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Recurrent pregnancy loss and future risk of female malignancies

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether patients with a history of recurrent pregnancy loss (RPL) have an increased risk for future female malignancies.

Methods

A retrospective population-based study compared the incidence of long-term female malignancies in a cohort of women with and without a history of RPL (2 or more consecutive pregnancy losses). Deliveries occurred between the years 1988 and 2013, with a mean follow-up duration of 12 years. Women with known malignancies before the index pregnancy were excluded from the analysis. Female malignancies were divided according to specific type including ovary, breast, uterine and uterine cervix. Kaplan–Meier survival curve was used to estimate the cumulative incidence of malignancies. Cox proportional hazards model was used to determine the adjusted hazard ratios (HR) for female malignancy after controlling for confounders.

Results

During the study period, 106,265 patients met the inclusion criteria; 6.6% (n = 7052) of patients had a diagnosis of RPL. During the follow-up period, patients with RPL had a significantly increased risk of being diagnosed with female malignancies as a group, while individually there was an increased risk of breast and uterine cervix cancer. Using a Kaplan–Meier survival curve, patients with a history of RPL had a significantly higher cumulative incidence of female malignancies. Using a Cox proportional hazards model, adjusted for confounders such as smoking, parity, and diabetes mellitus, a history of RPL remained independently associated with female malignancies (adjusted HR 1.4; P = 0.003).

Conclusions

RPL is independently associated with long-term female malignancies. Patients with a history of RPL may benefit from counseling and screening for breast and uterine cervix cancer in particular.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Ron Charach, Eyal Sheiner & Ofer Beharier

  2. Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Ruslan Sergienko

  3. Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Chemin de la Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada

    Roy Kessous

Authors
  1. Ron Charach
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  2. Eyal Sheiner
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  3. Ofer Beharier
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  4. Ruslan Sergienko
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  5. Roy Kessous
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Contributions

RC manuscript writing, protocol development, project administration. ES protocol development, manuscript editing. OB manuscript editing, project administration. RS data analysis. RK protocol development, manuscript editing.

Corresponding author

Correspondence to Roy Kessous.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval with regard to research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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No humans involved in this article.

Appendix

Appendix

Dig

ICD code

Diagnosis

Ovary

7300

V1043

Personal history of malignant neoplasm of ovary

21899

183

Malignant neoplasm of ovary and other uterine adnexa

21900

1830

Malignant neoplasm of ovary

21901

1832

Malignant neoplasm of ovary

21905

1838

Malignant neoplasm of other specified sites of uterine adnexa

21906

1839

Malignant neoplasm of uterine adnexa, unspecified

21758

1588

Malignant neoplasm of specified parts of peritoneum

Uterus

22575

2332

Carcinoma in situ of other and unspecified parts of uterus

21895

182

Malignant neoplasm of body of uterus

21896

1820

Malignant neoplasm of corpus uteri, except isthmus

21897

1821

Malignant neoplasm of isthmus

21898

1828

Malignant neoplasm of other specified sites of body of uterus

21888

179

Malignant neoplasm of uterus, part unspecified

7299

V1042

Personal history of malignant neoplasm of other parts of uterus

Cervical Ca

22575

2331

Carcinoma in situ of cervix uteri

7928

V1041

Personal history of malignant neoplasm of cervix uteri

21889

180

Malignant neoplasm of cervix uteri

21890

1800

Malignant neoplasm of endocervix

21891

1801

Malignant neoplasm of exocervix

21892

1808

Malignant neoplasm of other specified sites of cervix

Breast Ca

7295

V103

Personal history of malignant neoplasm of breast

22574

2330

Carcinoma in situ of breast

22630

2383

Neoplasm of uncertain behavior of breast

22642

2393

Neoplasm of unspecified nature of breast

21857

174

Malignant neoplasm of female breast

21858

1740

Malignant neoplasm of nipple and areola of female breast

21859

1741

Malignant neoplasm of central portion of female breast

21860

1742

Malignant neoplasm of upper-inner quadrant of female breast

21861

1743

Malignant neoplasm of lower-inner quadrant of female breast

21862

1744

Malignant neoplasm of upper-outer quadrant of female breast

21863

1745

Malignant neoplasm of lower-outer quadrant of female breast

21864

1746

Malignant neoplasm of axillary tail of female breast

21865

1747

Malignant neoplasm of other specified sites of female breast

21866

1748

Malignant neoplasm of breast (female), unspecified

Surgery procedure for breast Ca

1182–1183

Z8521

Local excision of lesion of breast

1184

Z85210

Local exc. breast lesion + reg. lymph node exc.

1185

Z85211

Local exc. breast lesion + rad. cervical node exc.

1186

Z8522

Resection of quadrant of breast

1187

Z85220

Quadrant resect. breast + rad. cervical node exc.

1188

Z85221

Quadrant resect. breast regional lymph node exc.

1189

Z8523

Subtotal mastectomy

1199

Z854

Mastectomy

1200

Z8541

Unilateral simple mastectomy

1201

Z8542

Bilateral simple mastectomy

1202

Z8543

Unilateral extended simple mastectomy

1203

Z85430

Radical modified mastectomy

1204

Z8544

Bilateral extended simple mastectomy

1205

Z8545

Unilateral radical mastectomy

1206

Z8546

Bilateral radical mastectomy

1207

Z8547

Unilateral extended radical mastectomy

1208

Z8548

Bilateral extended radical mastectomy

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Charach, R., Sheiner, E., Beharier, O. et al. Recurrent pregnancy loss and future risk of female malignancies. Arch Gynecol Obstet 298, 781–787 (2018). https://doi.org/10.1007/s00404-018-4868-4

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  • DOI: https://doi.org/10.1007/s00404-018-4868-4

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