Post-diagnosis fertility is a critical issue for adolescent and young adult cancer survivors (diagnosed at age 15 to 39 years), with little information on the impact of cancer diagnosis and treatment on pregnancy outcomes. This study focuses on five leading cancer types among female adolescent and young adult cancer survivors: breast, melanoma, thyroid, and Hodgkins and non-Hodgkins lymphomas. We will analyze North Carolina state-wide cancer registry data linked to claims and offspring birth records from 2003 to 2012, as well as data from Kaiser Permanente Northern California (KPNC) and Kaiser Permanente Southern California (KPSC) for 2000 to 2016. Study aims include assessment of adverse pregnancy outcome risk among 7,200 female adult and young adult cancer survivors at KPNC and KPSC, with 1,300 births, matched five-to-one to 36,000 women without a prior cancer diagnosis on age and enrollment year. Adverse pregnancy outcome risk will also be assessed among 8,000 female adult and young adult cancer survivors in North Carolina, matched five-to-one on maternal age, state, and delivery year. Additionally, the impact of fertility preservation counseling and use on risk of adverse pregnancy and birth outcomes will be evaluated.