Findings Reveal Gaps in Care for Pregnant Minority Women With Cancer

In this interview with The American Journal of Managed Care (AJMC), Duke Appiah, PhD, MPH, associate professor at Texas Tech University Health Sciences Center, highlights the findings of his abstract “Higher Risk of Adverse Pregnancy Outcomes Among Racial and Ethnic Minority Women With Cancer in the US,” which he presented at the American Association for Cancer Research Annual Meeting 2025, which took place in Chicago, Illinois.
Building on these findings, he discusses how clinicians can better support pregnant minority women with cancer and highlights key areas for future research.

This transcript has been lightly edited.

AJMC: Before your study, what was known about obstetric complications in women with cancer? Were there any gaps in the literature?

Duke Appiah, PhD, MPH | Image: Texas Tech

Appiah: Prior to my work, there were some reports out there that talked about, for instance, preterm birth being more common among women with cancer, especially those who are adolescents and young adults. However, not much has been looked at in terms of the racial and ethnic differences.
Now, why would we just look at racial and ethnic differences? This is very important for decision-making. Again, prior studies have just looked at, let’s say, a few of the adverse pregnancy outcomes. Still, we look at it more comprehensively and also to provide data that reflect every racial and ethnic group that we know currently in the United States, to help them in decision-making.

Having cancer, getting pregnant, and [delivering] a baby is a very complicated situation, which needs multifactorial factors to be [considered]. Shared decisions have to be made between different specialties, so our work addressed the gap that there was not much comprehensive information on it and also reflected every race and ethnic group in the United States. We provide information to help in the decision-making, especially for the patients.

AJMC: Can you summarize the main findings? Were there any that stood out to you?

Appiah: The main findings tended to reflect what we see in patients who do not have cancer. For instance, we looked at hypertensive disorders of pregnancy, gestational diabetes. We also looked at fetal growth restriction. We also looked at intrauterine fetal death. We also looked at preterm birth and maternal mortality.

For all these factors that I have mentioned, they tended to be higher in women in racial and ethnic minority groups. Then, if we look at it [based on] the type of cancer, we didn’t see much stronger association for those who had, let’s say, melanoma, or those who had ovarian cancer. But when we came to breast cancer, as well as thyroid cancer, there was a 30% elevated risk in these groups.

Then, finally, we just wanted to compare whether, even within the same race, having cancer makes an impact, or does it make a difference? We saw that, yes, it made a lot of difference in many of the adverse pregnancy outcomes.

Just to highlight, for instance, maternal mortality was high among patients with cancer for all racial and ethnic groups compared with the same racial and ethnic groups of women who did not have cancer. This highlighted the importance of adverse pregnancy outcomes, such as maternal mortality, in this vulnerable population.

AJMC: Your findings showed that adverse pregnancy outcomes were more common among racial and ethnic minority women with cancer. What do you think is driving these disparities?

Appiah: Most of the things that drive health disparities in most diseases will be at play here. For instance, preexisting conditions, such as hypertension and diabetes, even before pregnancy, also exacerbate the occurrence of these adverse pregnancy outcomes.

Some studies have reported, again, isolated studies, that even the treatment itself that a woman receives during, let’s say, pregnancy for cancer, can also influence some of the adverse pregnancy outcomes. These factors [and] others, such as socioeconomic status, can all play a role in some of these findings that we have reported.

But the good news is that this is also to help people explore more of the differences, that even within the same race or the same ethnicity, just having cancer elevates your risk for advanced pregnancy outcomes.

We put out data to also stimulate more findings and more investigations. From the broad view, I would say some of these factors that we have known to predispose racial and ethnic groups to a higher incidence of cancer are some of the driving factors.

AJMC: What are the most immediate steps clinicians can take to better support pregnant patients with cancer from racial and ethnic minority groups?

Appiah: Currently, the guidelines are not [very] comprehensive, and so physicians are doing their best, and I’ve always said I will support that, and I’m just providing them with information, that is, my team and I. We are providing them with information to [help them] make more informed decisions.

For instance, knowing that, let’s say, an African American woman and a Hispanic woman have in common preexisting diabetes. At the outset, you know that they are going to have a higher risk. For instance, 4 in 10 women with cancer from racial and ethnic minority groups are likely to have one of the adverse pregnancy outcomes. This is to inform physicians, to let them know, and also to inform patients to make decisions.

The thing about it is we studied a wide, comprehensive range of adverse pregnancy outcomes to help in making the decisions, and we represented all racial and ethnic groups. Based on some of this data, at least women and pregnant individuals can make some decisions whether to go on with the pregnancy, or what type of treatment to seek during pregnancy when they have cancer.