Abstract
Cancer and pregnancy rarely coincide. Gynecological cancers are among the most common malignancies to occur during pregnancy, and chemotherapy with or without surgery is the primary treatment option. The main concern of administering chemotherapy during pregnancy is congenital malformation, although it can be avoided by delaying treatment until after organogenesis. The dose, frequency, choice of chemotherapeutic agents, time of treatment commencement, and method of administration can be adjusted to obtain the best maternal treatment outcomes while simultaneously minimizing fetal toxicity. Use of chemotherapy after the first trimester, while seemingly safe, can cause fetal growth restriction. However, the exact effect of chemotherapy on such fetal growth restriction has not been fully established; information is scarce owing to the rarity of malignancy occurring during pregnancy, the lack of uniform treatment protocols, different terminologies for defining certain fetal growth abnormalities, the influence of mothers' preferred options, and ethical issues. Herein, we present up-to-date findings from the literature regarding the impact of chemotherapy on fetal growth.
Highlights
Malignancies rarely coincide with pregnancies; only 1 in 1000 pregnancies occur concurrently with cancer
Results of the analysis of an American registry of perinatal outcomes describing 152 pregnant women managed with chemotherapy were presented in 2010, where the mean gestational age at delivery for fetuses exposed to chemotherapy was 35.8±2.8 weeks and the mean birth weight was 2647 ± 713 g
Investigations in human beings by Lanowska et al examined the level of cisplatin in the amniotic fluid and umbilical cord blood of fetuses whose mothers underwent cisplatin monotherapy for cervical cancer during the second trimester; they found that the cisplatin concentrations in the umbilical cord and amniotic fluid were 31–65% and 13–42% of those in the maternal blood, respectively [23]
Summary
Malignancies rarely coincide with pregnancies; only 1 in 1000 pregnancies occur concurrently with cancer. Results of the analysis of an American registry of perinatal outcomes describing 152 pregnant women managed with chemotherapy were presented in 2010, where the mean gestational age at delivery for fetuses exposed to chemotherapy was 35.8±2.8 weeks and the mean birth weight was 2647 ± 713 g. In 12 cases (7.7%), the neonate had SGA The authors compared their results to those of 67 pregnant women who did not receive chemotherapy during pregnancy and concluded that congenital abnormalities, IUGR, and preterm deliveries were not increased among pregnancies managed with chemotherapy after the first trimester compared to the rates in the general population. We review the most current literature describing the effects of chemotherapy on fetal growth restriction in pregnant women with gynecological malignancies, including those of the breast, ovary, and cervix. IUGR can result from smoking, which is a well-known risk factor for certain malignancies such as cervical cancer [20, 21]
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