Maternal and obstetric outcomes in women with pregnancy-associated haematological malignancies: an observational nationwide cohort study.

Journal

The Lancet. Haematology
ISSN: 2352-3026
Titre abrégé: Lancet Haematol
Pays: England
ID NLM: 101643584

Informations de publication

Date de publication:
07 Oct 2024
Historique:
received: 10 04 2024
revised: 10 09 2024
accepted: 11 09 2024
medline: 11 10 2024
pubmed: 11 10 2024
entrez: 10 10 2024
Statut: aheadofprint

Résumé

Pregnancy-associated haematological malignancy is a rare event; therefore, data available to guide the treatment are scarce. We aimed to evaluate the incidence, overall survival, and maternal morbidity and mortality of women with pregnancy-associated haematological malignancies. We conducted a nationwide observational cohort study using the French National Healthcare Data System (SNDS), a health-care administrative database covering up to 99% of the French population. We included all pregnancies in France ending between Jan 1, 2012, and Dec 31, 2022. Pregnancies with terminations or miscarriages managed on an outpatient basis, and women with a history of haematological malignancies before pregnancy were excluded. A Cox proportional hazards model was used to assess overall survival, defined as the date of haematological malignancy diagnosis to either death or the end of the study follow-up, in the haematological malignancy during pregnancy group (pregnancies with a diagnosis of haematological malignancy during pregnancy) compared with the haematological malignancy post-pregnancy group (pregnancies with a diagnosis of haematological malignancy in the year following pregnancy). Severe maternal morbidity was compared in the haematological malignancy during pregnancy group versus the reference group (pregnancies without a history of haematological malignancy or a diagnosis of pregnancy-associated haematological malignancy). Births were classified as very preterm (<32 weeks of pregnancy), preterm (32-36 weeks), and term (≥37 weeks) and compared in the haematological malignancy during pregnancy group versus the reference group. Inverse probability weighting (IPW) was used for confounder adjustment, using maternal age (categorised), comorbidities, socioeconomic status, and year of delivery (as a category). Of 9 996 523 pregnancies in 5 995 235 women, 1366 pregnancy-associated haematological malignancies were identified: 413 during pregnancy (4·13 per 100 000 pregnancies) and 953 (9·53 per 100 000 pregnancies) within 12 months of the end of pregnancy (post-pregnancy). No significant differences in overall survival were observed between the haematological malignancy during and post-pregnancy groups across all types of haematological malignancy (IPW-adjusted hazard ratio 0·91 [95% CI 0·62-1·34], p=0·63), specifically for Hodgkin lymphoma (0·56 [0·07-4·53], p=0·59), aggressive B-cell non-Hodgkin lymphoma (0·52 [0·12-2·38], p=0·40), and acute leukaemia alone (0·84 [0·50-1·41], p=0·51). Severe maternal morbidity was more frequent in the haematological malignancy during pregnancy group than in the reference group (86 [26·2%] of 328 completed pregnancies vs 120 335 [1·5%] of 7 945 909 completed pregnancies; IPW-adjusted odds ratio 22·71 [95% CI 17·72-29·10], p<0·0001). We observed an increase in very preterm birth (32 [9·8%] vs 92 712 [1·2%]; IPW-adjusted odds ratio 11·90 [95% CI 7·91-17·91], p<0·0001) and preterm birth (116 [35·4%] vs 430 472 [5·4%]; 11·76 [9·34-14·81], p<0·0001) in the haematological malignancy during pregnancy group compared with the reference group. This nationwide observational study examines pregnancy-associated haematological malignancies in France, revealing no significant difference in overall survival between women diagnosed during pregnancy and post-pregnancy. Our data highlight an increased frequency of severe maternal morbidity and obstetric complications among women diagnosed during pregnancy. Notably, the study underscores the necessity for specialised care to manage these complex cases effectively. None. For the French translation of the abstract see Supplementary Materials section.

