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Cancer diagnosis among women with recurrent pregnancy loss: a retrospective cohort study

Published:August 10, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.08.001

      Abstract

      Research question

      What is relationship between unexplained recurrent pregnancy loss (RPL) and risk of cancer morbidity?

      Design

      A retrospective observational cohort study was conducted, based on data from a tertiary medical centre. RPL cases (exposed) were defined as women presenting with three or more unexplained confirmed pregnancy losses at 5–24 weeks, whose first visit to the RPL clinic was between 1990 and 2010. The unexposed group included women giving birth who were not RPL patients; these were matched by age and year of giving birth/admission (1:5 ratio). Data from the RPL and the live birth registries were cross-linked to the Israeli national cancer registry according to the unique ID number and merged into one database.

      Results

      The study group comprised 937 RPL patients who were matched by maternal age (P = 1.0) and admission date (P = 0.84) to 4685 women achieving a live birth. There was no difference in overall cancer incidence between groups (adjusted odds ratio [OR] 0.76, 95% confidence interval [CI] 0.55–1.03; P = 0.08). The secondary RPL group showed a trend towards decreased cancer morbidity incidence compared with primary RPL (adjusted OR 0.65, 95% CI 0.41–1.03; P = 0.07). Analysis by cancer type showed a similar risk for breast cancer among women with RPL compared with live birth, but a significantly lower risk for gynaecological cancers among women with RPL (adjusted OR 0.25, 95% CI 0.08–0.79; P = 0.018).

      Conclusions

      Unexplained RPL may be related to a lower risk of gynaecological cancers, possibly explained by hyper-responsive immunological mechanisms involving uterine natural killer cells.

      Key words

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      Biography

      Anat Hershko Klement completed her Obstetrics and Gynaecology Residency in 2010 and then became a postgraduate in reproductive endocrinology and infertility at the University of Toronto, Canada. She is currently the Head of the reproduction and IVF unit, Hadassah Mount Scopus, Israel. Her special research interests are epidemiological aspects of ART and IVF pregnancy outcomes.
      Key message
      Women with unexplained repeated pregnancy loss showed no difference in overall cancer incidence but a lower incidence of gynaecological cancer than age- and time-matched control women who had a live birth. The mechanism may be an increased immunological response to cancer cells mediated by uterine natural killer cells.