Preterm birth associated with cancer diagnosis during pregnancy

Patients diagnosed with cancer while pregnant should have access to maternal and neonatal intensive care units as many children were born prematurely by iatrogenically induced delivery.

Researchers examined management options and the effect on obstetric and neonatal outcomes in 215 patients from Belgium, the Netherlands or the Czech Republic diagnosed with cancer during pregnancy.

Maternal age at diagnosis was 33.2 years and gestational age was 21 weeks; 24.2% were diagnosed during the first trimester, 42.8% were diagnosed during the second and 33% were diagnosed during the third. Breast cancer (46%), hematologic malignancies (18%) and dermatologic malignancies (10%) were the most common tumor types.

A miscarriage occurred in 2.3% of patients before cancer treatment was started. Pregnancy was terminated in 14% of patients, and treatment was delayed until postpartum in 27% of patients. A single treatment modality or a combination was initiated during pregnancy in 56.7% of patients.

In patients exposed to chemotherapy and/or radiotherapy, there was an 11.8% increase in preterm labor (P=.012). Elective cesarean section or induced delivery was performed in 71.7% of patients; maternal cancer was the indication in 76.7%. Preterm births occurred in 54.2% of women.

Among those treated with chemotherapy and/or radiotherapy, 24.2% were small-for-gestational-age babies (P=.001). Incidences of malformations were within the normal range for patients exposed to cytotoxic treatment. Overall, 51.2% of children were hospitalized in the neonatal ICU; 85.2% were hospitalized for prematurity.

“In this study, neonatal problems were mainly due to iatrogenic, and therefore preventable, prematurity,” the researchers said. “Prematurity can be prevented by postponing or continuing treatment until a term delivery can be obtained.”

Van Calsteren K. J Clin Oncol. 2009;doi:10.1200/JCO.2009.23.2801.