of confirmed cancer diagnosis made in 137 otolaryngology practices between January 2012 and December 2016 (index date). The main outcome of the study was the prevalence of diagnoses of suspected cancer in otolaryngology practices within one year prior to the first documentation of a confirmed cancer diagnosis. The association between the defined demographic and clinical variables with diagnoses of suspected cancer was analyzed using a logistic regression model. A total of 6,446 patients received a confirmed cancer diagnosis. A total of 23.1% of the population received a diagnosis of suspected cancer within 12 months prior to the first documentation of a confirmed cancer diagnosis. Patients over the age of 50 (ORs ranging from 1.44 to 1.55) and men (OR=1.52) were more likely to receive a diagnosis of suspected cancer compared with patients aged 50 or under and women. Cancer of the pyriform sinus (OR=3.00) and cancer of the thyroid gland (OR=0.27) were associated with increased and decreased odds of a diagnosis of suspected cancer compared to laryngeal cancer respectively. Overall, approximately 23% of individuals received a diagnosis of suspected cancer within a year prior to the first documentation of confirmed HNC.

Perinatal risks in female cancer survivors: A population-based analysis

Background/objectives

Advances in cancer management have resulted in improved survival rates, particularly in children and young adults. However, treatment may adversely affect reproductive outcomes among female cancer survivors. The objective of this study was to investigate their risk of adverse perinatal outcomes compared to the general population.

Design/methods

We performed a population-based analysis, including all female cancer survivors diagnosed before the age of 40 years between 1981 and 2012. Pregnancy and perinatal complications were identified through linkage of the Scottish Cancer Registry with hospital discharge records based on the Community Health Index (CHI) database. We compared 1,629 female cancer survivors with a first ever singleton pregnancy after diagnosis, with controls matched on age, deprivation quintile, and year of cancer diagnosis selected from the general population (n = 8,899). Relative risks and 95%-confidence intervals of perinatal risks were calculated using log-binomial regression.

Results

Survivors were more likely to give birth before 37 weeks of gestation (relative risk (RR]) 1.32, 95%-CI 1.10–1.59), but did not show an increased risk of low birth weight (<2.5kg: RR 1.15, 95%-CI 0.94–1.39), and were less likely to give birth to offspring small for gestational age (RR 0.81, 95%-CI 0.68–0.98). Operative delivery and postpartum haemorrhage were more common but approached rates in controls with more recent diagnosis. The risk of congenital abnormalities was not increased (RR 1.01, 95%-CI 0.85–1.20).

Conclusion

Cancer survivors have an increased risk of premature delivery and postpartum haemorrhage, but their offspring are not at increased risk for low birth weight or congenital abnormalities. In recent decades there has been a normalisation of delivery method in cancer survivors, nevertheless careful management remains appropriate particularly for those diagnosed in childhood.

Acculturative stress and lack of social support predict postpartum depression among U.S. immigrant women of Arabic descent

PURPOSE

To examine the relationships among acculturative stress, social support, and postpartum depression (PPD) symptoms among U.S. immigrant women of Arabic descent; and to examine if social support moderates the associations between acculturative stress and PPD symptoms.

METHODS

Using a cross-sectional design, a sample of 115 U.S. immigrant women of Arabic descent, all between 1 and 12 months postpartum, were enrolled from clinics in Dearborn, MI. Data were analyzed using correlational and multiple linear regression.

RESULTS

Women had a mean age of 29 ± 5 years and were 5 ± 4 months postpartum. Women had been in the U.S. for 7 ± 6 years and had a mean education of 12 ± 4 years. The majority had an annual household income of <$40,000 (88%), were unemployed (80%), and preferred Arabic language for interview (68%). Higher levels of acculturative stress, higher levels of education, antenatal anxiety, and lower levels of social support predicted PPD symptoms (all significant at p < .05). The moderating effect of social support on the association between acculturative stress and PPD symptoms was not supported.

CONCLUSIONS

Acculturative stress, lack of social support, higher level of education, and antenatal anxiety predicted PPD symptoms. Future research is needed to examine acculturative stress among immigrant women in different U.S.

SETTINGS

Longitudinal studies and utilizing diagnostic assessments of PPD is highly recommended. Nurses need to screen immigrant women of Arabic descent for anxiety and depression during antenatal visits and develop evidence-based interventions targeted to improve mental health during pregnancy and postpartum.

Patterns of Fertility Preservation and Pregnancy Outcome After Breast Cancer at a Large Comprehensive Cancer Center

Background: In the last decades, long-term outcomes of breast cancer (BC) patients have improved, raising new survivorship issues, including fertility preservation and safety of pregnancy after BC. This study assesses evolution in patterns of fertility discussion/preservation over time and reports pregnancy outcomes in a cohort of young BC patients.

Methods: A retrospective cohort of 590 BC patients aged ≤40 diagnosed between 2000 and 2016 at a large cancer center was identified. Fertility counseling and preservation patterns for patients receiving chemotherapy were analyzed and compared for two cohorts: 2004–2006 and 2014–2016 (total n = 161). Outcomes were reported for patients with documented pregnancy after BC.

