Medical/Surgical/Diseases/Complications
Poster Session 1
Noa Gohar-Portnoy, MD (she/her/hers)
Dr.
Soroka University Medical Center
Givot Bar, HaDarom, Israel
Sharon Davidesko, MD
Gynecology and Obstetrics Resident
Soroka University Medical Center
Omer, HaDarom, Israel
Eyal Sheiner, MD, PhD
Head of department of Obstetrics and Gynecology B, Soroka University Medical Center
Soroka University Medical Center
Beer-Sheva, HaDarom, Israel
Tamar Wainstock, PhD (she/her/hers)
Ben Gurion University
Beer-Sheva, HaDarom, Israel
Ruslan Sergienko, MHA
Ben Gurion University of the Negev
Beer-Sheva, HaDarom, Israel
Roy Kessous, MD
Soroka University Medical Center
Beer-Sheva, HaDarom, Israel
Global trends indicate women increasingly delaying childbirth. This study aims to assess the impact of advanced maternal age at first delivery on the long-term incidence of gynecological cancers.
Study Design:
A population-based cohort study including all primigravida delivering between the years 1991-2019, stratified by age (up to vs. over 35 years at delivery). Data were collected retrospectively from medical records according to pre-defined ICD-9 codes. The incidence of gynecological cancers were compared and analyzed. Kaplan-Meier survival curves compared malignant morbidity controlling for time, and a Cox regression model controlled for confounders.
Results:
Among 44,230 first deliveries, 788 (1.8%) were in elderly primigravida who were more likely to have undergone fertility treatment (29.1%vs. 3.1%, p< 0.01) as well as higher prevalence of diabetes (18.4% vs. 3.8%, p< 0.01), hypertension (16.6% vs. 6.9%, p<0.01), and pre-pregnancy obesity (2.3% vs. 0.9%, p< 0.01).
The overall incidence of gynecological malignancies was higher in elderly primigravida (1.8% vs. 0.8%, p=0.003) and specifically, breast and endometrial (1.5% vs. 0.7%, p=0.003 and 0.3% vs. 0.0%, p=0.004 respectively). No differences were noted in the incidence of cervical and ovarian cancer. Kaplan-Meier survival curves reiterated these findings (Figure, log-rank test p< 0.01 for endometrial and breast cancers).
Multivariate analysis controlling for other risk factors such as hypertension, pre-eclampsia, diabetes and fertility treatment showed that elderly primigravida had an adjusted HR of 1.792 (95%CI 1.030-3.118, p=0.001) for composite malignancy, 3.398 (95%CI 0.700-16.504, p=0.129) for uterine cancer and 1.905 (95%CI 1.045-3.470, p=0.035) for breast cancer.
Conclusion:
First pregnancy at advanced age is associated with increased lifetime risk for breast and endometrial malignancies, an additional factor to consider in family planning decisions.