Adverse birth outcomes in adolescent and young adult female cancer survivors: a nationwide population-based study



For female adolescent and young adult (AYA), cancer with treatments may affect their children’s health. Our aim was to determine reliable risk estimates of adverse birth outcomes in AYA cancer survivors and the differential effects of treatments.


The study population of 4547 births in the AYA cancer survivor group and 45,463 in the comparison group were identified from two national databases between 2004 and 2014. Detailed maternal health conditions, such as maternal comorbidities, medication use during pregnancy and lifestyles, were adjusted in the statistical analyses. The outcomes included low birth weight, preterm labour, stillbirth, small or large for gestational age, a 5-min Apgar score <7, congenital malformation and foetal distress.


The AYA cancer survivor group had a 9% higher risk of overall adverse birth outcomes (adjusted odds ratio, 1.09; 95% confidence interval, 1.02–1.16), especially low birth weight and preterm labour than the comparison group. The radiotherapy-only group additionally had a higher risk of foetal distress, and a 5-min Apgar score <7.


AYA cancer survivors, especially those who have received radiotherapy, still have higher risks of adverse birth outcomes after adjusting for detailed maternal health conditions. Preconception counselling and additional surveillance may be warranted in this population.

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We would like to thank Centre for Big Data Analytics and Statistics in the Chang Gung Memorial Hospital, Linkou branch for their assistance in data analysis. The sponsors of the study had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

Author information

W.-H.K.: literature search, study design, data analysis, data interpretation and writing. C.-F.K.: study design, data collection, data analysis and data interpretation. M.-J.C.: study design, data collection and data analysis. Y.-C.L.: data analysis, data interpretation and writing. C.-C.W.: study design, data analysis and data interpretation. J.-H.H.: literature search, data interpretation and writing. J.-T.H.: data analysis, data interpretation and writing. Y.-J.C.: literature search, data interpretation and writing. Y.-F.C.: literature search, study design, data analysis, data interpretation and writing.

Correspondence to Yi-Fang Chuang.

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Ethics approval and consent to participate

This study was approved by the Chang Gung Medical Foundation Institutional Review Board in Taiwan (approval number 201900392B0).

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This study contained no individual person’s data.

Data availability

The data sources are the Taiwan Nation Health Insurance Database and TBRS. The data that support the findings of this study are available from Taiwan Health and Welfare Data Science Centre. Restrictions apply to the availability of these data, which were used under license for this study. Data are available at https://dep.mohw.gov.tw/DOS/np-2497-113.html with the permission of Taiwan Health and Welfare Data Science Centre.

Competing interests

The authors declare no competing interests.

Funding information

This work was funded by the Ministry of Science and Technology (project 107-2314-B-182A-133-MY3) and Chang Gung Memorial Hospital (project CORPG3E0153, CORPG3E0143, CMRPG3F0833, CORPG3G0231, CMRPG3G1401, CMRPG3H1391, CORPG3H0071, CORPG3G0111, CORPG3G0161) and supported by the University of Nottingham for methodological assistance.

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Kao, W., Kuo, C., Chiou, M. et al. Adverse birth outcomes in adolescent and young adult female cancer survivors: a nationwide population-based study. Br J Cancer (2020). https://doi.org/10.1038/s41416-019-0712-2

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