Results: Significantly, more patients diagnosed in 2014–2016 had evidence of discussion on fertility issues and/or application of fertility preservation techniques versus patients diagnosed in 2004–2006 (82.9% vs. 66.0%, p = 0.017). In particular, there was a significant difference in rate of documented fertility issues discussion (67.6% vs. 34.0%, p < 0.001). Age >35 and parity were associated with lower rates of fertility discussion/preservation. However, rates significantly improved over time (77.6% in 2014–2016 vs. 58.1% in 2004–2006 for patients aged >35, p = 0.046; 80.7% in 2014–2016 vs. 57.6% in 2004–2006 for patients with children at diagnosis, p = 0.018). Twenty-six patients with pregnancy after BC were identified; eight delivered at the age of >40. No complications for women or newborns were reported. Only two patients experienced BC relapse.

Conclusions: In this small retrospective cohort, no safety concerns were identified for pregnancy after BC. The importance attributed by clinicians to address fertility issues has increased over time.

Association of laryngeal cancer with vocal cord leukoplakia and associated risk factors in 1,184 patients diagnosed in otorhinolaryngology practices in Germany

The aim of the present study was to analyze the association between laryngeal cancer and vocal cord leukoplakia in a large nationwide practice database. The study sample included 1,184 patients aged 18-90 years from 113 otorhinolaryngology practices in Germany who were diagnosed with vocal cord leukoplakia between 2007 and 2014. The rates of laryngeal cancer diagnosis within 5 years and the associated risk factors were analyzed. Within 6 months of initial diagnosis of vocal cord leukoplakia, 11% of the patients were diagnosed with laryngeal cancer. Between 7 months and 5 years after the diagnosis of leukoplakia, laryngeal cancer was diagnosed in 7.6% of the patients. Overall, within 5 years of leukoplakia diagnosis, 18.6% of the patients were diagnosed with laryngeal cancer (26.1% of men and 6.3% of women; P<0.001). Moreover, 31.3% of patients aged >65 years, 16.1% of patients aged 50-65 years and 7.6% of patients aged <50 years were diagnosed with laryngeal cancer (P<0.001). Patients aged >65 and those aged 50-65 years had a higher risk of being diagnosed with laryngeal cancer [odds ratio (OR)=4.90 and 2.55, respectively]. Furthermore, the risk of being diagnosed with laryngeal cancer was higher in men compared with that in women (OR=4.09). In the present real-world analysis, the rate of laryngeal cancer underlying vocal cord leukoplakia at first diagnosis appeared to be higher compared with the secondary malignant transformation rate occurring later during the course of the disease. Risk factors for laryngeal cancer included advanced age and male sex.

Potential delay in the diagnosis of vulvar cancer and associated risk factors in women treated in German gynecological practices

The goal of this study was to estimate a potential delay in the diagnosis of vulvar cancer and identify associated risk factors in women treated in gynecological practices in Germany. The current study sample included 1,652 women from 218 gynecological practices who received an initial diagnosis of vulvar cancer (ICD 10: C51) between January 2000 and December 2015 (index date). After applying several exclusion criteria, 505 non-cancer controls were matched (1:1) to 505 vulvar cancer cases based on age, health insurance status, and index date. The primary outcome was the delay in vulvar cancer diagnosis in women who had received an initial diagnosis of diseases of Bartholin's gland, inflammation of vagina and vulva, or other specified noninflammatory disorders of vulva, including atrophy, hypertrophy, and cyst. A logistic regression model was used to estimate the association between vulvar cancer and pre-defined diagnoses. The mean age was 60.8 years (SD = 15.6 years), and 4.8% of women had private health insurance coverage. Inflammation of vagina and vulva was diagnosed 328 days (SD = 95 days) prior to the detection of vulvar cancer. This delay was 186 days (SD = 196 days) in patients affected by diseases of Bartholin’s gland and 300 days (SD = 116 days) in those with other specified noninflammatory disorders of vulva including atrophy, hypertrophy, and cyst. The risk of vulvar cancer was positively associated with inflammation of vagina and vulva (OR = 2.28) and other specified noninflammatory disorders of vulva (OR = 5.39). The mean potential delay of vulvar cancer diagnosis ranged from 186 to 328 days.

Persistence With Oral Antihyperglycemic Drugs in Type 2 Diabetes Mellitus Patients With Dementia in Germany

BACKGROUND

The aim of this study was to analyze the persistence with oral antihyperglycemic drugs in type 2 diabetes mellitus (T2DM) patients with dementia in Germany.

