Understanding preterm birth in female survivors of childhood cancer
Research institutes:
Academic Department of
Obstetrics and Gynaecology,
University Hospitals Bristol NHS
Foundation Trust
EGA Institute for Women’s Health,
University College London
Reproductive Medicine Unit,
University College London
Children
and Young People’s Cancer Service,
University College London Hospitals
Institute of Applied Health Research,
University of BirminghamProject dates:
Grant Awarded: 18 jul 2019
Funding awarded:
Grant Amount (Borne’s share): £25,824
Total Award: £51,650
Women who were treated for cancer as girls are thought to have a higher chance of giving birth prematurely. Dr Melanie Griffin and her team explored existing data to discover the extent of the risks this group of women face, and how the care they receive varies across the UK. Their research could improve care for these women, and reduce the number of babies that are born prematurely.
The challenge
Thanks to improvement in treatments, more children and young people with cancer are surviving and living into adulthood to have children of their own. However, previous research has suggested that female survivors of childhood cancer might have a higher risk of pregnancy problems, including preterm birth.
One group that may be at particularly high risk are women who were treated for blood cancers with a stem cell transplant, who may have also received total body irradiation (radiotherapy to the whole body to kill cancer cells).
We don’t know the exact risk of preterm birth faced by female survivors of childhood cancer. We also suspect that these women don’t always receive the same level of care across the UK, and that they are not always referred to preterm birth specialists.
We need to better understand the risks faced by this group, and improve the care they receive, to reduce the number of babies born too early.
The project
In this project, which ended in March 2023, Dr Melanie Griffin and her colleagues set out to determine whether having received a stem cell transplant as a treatment for cancer in childhood, with or without total body irradiation, increases a woman’s chances of preterm birth.
The team used existing healthcare data about recipients of stem cells transplants, and childhood and young adult cancer survivors. They found that women who had received total body irradiation as part of cancer treatment as a child had a higher risk of giving birth too early, and having smaller babies. The preterm birth rate in this group was as high as 25%, much higher than the UK average of 8%.
But reassuringly, they found that stem cell transplants on their own (without total body irradiation) did not significantly increase preterm birth rates.
Dr Griffin and her team also conducted a national survey of doctors to understand the pregnancy care given to female survivors of childhood cancer. They found that overall, there was good care, with pregnancy and fertility discussed early. However, the care given during pregnancy varied a lot, and some women in this group were not referred to specialists to reduce their risk of preterm birth.
The team have since worked with the stem cell transplant charity Anthony Nolan to update their webpages relating to pregnancy and fertility. The team are also discussing with the Royal College of Obstetrics and Gynaecologists to update their national guidance, to recommend that women who have received total body irradiation as a child should be considered for referral to preterm birth specialists.
What difference will this project make?
Previous research suggested that some female survivors of childhood cancer are at risk of preterm birth. Dr Griffin’s project has provided valuable concrete data on preterm birth rates in this group. It is reassuring to know that receiving a stem cell transplant in childhood does not on its own appear to significantly increase a woman’s chances of preterm birth.
Dr Griffin’s research has confirmed that total body irradiation as part of childhood cancer treatment increases risk of preterm birth in adulthood, and can lead to smaller babies. This knowledge can now be shared with girls undergoing cancer treatment and their families, as well as women who have survived cancer, so they can understand their risks and make informed choices.
If national guidelines are updated, this would mean that, for pregnant women who received total body irradiation as a child, it will be standard practice to refer them to preterm birth specialists.
The knowledge generated by this project will help improve the care these women receive, as well as reducing their risk of preterm birth to make sure their babies are born healthy.
We would not have been able to conduct this essential work without the support of Borne and Action Medical Research. Through this funding we have been able to improve our understanding of the effect [stem cell transplant with or without total body irradiation] has on pregnancy outcomes, enabling better provision of counselling and care for those affected.
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This project is jointly funded by Borne and Action Medical Research