Sections du résumé

BACKGROUND BACKGROUND
Pregnancy-associated haematological malignancy is a rare event; therefore, data available to guide the treatment are scarce. We aimed to evaluate the incidence, overall survival, and maternal morbidity and mortality of women with pregnancy-associated haematological malignancies.
METHODS METHODS
We conducted a nationwide observational cohort study using the French National Healthcare Data System (SNDS), a health-care administrative database covering up to 99% of the French population. We included all pregnancies in France ending between Jan 1, 2012, and Dec 31, 2022. Pregnancies with terminations or miscarriages managed on an outpatient basis, and women with a history of haematological malignancies before pregnancy were excluded. A Cox proportional hazards model was used to assess overall survival, defined as the date of haematological malignancy diagnosis to either death or the end of the study follow-up, in the haematological malignancy during pregnancy group (pregnancies with a diagnosis of haematological malignancy during pregnancy) compared with the haematological malignancy post-pregnancy group (pregnancies with a diagnosis of haematological malignancy in the year following pregnancy). Severe maternal morbidity was compared in the haematological malignancy during pregnancy group versus the reference group (pregnancies without a history of haematological malignancy or a diagnosis of pregnancy-associated haematological malignancy). Births were classified as very preterm (<32 weeks of pregnancy), preterm (32-36 weeks), and term (≥37 weeks) and compared in the haematological malignancy during pregnancy group versus the reference group. Inverse probability weighting (IPW) was used for confounder adjustment, using maternal age (categorised), comorbidities, socioeconomic status, and year of delivery (as a category).
FINDINGS RESULTS
Of 9 996 523 pregnancies in 5 995 235 women, 1366 pregnancy-associated haematological malignancies were identified: 413 during pregnancy (4·13 per 100 000 pregnancies) and 953 (9·53 per 100 000 pregnancies) within 12 months of the end of pregnancy (post-pregnancy). No significant differences in overall survival were observed between the haematological malignancy during and post-pregnancy groups across all types of haematological malignancy (IPW-adjusted hazard ratio 0·91 [95% CI 0·62-1·34], p=0·63), specifically for Hodgkin lymphoma (0·56 [0·07-4·53], p=0·59), aggressive B-cell non-Hodgkin lymphoma (0·52 [0·12-2·38], p=0·40), and acute leukaemia alone (0·84 [0·50-1·41], p=0·51). Severe maternal morbidity was more frequent in the haematological malignancy during pregnancy group than in the reference group (86 [26·2%] of 328 completed pregnancies vs 120 335 [1·5%] of 7 945 909 completed pregnancies; IPW-adjusted odds ratio 22·71 [95% CI 17·72-29·10], p<0·0001). We observed an increase in very preterm birth (32 [9·8%] vs 92 712 [1·2%]; IPW-adjusted odds ratio 11·90 [95% CI 7·91-17·91], p<0·0001) and preterm birth (116 [35·4%] vs 430 472 [5·4%]; 11·76 [9·34-14·81], p<0·0001) in the haematological malignancy during pregnancy group compared with the reference group.
INTERPRETATION CONCLUSIONS
This nationwide observational study examines pregnancy-associated haematological malignancies in France, revealing no significant difference in overall survival between women diagnosed during pregnancy and post-pregnancy. Our data highlight an increased frequency of severe maternal morbidity and obstetric complications among women diagnosed during pregnancy. Notably, the study underscores the necessity for specialised care to manage these complex cases effectively.
FUNDING BACKGROUND
None.
TRANSLATION UNASSIGNED
For the French translation of the abstract see Supplementary Materials section.

Identifiants

DOI: 10.1016/S2352-3026(24)00288-6 PMID: 39389070
pubmed: 39389070
pii: S2352-3026(24)00288-6
doi: 10.1016/S2352-3026(24)00288-6
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Déclaration de conflit d'intérêts

Declaration of interests CC declares consulting fees from Pfizer. LH declares support for attending meeting from Servier. NB is an unpaid member of the French Birth Defects Scientific Expert Committee (Santé Publique France). RB declares consulting fees from Bristol Myers Squibb, honoraria for presentations form Jazz Pharma, and support for attending meetings from Sandoz. All other authors declare no competing interests.

Auteurs

Pierre Pinson (P)

Clinical Research Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France. Electronic address: pierre.pinson@aphp.fr.

Ismael Boussaid (I)

Department of Biological Haematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; Institut Cochin, CNRS U8104, Inserm U1016, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Justine Decroocq (J)

Department of Clinical Haematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Laurent Chouchana (L)

Clinical Research Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; Department of Perinatal, Pediatric and Adult Pharmacology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Gary Birsen (G)

Department of Pneumology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Mathilde Barrois (M)

Department of Obstetrics and Gynecology, Port-Royal Maternity Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Vassilis Tsatsaris (V)

Department of Obstetrics and Gynecology, Port-Royal Maternity Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Charlotte Godeberge (C)

Department of Anesthesia and Intensive Care, Port-Royal Maternity Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Jeremie Zerbit (J)

Cancer Unit, Hospital at Home, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Barbara Burroni (B)

Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Frederic Pene (F)

Department of Intensive Care Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Laurence Huynh (L)

Department of Clinical Haematology, Charles Foix Hospital, Assistance Publique-Hôpitaux de Paris, Ivry sur Seine, France; HeMaPreg Network, Paris, France.

Caroline Charlier (C)

Department of Infectious Disease, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Jerome Tamburini (J)

Translational Research Centre in Onco-Hematology, Faculty of Medicine, University of Geneva, and Swiss Cancer Center Leman, Geneva, Switzerland.

Nathanael Beeker (N)

Clinical Research Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France.

Mathis Collier (M)

Clinical Research Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France.

Didier Bouscary (D)

Department of Clinical Haematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; Institut Cochin, CNRS U8104, Inserm U1016, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France.

Jean Marc Treluyer (JM)

Clinical Research Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; Department of Perinatal, Pediatric and Adult Pharmacology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France.

Rudy Birsen (R)

Department of Clinical Haematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France; Institut Cochin, CNRS U8104, Inserm U1016, University Paris Cité, Paris, France; HeMaPreg Network, Paris, France. Electronic address: rudy.birsen@aphp.fr.

Classifications MeSH