Procedural abortion, provider‐initiated preterm delivery and survival in pregnant people with cancer: A population‐based cohort study

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Objective To assess whether procedural‐induced abortion or provider‐initiated preterm delivery are associated with improved survival in pregnant people with cancer. Design Retrospective population‐based cohort study. Setting Provinces of Alberta and Ontario, Canada, 2003–2016. Population Females aged 18–50 years diagnosed with cancer at <20 weeks' (for the assessment of procedural‐induced abortion) or <37 weeks' gestation (for the assessment of provider‐initiated delivery). Methods Cox proportional hazard models assessed all‐cause mortality in relation to procedural‐induced abortion and provider‐initiated preterm delivery, adjusting for cancer site, stage at diagnosis and age. Meta‐analysis pooled the results across both provinces. Main Outcome Measures All cause mortality. Results There were 512 pregnant people diagnosed with cancer at <20 weeks' gestation and 782 diagnosed with cancer at <37 weeks' gestation. Neither procedural‐induced abortion (adjusted hazard ratio [aHR] = 1.39, 95% CI: 0.32–6.17) nor provider‐initiated preterm delivery (aHR = 1.17, 95% CI: 0.76–1.81) were associated with improved survival following adjustment for age, stage at diagnosis and cancer site. Conclusions Neither procedural‐induced abortion nor provider‐initiated preterm birth was associated with improved survival in pregnant people diagnosed with cancer; however, these obstetric interventions are highly personal decisions best decided by the pregnant person in consultation with their care providers.