Overall, cancer survivors' offspring were not at excess risk for malformations or infant death; moreover, sex ratios were similar to those in children of women who did not have childhood or adolescent cancer histories. Infants born to cancer survivors were more likely to be delivered before 37 weeks' gestation (relative risk, 1.5) and to weigh <2500 g (RR, 1.3); risks for preterm delivery and birth weight <2500 g also were modestly elevated for offspring of genital tract cancer survivors (RR, 1.3). Cesarean delivery was not more common in women with histories of cancers in the abdomen or pelvis but was twice as common in bone cancer survivors as in controls.

Comment: The conclusions of this large study are reassuring. I have found that many parents and their daughters have major concerns about the effects of cancer treatment (particularly if it involves the reproductive tract) on later pregnancy outcomes. Preliminary discussions about potential birth outcomes should be presented in child-friendly language at the time of initial treatment, whether for reproductive or nonreproductive cancers. The finding that childhood cancer and its treatment did not seem to cause germ cell mutations — evidenced by the lack of effect on rates of infant death and congenital malformations, as well as sex ratios — is good news that should be shared with patients and their families. However, the current study is only relevant to women who achieved live births; issues such as ovarian insufficiency after chemotherapy or radiation were not analyzed.