June 18th, 2018

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Cancer-related Maternal Mortality: Findings from the State of Hawaii
Authors:  Keith Y. Terada, M.D., Scott A. Harvey, M.D., James Davis, Ph.D., and Janet Burlingame, M.D.
  OBJECTIVE: To compare cancer-related maternal mortality to cancer mortality in nonpregnant reproductive age women for the State of Hawaii.

STUDY DESIGN: Death certificates for all women who died from cancer during pregnancy and postpartum were obtained from the State Department of Health for the period 1991–2007. Reporting changes beginning in 2006 included an electronic reporting system for filing death certificates; also maternal deaths occurring within 365 days after any pregnancy, not just live births, were required to be reported. There were 28 women during this period who had cancer listed as the cause of death within 1 year of a live birth. Information regarding the primary site was abstracted and compared to cancer mortality in the Hawaii State Tumor Registry for all women aged 17–45 for this same time period. Primary site–specific cancer mortality was then compared between pregnant women and nonpregnant women. The mortality odds ratios were compared using the Mantel-Haenszel procedure.

RESULTS: Maternal mortality due to leukemia (p= 0.005) and primary brain malignancies (p=0.011) were significantly increased compared to that of the nonpregnant population. Maternal mortality due to primary malignancies of the female genital tract were significantly lower (p=0.029). There was no significant difference in mortality for all other primary sites.

CONCLUSION: There appear to be significant differences in the distribution of site-specific cancer mortality between the maternal and nonmaternal population. The risk is significantly increased for hematologic and brain malignancies. Mortality due to malignancies of the female genital tract, however, is significantly reduced. An enhanced electronic reporting system for recording death certificates beginning in 2006 will provide additional data and better insight into this critically important issue.
Keywords:  cancer in pregnancy, cancer mortality, maternal mortality
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