Abstract
Background/Objectives: Pregnancy-associated cancer (PAC) presents significant challenges for maternal and neonatal health, and yet its impact on neonatal outcomes remains poorly understood. This systematic review aims to evaluate the neonatal risks associated with PAC. Methods: A systematic search of PubMed, Embase, Scopus, and other databases was conducted up to 1 November 2024, identifying observational studies and randomized controlled trials assessing neonatal outcomes in pregnancies affected by PAC. Outcomes included preterm birth, low birthweight, macrosomia, small and large for gestational age, low Apgar score, congenital anomalies, and neonatal mortality. Results: Eleven high-quality studies encompassing over 46 million births, including 9953 PAC-affected pregnancies, were reviewed. PAC significantly increased the risks of preterm birth (adjusted ORs ranging from 1.48 to 6.34) and low birthweight (adjusted ORs up to 5.5). Other adverse outcomes included low Apgar scores and neonatal mortality, primarily linked to prematurity. Cancer type and treatment timing influenced these outcomes, with gynecological and breast cancers posing higher risks. Conclusions: Neonates of mothers with PAC face increased risks of adverse outcomes, underscoring the importance of tailored, multidisciplinary management. Further prospective studies are needed to clarify the impacts of specific cancer treatments during pregnancy.