Cancer treatments are taxing on the body, and it seems like it would be nearly impossible to grow and nurture a life while receiving weekly doses of chemotherapy.
Deciding how to deal with a cancer diagnosis while pregnant is one of the most difficult choices a woman has to make. Medical professionals are equally as perplexed. Advice varies, with some doctors suggesting early delivery and others recommending termination.
A new study shows that undergoing cancer treatment while pregnant may not harm the fetus.
The study, published in The New England Journal of Medicine, was presented to the European Cancer Congress in Vienna. It included 129 children who had mothers that underwent cancer treatment while pregnant.
The children were exposed to chemotherapy, radiation or surgery during the last two trimesters.
After birth, the researchers conducted a neurological test, called the Bayley Scales of Infant Development, at 18 months and 3 years of age. The exam showed the children had normal cognitive and cardiac functioning.
“We didn’t find any difference in cardiac functioning or cognitive function between children exposed to cancer treatment in utero and the control group,” said Dr. Frédéric Amant, the lead author of the study and a professor of obstetrics and gynecology at the Katholieke Universiteit Leuven in Belgium.
“To some extent, it’s surprising because cancer treatment is quite toxic and we know most chemotherapy drugs cross the placenta,” he said.
The mothers didn’t go through chemotherapy during the first trimester because a heightened risk of birth defects is associated with that period. Mental development is less likely to be affected by cancer treatments later in pregnancy.
The mothers included in the study had various types of cancer. A vast majority were diagnosed with breast cancer, whereas 16 percent had blood cancers.
“The main message of this study is that termination of pregnancy is not necessarily warranted, and that early preterm delivery to be able to do cancer treatment isn’t warranted, either,” said Dr. Elyce H. Cardonick, a maternal-fetal specialist at Cooper Medical School of Rowan University.
The Problem of Prematurity
For mothers with cancer, more than 60 percent of children were born earlier than 37 weeks. In comparison, only 8 percent of healthy mothers have premature births.
The majority of mothers had induced labor in order to continue cancer treatment, but Dr. Amant wants to stop this practice. He hopes the study’s findings will help persuade doctors to allow full-term births.
The premature babies were matched with a control group of children of the same age born to mothers without cancer. While the amount of chemotherapy sessions did not impact the cognitive functioning of children, the degree of prematurity did.
Prematurity was associated with lessened cognitive abilities in both study groups. The authors took factors like parental education into account, but still found that more time spent in the womb added two more points on the Bayley test.
“Prematurity is a problem for these children, but chemotherapy is not,” Dr. Amant said.
Chemotherapy treatments use a chemical called doxorubicin, which has been known cause damage to adult hearts in specific doses. The researchers studied the hearts of 47 of the 129 children in the study using electrocardiography and echocardiography.
Researchers found no difference in the size of the heart chambers or the muscle’s ability to pump blood.
At age 3, “the cardiac development of these babies was pretty normal,” said Dr. Michael F. Greene, the chief of obstetrics at Massachusetts General Hospital.
Limitations Of The Study
Dr. Greene expressed cautious optimism about the results, but assures pregnant women undergoing cancer treatment that “it’s not inevitably a horrible problem for their offspring.”
However, the study did not include all chemotherapy drugs and left out targeted anticancer drugs. The study is limited by the rarity of women who receive a cancer diagnosis while pregnant, which only happens in one of every 1,000 pregnancies.
“This paper has very detailed standardized follow-up on children,” Dr. Cardonick said, adding that the multi-center study would provide valuable information to physicians and patients.
Dr. Cardonick, who tracks cancer and pregnancy, has heard of a couple of “sad cases” where “a patient was denied cancer treatment during pregnancy, and died soon after the baby was born, because there was no confidence that cancer treatment during pregnancy would be tolerated by the fetus.”
It is hard to say whether doctors will take the study results into account, but hopefully it will be able to allow the women facing the decision to rest easier.
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