Incidence and outcomes of women with non-Hodgkin's lymphoma in pregnancy: a population-based study on 7.9 million births

Aim: Non-Hodgkin's lymphoma (NHL) is a rare malignancy that can affect women of all ages. The purpose of our study was to estimate the incidence, maternal and fetal outcomes of pregnancy-associated non-Hodgkin's lymphoma (PANHL).

Material and methods: We conducted a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample from 2003 to 2011. Disease incidence was calculated and logistic regression was used to estimate the adjusted effect of NHL on maternal and fetal outcomes.

Results: Of 7,917,453 births, there were 427 cases of PANHL for an overall incidence of 5.39 per 100,000 births, increasing from 4.44 per 100,000 births to 7.17 per 100,000 births over the 9-year period. Relative to controls, PANHL was more common among Caucasians and women aged 25-34 years. Non-specified PANHL was most commonly coded in >81% of cases, with mycosis fungoides and Burkitt's lymphoma being the other two most common. After adjusting for baseline characteristics, women with PANHL were more likely to have pre-eclampsia, odds ratio (OR) 1.57 (95% confidence interval [CI] 1.06-2.32), cesarean section, OR 1.37 (95%CI 1.13-1.67), preterm births OR 2.50 (95%CI 1.94-3.22), postpartum blood transfusions, OR 2.73 (2.10-3.55), and infectious morbidity, OR 2.81 (95%CI 1.16-6.79). Maternal and fetal mortality rates were significantly increased among women with PANHL.

Conclusion: The incidence of PANHL is increasing and is associated with an increased risk of maternal and neonatal morbidity and mortality, and as such, women with PANHL may best be managed in specialized centers.