Reproductive Health Outcomes among Adolescent and Young Adult Cancer Patients: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Reproductive health is an important consideration for adolescents and young adults (AYAs, aged 15–39 years) with cancer. Our systematic review and meta-analysis synthesized the current literature on the impacts of AYA cancer on reproductive health outcomes. We searched EMBASE and MEDLINE from 1 January 2000 to 26 January 2022 to capture observational studies exploring impacts of AYA cancer on reproductive health outcomes compared to controls. A total of 21 studies were included, and 62 outcomes were explored across all studies. We classified these outcomes in a sex-based framework as fetal/neonatal (n = 26), maternal (n = 11), fetal/neonatal-maternal (n = 23), and maternal-paternal (n = 2). Our analysis showed significantly higher preterm birth, gestational diabetes, and use of fertility treatment in AYA cancer patients compared to controls. Additionally, there is a higher risk of preterm birth and low APGAR score at birth for AYA cancer patients who receive radiation compared to controls. This review provides evidence of impacts of AYA cancer on reproductive health outcomes. ABSTRACT: Background: This systematic review and meta-analysis (SRMA) aimed to synthesize the current literature on the impacts of adolescent and young adult (AYA, ages 15–39 years) cancer on reproductive health outcomes. Methods: EMBASE and Medline were searched from 1 January 2000 to 26 January 2022 for observational studies that included individuals with AYA cancer and controls which evaluated reproductive health outcomes. We used random effects models and 95% confidence intervals to obtain pooled measures of associations between AYA cancer, cancer treatment, and reproductive health outcomes. Results: The search identified 8625 articles; 21 were included. 62 reproductive outcomes were assessed and classified according to a sex-based framework as fetal/neonatal (n = 26), maternal (n = 11), fetal/neonatal-maternal (n = 23), and maternal-paternal (n = 2). Meta-analyses of crude estimates showed significant associations between AYA cancer and outcomes including preterm birth (pooled odds ratio [pOR] 1.31; 95% CI: 1.22, 1.42), gestational diabetes (pOR 1.43; 95% CI: 1.03, 1.99), and fertility treatment (pOR 2.66; 95% CI 1.71, 4.11). We also found higher odds of preterm birth (pOR 1.65; 95% CI: 1.21, 2.26) and low APGAR score at birth (pOR 2.03; 95% CI: 1.32, 3.13) among AYA cancer patients who received radiation compared to controls. Conclusions: Our SRMA quantified impacts of AYA cancers and treatments on several reproductive health outcomes.