METHODS

This study included adults with T2DM who were treated with oral antihyperglycemic drugs and were diagnosed with dementia in 1262 German general practices between January 2013 and December 2015 (index date). Dementia cases were matched (1:1) to controls without dementia by age, gender, type of practice, type of residence, physician, and initial antihyperglycemic therapy, using a propensity score method. The primary outcome of the study was the rate of persistence with oral antihyperglycemic drugs in dementia cases and controls without dementia in the year following the index date. Persistence was estimated as therapy time without treatment discontinuation, which was defined as at least 90 days without oral antihyperglycemic therapy. Cox regressions were used to determine the impact of dementia on persistence with oral antihyperglycemic treatment in the entire population and in different subgroups.

RESULTS

This study included 848 T2DM patients with dementia and 848 T2DM patients without dementia. In the dementia group, 39.2% of patients were men, while the control group included 40.8% men. After 12 months of follow-up, 72.7% of dementia cases and 71.4% of controls without dementia were persistent ( P = .291). No significant association was found between dementia and persistence with oral antihyperglycemic drugs in the entire population and in different subgroups (HR ranging from 0.84 to 1.25).

CONCLUSIONS

Dementia did not have a significant impact on persistence with oral antihyperglycemic drugs in T2DM patients in Germany.

Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients

Aim: The goal of this study was to identify potential risk factors for ectopic pregnancy in women followed in German gynecological practices.

Methods: The present study included pregnant women diagnosed with ectopic pregnancy and pregnant women without ectopic pregnancy followed in 262 gynecological practices between January 2012 and December 2016. The effects of demographic and clinical variables on the risk of developing ectopic pregnancy were estimated using a multivariate logistic regression model.

Results: This study included 3,003 women with ectopic pregnancy and 97,194 women without ectopic pregnancy. The mean age was 31.4 years (SD=5.9 years) in ectopic pregnancy patients and 31.1 years (SD=5.6 years) in non-ectopic pregnancy patients. Women aged 36–40 (OR=1.12) and 41–45 years (OR=1.46) were at a higher risk of ectopic pregnancy than women aged 31–35 years. Prior ectopic pregnancy was strongly associated with a risk of recurring ectopic pregnancy (OR=8.17). Prior genital surgery (OR=2.67), endometriosis (OR=1.51), and eight other gynecological diseases were also positively associated with ectopic pregnancy (ORs ranging from 1.19 to 2.06). Finally, there was a 1.80-fold increase in women previously diagnosed with psychiatric disorders.

Conclusions: Prior ectopic pregnancy and prior genital surgery were strongly associated with ectopic pregnancy in women followed in German gynecological practices. Psychiatric diseases had an additional impact on the risk of ectopic pregnancy.

Prevalence of depression, anxiety, and adjustment disorders in women with spontaneous abortion in Germany - A retrospective cohort study

The aim of this study was to analyze the prevalence of depression, anxiety, and adjustment disorders in women within the year following miscarriage in Germany. This study included women between the ages of 16 and 45 with a first pregnancy terminated by spontaneous abortion between January 2007 and December 2015 (index date). These women were followed in 262 gynecological practices. Women with a spontaneous abortion were matched (1:1) with pregnant women without spontaneous abortion by age, index year, diagnosis of female infertility prior to the index date, procreative management prior to the index date, and physician. This retrospective cohort study included 12,158 women with a spontaneous abortion and 12,158 pregnant women without a spontaneous abortion. The mean age was 31.6 (SD: 5.5).years. One year after the index date, 8.9% of women with spontaneous abortion and 5.7% of controls were diagnosed with depression, anxiety, or adjustment disorder. Individuals who had previously undergone a spontaneous abortion were more likely to have one of these three psychiatric disorders compared to controls (OR = 1.53). Similar results were found in the age groups 21-30 and 31-40. Spontaneous abortion is associated with an increased prevalence of developing psychiatric diseases within the first year.

Suspected cancer diagnoses made by general practitioners in a population with subsequently confirmed cancer diagnoses in Germany: a retrospective study of 31,628 patients

The goal of the present study was to analyze the prevalence and risk factors of suspected cancer diagnoses made by general practitioners (GP) in a population with subsequently confirmed cancer diagnoses in Germany. This study included patients aged 18 years or older who received an initial documentation of a confirmed cancer diagnosis from 1,262 German GP between January and December 2016 (index date). The main outcome measure of the study was the rate of suspected cancer diagnoses made by GP within one year prior to the index date. A multivariate logistic regression model was used to estimate the relationship between defined demographic and clinical variables and suspected cancer diagnoses. This study included 31,628 individuals. Within the year prior to the confirmed cancer diagnosis, 5% of the population received suspected cancer diagnoses. Patients in the age groups 41–50, 51–60, and 61–70 years were more likely to receive a suspected cancer diagnosis from a GP than those in the age group > 80 years (OR ranging from 1.30 to 1.38). Lung cancer, skin cancer, prostate cancer, and leukemia were associated with an increase in such odds when compared to cancers of the digestive organs (OR ranging from 1.56 to 2.26), whereas female genital organ cancers were associated with decreased odds (OR = 0.63). Overall, approximately 5% of patients received suspected diagnoses of cancer prior to their confirmed diagnoses. Suspected cancer diagnoses were associated with age and several types of cancer.