Assessment of fetal risk associated with exposure to cancer chemotherapy during pregnancy: a multicenter study

Abstract

The objective of the present study was to evaluate and quantify fetal risks involved in the administration of cancer chemotherapy during gestation, as well as to assess the long-term effects on the exposed children. In this retrospective, cohort study, we reviewed the records of women aged 15 to 45 years with a diagnosis of malignancy or benign tumors with malignant behavior at three reference services in the State of Rio Grande do Sul, Brazil, from 1990 to 1997. All patients with a diagnosis of pregnancy at any time during the course of the disease were selected, regardless of whether or not they received specific medication. Fetal outcomes of 14 pregnancies with chemotherapy exposure were compared to that of 15 control pregnancies in which these drugs were not used. Long-term follow-up of the exposed children was carried out. Fisher's exact test was used to compare the groups. Continuous variables were compared by the Wilcoxon-Mann-Whitney test. We found an increased rate of prematurity (6/8 vs 2/10; RR: 3.75; CI: 1.02-13.8; P = 0.03) in the exposed group. There was a trend to an increased fetal death rate (4/12 vs 0/10; P = 0.07) in the group exposed to chemotherapy. No malformations were detected in any child, which can be related to our small sample size as well as to the fact that most exposures occurred after the first trimester of pregnancy. Other larger, controlled studies are needed to establish the actual risk related to cancer chemotherapy during pregnancy.

The treatment of Hodgkin's and non-Hodgkin's lymphoma in pregnancy

“…The existing data suggest that treatment with CHOP during the second and third trimesters may be administered safely without adverse fetal outcomes. 2,35,38,39,[42][43][44][45][46][47][48][49][50][51][52][53][54] These relatively limited data are further supported by data arriving from the treatment of pregnant patients with non-hematologic malignancies such as breast cancer, who were treated with regimens that share major similarities with CHOP. Two reports on a total of 53 pregnant patients with breast cancer who were treated with cyclophosphamide and doxorubicin with or without 5-fluorouracil during the second and third trimesters, documented no congenital anomalies or growth restriction in the women's offspring.…”

Management of malignant gliomas during pregnancy

“…For the mother, chemotherapyassociated risks include stillbirth, spontaneous abortion, and maternal sterility. 14,15 Procarbazine is a potent teratogen and carcinogen in animal models and, in such models, can cross the placenta in sufficient concentration to cause fetal death or malformation, particularly when the exposure is in early gestation. 16 Four case reports have described the use of procarbazine in Hodgkin-disease patients with unplanned pregnancies.…”

Acute lymphoblastic leukemia in pregnancy: a case report with literature review

“…Overall, long-term follow-up reports show few side effects. Most of these reports come from observation following the treatment of pregnant patients with breast cancer, lymphomas, leukemia and other solid tumors [Gulati et al 1986;Partridge et al 2000;Aviles et al 2001;Peres et al 2001;Hahn et al 2006;Ali et al 2009;Cardonick et al 2010]. Many of the studies reported that these children have normal height and weight compared with controls, have no abnormal behavior or learning deficit, and [ 2008] 6-MP, 6-mercaptopurine; Allo-SCT, allogeneic stem cell transplant; CR, complete remission; Ctx, cyclophosphamide; CR1, first complete remission; Cyt, cytarabine; DNM, daunomycin; DNR, daunorubicin; G-CSF, granulocyte colony stimulating factor; Ida, idarubicin; IT-Mtx, intrathecal methotrexate; L-asp, L-asparaginase; Pre, prednisone; Prd, prednisolone; Tg, thioguanine; VCR, vincristine; WBRT, whole brain radiation therapy.…”

“…*Approximate gestational age. have normal psychological and neurological evaluations [Peres et al 2001;Hahn et al 2006;Cardonick et al 2010].…”