Pregnant patients with cancer who receive anticancer treatment may have an increased risk of specific neonatal complications, a study published in Lancet Oncology has shown.
The incidence of antenatal cancer treatment has increased over the past 2 decades, and although studies have been conducted to assess the effects of therapy on maternal, neonatal, and obstetric outcomes, the small sample sizes have produced less than robust data.
For this descriptive cohort study, researchers retrospectively and prospectively registered 1170 patients with cancer diagnosed during pregnancy who were entered into the International Network on Cancer, Infertility, and Pregnancy (INCIP). Patients were assigned to 3 subgroups stratified by year of diagnosis: 1996 to 2004, 2005 to 2009, and 2010 to 2016. The long term results of patients were analyzed, including changes to patient characteristics, outcomes, and treatment methods, as well as complications such as preterm, prelabor rupture of membranes (PPROM)/preterm contractions, small for gestational age, and admission to the neonatal intensive care unit (NICU).
Of the 1170 registered patients, 779 (67%) patients received antenatal treatment; an increase in treatment was observed every 5 years, especially with chemotherapy. Overall, 955 (88%) of 1089 singleton pregnancies resulted in livebirth, of which 430 (48%) of 887 pregnancies terminated preterm; every 5 years, there were fewer iatrogenic preterm births and more livebirths.
An association between small-for-gestational age and platinum-based chemotherapy, and between NICU admission and taxane chemotherapy was observed. Gastrointestinal cancers were associated with the high risk of NICU admission whereas thyroid cancers had the lowest risk compared with breast cancer, the most frequently reported malignancy during this study. Abdominal and cervical surgery led to a decreased likelihood of NICU admission.
The authors concluded that “our data indicate that babies exposed to antenatal chemotherapy might be more likely to develop complications, specifically small for gestational age and NICU admission, than babies not exposed. We therefore recommend involving hospitals with obstetric high-care units in the management of these patients.”
de Haan J, Verheecke M, Van Calsteren K, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients [published online January 24, 2018]. Lancet Oncol. doi: 10.1016/s1470-2045(18)30058-5