Chemotherapy during pregnancy influences child development

One of the major concerns of women of childbearing age who are diagnosed with cancer lies in their ability to have children and how the treatments can affect the development of their children. The Lancet, in a series of articles published today, seeks to provide answers to these questions, and the main conclusion is that, today, the vast majority of women can have children and that even if treated during pregnancy, their children will have normal development .

The first article in a series about cancer in pregnancy explores issues related to gynecologic cancers, especially cancers of the neck of the uterus and ovary. The current trend is to preserve the pregnancy whenever possible, explains Philippe Morice, Institut Gustave Roussy (France). Up to 1 in 1,000 pregnancies are affected by cancer, but this number could increase in the high-income countries, as more women are delaying pregnancy until later ages, and age increases the risk of most cancers.

The treatment of cervical cancer during pregnancy depends primarily on four criteria: the degree of local spread (ie, tumor stage and tumor size, determined clinically and use of radiological imaging), nodal status (determined by radiological images and surgical nodal staging feasible to 20-22 weeks gestation), the term of pregnancy, and histologic subtype. All these factors must be taken into account when considering treatment.

It is known that chemotherapy should not be used within 8 weeks of pregnancy because it causes harm to the fetus, but evidence suggests it may be used in the second or third trimester, because it increases the chances of preservation of the fetus. Moreover, the children exposed to chemotherapy in utero after the first trimester do not seem to have more birth defects.

With regard to breast cancer, in another article, stated that it is possible that breast cancer is treated during pregnancy. In fact, cancer treatment during pregnancy reduces the need for preterm delivery and, therefore, prematurity, which is a major concern in the management of breast cancer in pregnancy.

The author of this work, Frederic Amant, Catholic University of Leuven (Belgium) said that radiotherapy is not recommended during pregnancy, especially in late stages, where it becomes more difficult to protect the fetus. However, he notes, chemotherapy can be administered according to standard guidelines for pregnant women in the second and third quarters. In fact, notes that there is evidence to suggest that if properly administered chemotherapy is not hurting the child, although it is advisable to examine the placenta after birth to check for metastasis. In addition, we can not recommend breastfeeding in the first weeks after chemotherapy.

In this regard, a study published in The Lancet Oncology shows that the development of the children of women exposed to chemotherapy during pregnancy is similar to the general population. The team has evaluated 68 pregnancies (70 children) were administered to 236 cycles of chemotherapy (three or four per pregnancy). The mean gestational age at cancer diagnosis was 18 weeks. Children born between 36 and 37 weeks of pregnancy. The children tested were between 1.5 and 18.

The tests were performed for children included neurological examinations, tests of the general level of cognitive functioning, electrocardiogram and echocardiogram, and a questionnaire on general health and development. In children older than five years, further tests were performed audiometry, auditory verbal learning and other cognitive and behavioral tests.

The results showed that although neurocognitive outcomes were within normal ranges, cognitive development scores were lower for children born preterm than for term infants. However, these differences, the researchers say, are in any group of children born prematurely, not only in this study.

The authors stress that it has been shown that "children who were prenatally exposed to chemotherapy have a similar development as any other child." With these data, highlights "the decision to administer chemotherapy should follow the same pattern as in nonpregnant patients, notes in practice-Amant, chemotherapy can be given from 14 weeks gestational age onwards, with particular attention to the prenatal care".

And, they say, that the only way to certify that chemotherapy does not affect children is to monitor the longer term. In this sense, Elyce Cardonick, Rowan University, New Jersey (USA), thinks this study has the potential to affect clinical practice, "if we are able to present these data reassuring to pregnant women with cancer, they could accept further treatment during pregnancy. In addition, this report could encourage oncologists and obstetricians to recognize the benefits of their collaboration in pregnant women with cancer."

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