Prenatal exposure to cancer treatment: is it dangerous for the baby?

28 Sep 2015

Women who are pregnant when diagnosed with cancer can start treatment for their disease immediately and do not need to terminate their pregnancy due to worries over the effects of therapy on the development of their child.

New results from a study of 129 children, aged between one and three, born after prenatal exposure to cancer treatment, showed normal development of their mental processes and heart function when compared to a matching group of children from the general population.

"Our results show that fear of cancer treatment is no reason to terminate a pregnancy, that maternal treatment should not be delayed and that chemotherapy can be given. The study also shows that children suffer more from prematurity than from chemotherapy, so avoiding prematurity is more important than avoiding chemotherapy," said Prof Amant, who is a gynecological oncologist at the University Hospitals Leuven (Belgium) and at Antoni van Leeuwenhoek (Amsterdam, The Netherlands).

Mothers’ most common cancers were breast and hematological cancers

A total of 129 children from Belgium, The Netherlands, Italy, and the Czech Republic were included in the study and were matched with a similar number of children of the same gestational age who were born to mothers unaffected by cancer. The children's general health and mental development were examined when they were 18 months and three years old. At the age of three, 47 of the children also had the functioning of their hearts checked with electrocardiograms (ECGs) and echocardiography.

The most common cancers among the mothers were breast and hematological cancers, such as leukemia and lymphoma. 69% of the children were exposed to chemotherapy before birth, 3.1% to radiotherapy, 5.4% to both chemo- and radiotherapy, 0.7% to trastuzumab, 0.7% to interferon β and 10.1% to surgery alone, while 10.9% mothers did not receive treatment during pregnancy.

CareAcross-pregnant-woman

Clinical results of the study—no differences or abnormalities were found

"Compared to the control group of children, we found no significant differences in mental development among children exposed to chemotherapy, radiotherapy, surgery alone or no treatment," said Prof Amant. "Nor was the number of chemotherapy cycles during pregnancy, which ranged from one to ten, related to the outcome of the children.

However, delayed development of mental processes appeared to be related to premature birth. Premature birth was more frequent among children born to mothers with cancer, regardless of whether or not they received prenatal treatment, than in the general population in the countries participating in the study.

"In most cases, they were born prematurely due to a medical decision to induce preterm so as to continue cancer treatment after the delivery," said Prof Amant. "In some cases preterm delivery was spontaneous and it is possible that cancer treatment plays a role in this. But we do not know what exactly triggers preterm delivery. It could be that chemotherapy induces preterm contractions or vaginal inflammation with preterm rupture of the membranes."

Of the 47 three-year-olds who had their cardiac functioning checked, 29 had been exposed to chemotherapy, but compared to the control group of children, there were no differences or abnormalities.

“We cannot guarantee that all types of chemotherapy are safe”

The results had some limitations. "Our data include many types of chemotherapy, but we cannot guarantee that all types of chemotherapy are safe.

"We need to look at larger numbers of children and larger numbers exposed to each drug in order to be able to document the potential effects of individual drugs. In addition, we cannot extrapolate to newer drugs, including targeted drugs. We need longer follow-up to see if there are any long-term toxic effects in cases where cisplatin was administered before birth. For these reasons we will continue to follow these children until the age of 18 years and we will enlarge the group. This will allow us to document longer-term effects and to draw conclusions for specific drugs. In addition we will investigate to what extent anti-cancer drugs are diluted in the body during pregnancy, and also at the psycho-emotional needs of mothers and their partners."

 

Source: Science Daily
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