A recent study published by the The Lancet Oncology indicates that children of women who received chemotherapy during their pregnancy suffer no adverse effects, developing as well as children in the general population. The study was led by Dr Frédéric Amant, Multidisciplinary Breast Cancer Center, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium.
The researchers assessed 68 pregnancies of mothers who received an average of three to four cycles of chemotherapy - a total of 236 cycles. The average age of cancer diagnosis for the mothers was 18 weeks into pregnancy. The median gestation age of birth was at 36 weeks, with two thirds (47) of the women giving birth before 37 weeks. A total of 70 children were assessed, ranging from ages 1.5 to 18 years.
They carried out a series of tests on the children to examine their overall health and development, including: Bayley or intelligence quotient tests, electrocardiography and echocardiography, and a questionnaire on general health and development. Children above the age of 5 were given more tests such as the Auditory Verbal Learning Test, audiometry, the Test of Everyday Attention for Children, and their parents were to complete a 'Child Behavior Checklist'.
Neurocognitive outcomes were within normal ranges for children born at full term, children born preterm, however, had lower results, but the authors stress that this difference is found among the general population as well. The results of the tests indicated that the children's behavior, general health, heart dimensions/function, hearing, and growth were all equal to the average results of children in the general population.
The authors said:
"We show that children who were prenatally exposed to chemotherapy do as well as other children... Our findings do not support a strategy of delay in chemotherapy administration or iatrogenic (ie physician induced) preterm delivery with post-partum chemotherapy administration to avoid harm to the fetus."
They also add:
"The decision to administer chemotherapy should follow the same guidelines as in non-pregnant patients. In practice, it is possible to administer chemotherapy from 14 weeks gestational age onwards with specific attention to prenatal care."
They stress the need for a follow-up with more children over a longer period to provide more certainty on whether or not chemotherapy in pregnancy has any detrimental health effects on children.
Dr Elyce Cardonick, Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, NJ, USA, comments:
"The study by Amant and colleagues has the potential to affect clinical practice: if we can present this reassuring data to pregnant women with cancer, women might be more likely to accept treatment during pregnancy when indicated. This report might encourage oncologists and obstetricians to recognise the advantages of collaboration when the subject under study such as cancer in pregnancy is rare."