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Cancer treatment during pregnancy does not affect pediatric outcomes
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Children born to mothers diagnosed with cancer during their pregnancy did not experience impairments to cognitive, cardiac or general development in early childhood regardless of maternal treatment receipt, according to research presented at European Society of Medical Oncology’s European Cancer Congress.
However, premature birth correlated with worse cognitive outcomes independent of cancer treatment, according to study results, which were simultaneously published in The New England Journal of Medicine.
“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,” Frédéric Amant, MD, PhD, gynecologic oncologist at University Hospitals Leuven in Belgium, said in a press release. “Avoiding prematurity is more important than avoiding chemotherapy.”
Frédéric Amant
Amant and colleagues conducted a multicenter case-control study to compare children whose mothers received a cancer diagnosis during pregnancy with children of women without a cancer diagnosis. They accessed medical files and used a health questionnaire to collect data regarding neonatal and general health.
Researchers also prospectively assessed children using a neurological examination and the Bayley Scales of Infant Development at 18 months, 36 months or both, in addition to a cardiac assessment at 36 months.
The study included data from 129 children (median age, 22 months; range, 12-42) whose mothers had cancer — or the prenatal-exposure group — and 129 matched children in the control group. Most of the mothers with cancer underwent treatment for breast cancer or hematologic malignancies.
Ninety-six children (74.4%) were exposed to chemotherapy alone or in conjunction with other treatments before birth. Other treatment exposures included radiotherapy (n = 11), surgery alone (n = 13) and other drug treatments (n = 2). Fourteen children were exposed to no treatment.
Twenty-two percent (n = 28) of children in the prenatal-exposure group had birth weight below the 10th percentile, which did not significantly differ from the 15.2% (n = 19) of children with a low birth weight in the control group.
Further, no significant between-group difference in cognitive development occurred on the basis of the Bayley score or in other subgroup analyses. Both cohorts had a median score of 101. Researchers observed no difference whether women underwent chemotherapy (100 vs. 99.5), radiation therapy (102 vs. 105), surgery alone (111 vs. 102) or no treatment (105 vs. 97.5).
However, gestational age appeared associated with cognitive outcome in the two study groups. In a univariate linear regression model, the average cognitive score tended to increase by 2.9 points for each additional week in gestational age at birth (95% CI, 2.2-3.7), based on an increase of 2.8 points (95% CI, 1.6-3.9) in the prenatal-exposure group and 3.1 points (95% CI, 2-4.1) in the control group. Overall, premature birth occurred more commonly among children in the exposure arm (birth before 37 weeks, 61.2% vs. 7-8%).
After adjusting for additional factors — including sex, race and parental education level — the researchers found that each additional week in gestational age at birth conferred an average increase in cognitive score of 2.2 points (95% CI, 1.5-3).
Researchers assessed cardiac function in 50 children in the prenatal-exposure cohort at 36 months and compared their data with those of 47 children in the control arm. Results showed no significant differences between the cohorts.
“Our data include many types of chemotherapy, but we cannot guarantee that all types of chemotherapy are safe,” Amant said. “We need to look at larger numbers of children and larger numbers of 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. … For these reasons, we will continue to follow these children until the age of 18 years and we will enlarge the group.”
These findings should reassure women who face the need to undergo cancer treatment while pregnant, Michael F. Greene, MD, chief of obstetrics at Massachusetts General Hospital, and Dan L. Longo, MD, professor of medicine at Harvard Medical School, wrote in an accompanying editorial.
“Overall these data should be reassuring to women who are facing a new diagnosis of cancer during pregnancy and to their families,” Greene and Longo wrote. “Most important, although these women are more likely to deliver prematurely than are women without cancer, the cognitive development of their offspring will be similar to that of children of the same gestational age who were not exposed to maternal cancer and chemotherapy. Prudence continues to suggest avoiding cancer treatment in the first trimester; however, treatment in the second and third trimester is likely to be best for both mothers and their offspring.” – by Cameron Kelsall
Disclosure: Amant reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures. Greene and Longo report editorial roles with The New England Journal of Medicine.
Perspective
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Motherhood and cancer are not mutually exclusive concepts.
Within both obstetrics and oncology, perhaps nothing is more devastating than a woman diagnosed with cancer during pregnancy. Issues of cancer and potentially toxic cancer treatment become even more complex as women and their clinicians confront what is the best approach, not only for the mother but for her fetus. In these situations, a few common questions arise: Can and should the pregnancy be continued? What will the impact of cancer treatment be on the growing fetus? Mothers facing the need for cancer treatment fear the potential lifelong consequences for their child.
To date, we have had retrospective data to help guide our discussions — and the subsequent decisions — and most of our data indicate that pregnancy during cancer treatment is safe for the mother and the baby. No — you do not need to terminate a wanted pregnancy. No — babies born to moms who had chemotherapy during the second and third trimesters of pregnancy are not at risk for long-term developmental disorders. Yet, even while we might believe these conclusions, if asked “How do you know,” clinicians have often pointed to relatively low-quality evidence.
To this end, the data from Amant and colleagues is quite important for clinicians and patients. In a prospectively designed case-controlled multi-institutional study, they set out to determine the long-term outcome of the children born from women treated for cancer during pregnancy. In it, the outcomes of 129 children exposed to prenatal cancer treatment (cases) were compared to development of the same number of children from the general population (controls). Outcomes included the general health, prenatal and postnatal growth, cognitive development, and cardiac function. The bottom line: Although women treated for cancer face a higher risk for preterm delivery, long-term development of these children was not impacted.
Although a small study, these findings are of great importance. They provide much needed reassurance that for any woman diagnosed with cancer during pregnancy, continuing the pregnancy is safe and their child will not be negatively impacted. This should come as a huge relief for woman already facing difficult choices about how to approach their cancer.
– Mary E. Sabatini, MD, PhD
Massachusetts General Hospital
Harvard Medical School
– Don S. Dizon, MD
Massachusetts General Hospital
Harvard Medical School
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