Drug use during pregnancy linked to certain pediatric cancers
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Gestational substance abuse appeared linked to certain cancers among children, according to study results published in Cancer Epidemiology, Biomarkers and Prevention.
Researchers surveyed parents of children diagnosed with cancer prior to their 18th birthday about maternal gestational use of alcohol, tobacco and illicit drugs.
The analysis — which included responses from 3,145 unique families — showed 14% reported gestational use of tobacco products; 4% reported use of illicit drugs, including marijuana or cocaine; and 2% reported greater than moderate use of alcohol.
Results showed an association between prenatal illicit drug use and increased prevalence of intracranial embryonal tumors (prevalence ratio = 1.94; 95% CI, 1.05-3.58) — specifically medulloblastoma (prevalence ratio = 1.82) and supratentorial primitive neuroectodermal tumors (prevalence ratio = 2.66) — and increased prevalence of retinoblastoma (prevalence ratio = 3.11; 95% CI, 1.2-8.08).
The results highlight the need to educate pregnant women about gestational substance use — particularly as cannabis use is on the rise as a method of relieving severe morning sickness, researchers concluded.
“We know that cancer is the leading cause of nonaccidental death among U.S. children and, despite massive improvements in therapeutics over the past few decades, we’re still seeing an increasing incidence of childhood cancer,” Courtney E. Wimberly, MSc, research program leader in the division of neuro-epidemiology at Duke University Medical Center, told Healio. “These increases vary across racial and ethnic backgrounds, depending on subtype. We’ve identified several genetic risk factors for childhood cancer but, to date, very few modifiable risk factors.”
Healio spoke with Wimberly about the findings, their potential implications and how clinicians can communicate these risks to their patients.
Healio: Why did you conduct this study?
Wimberly: It was driven by the need to identify more modifiable risk factors for childhood cancer, and also to explore the hypothesis that maternal substance use during pregnancy may influence fetal development and contribute to childhood cancer risk.
Past studies have explored associations between maternal prenatal substance use and childhood cancer, but most have focused on tobacco and alcohol use during pregnancy. There has not been as much focus on illicit drugs, partly due to small sample sizes and studies. This could be partially due to biased self-reporting of substance use during pregnancy. People might not want to divulge that information, but there is evidence that illicit drug use during pregnancy can contribute to certain neurologic disorders that persist into adulthood. For this reason, we think it may have relevance to childhood cancer risk, but its contribution is unclear. Identifying additional modifiable exposures that can reduce childhood cancer incidence is important, not only for primary prevention of childhood cancer, but also for the health of the larger U.S. population.
Healio: How did you conduct the study?
Wimberly: We partnered with a childhood cancer nonprofit organization — Alex’s Lemonade Stand Foundation — to conduct and analyze data from the My Childhood Cancer (MCC) Survey series. This longitudinal online survey — which ran from 2011 to 2023 — was designed as a needs assessment to gain insight into the impact of cancer on the family unit. Families of children around the world diagnosed before age 18 years were eligible.
We had more than 3,000 families who represented myriad childhood cancer subtypes, and the surveys collected information on the family’s experience from diagnosis through treatment and survivorship.
One section specifically asked about maternal behaviors during pregnancy. This included beneficial behaviors — like going to prenatal visits — and not-so-beneficial behaviors, like using alcohol, tobacco and illicit drugs during pregnancy. We were interested in independently assessing the associations between maternal use of different substances during pregnancy with 16 different childhood cancer subtypes.
Healio: What did you find?
Wimberly: Use of illicit drugs during pregnancy was associated with two childhood cancer types. The first was intracranial embryonal tumors, which develop from cells left over from fetal development. This included associations with medulloblastoma, which are tumors of the cerebellum and the back of the head, and supratentorial primitive neuroectodermal tumors, known as PNETs. We also saw an association between maternal illicit drug use and retinoblastoma. To our knowledge, this has not been seen before. We also saw an association between moderate-to-heavy alcohol use during pregnancy and non-Hodgkin lymphoma. Maternal alcohol use during pregnancy has been associated with certain blood cancers in the past.
Healio: What do you make of these associations?
Wimberly: In the U.S., fewer than 1,000 children per year are diagnosed with the types of brain and eye cancers that we found to be linked to maternal drug use. So, they’re still very rare. On the other hand, cannabis is the most commonly used illicit substance during pregnancy, and cannabinoids can cross the placental barrier and affect neurodevelopment in the fetal brain. There has been some research showing that fetal exposure to marijuana has been linked to altered neurodevelopmental traits, including ADHD and autism. So, instead of raising the alarm, I would hope that these findings raise awareness about potential risks associated with maternal substance use during pregnancy and inspire future research.
Healio: Based on your findings, should clinicians discourage pregnant women from using cannabis as a remedy for morning sickness or nausea?
Wimberly: The use of illicit drugs — particularly by expectant mothers — has been strongly discouraged by medical professionals for many years. The results of our analysis only underscore that safer, alternative methods for managing severe morning sickness should be explored and recommended, a least until we know more about the risk-benefit profile for expectant mothers.
Healio: What other implications might your findings have for clinical practice?
Wimberly: Changing attitudes toward cannabis have led to an increase in its use across many demographic groups, including women of childbearing age. More research is needed in terms of the risk-benefit profile of pregnant women, as well as lab research to understand the molecular and developmental mechanisms underlying the associations between maternal substance use and childhood cancer subtypes.
As far as clinical practice, it is essential for clinicians to communicate the potential risks and uncertainties associated with prenatal cannabis use to pregnant women, emphasizing the importance of both maternal and fetal health. Clinicians should provide evidence-based information on alternative approaches to managing morning sickness that do not pose risks to the developing fetus.
I see these findings having potential implications for provider-patient relationships. It’s an opportunity to engage in open and informed discussions with pregnant patients, while factoring in their medical histories, risk factors and preferences. It also provides an opportunity for a multidisciplinary approach to prenatal care. Clinicians can collaborate with other providers, like nutritionists, to develop individualized strategies for managing morning sickness and other symptoms during pregnancy.
Finally, the study results have several public health implications, namely the development of interventions aimed at reducing maternal substance abuse during pregnancy through targeted educational programs, counseling services and community-based initiatives. I could see public health policymakers considering incorporating this and future research into the development of maternal and child health policies. By bringing together health care providers, researchers, policymakers and public health experts, these collaborative efforts can lead to the development of comprehensive strategies that address the complex interplay of factors contributing to maternal substance use and childhood cancer risk.
Healio: Is there anything else you feel is important to emphasize?
Wimberly: It’s important for clinicians and public health practitioners to recognize the impact of socioeconomic factors on prenatal substance use. Clinical and public health efforts to reduce maternal substance use during pregnancy should be tailored to reach diverse populations and should also address the needs of vulnerable populations. This could involve providing additional support, resources and access to health care for people facing financial instability and other stressors that may prompt them to use substances during pregnancy.
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For more information:
Courtney E. Wimberly, MSc, can be reached at Duke University Medical Center, Division of Neuro-Epidemiology, Department of Neurosurgery, 200 Trent Drive, Box 3807, Durham, NC 27710; email: courtney.wimberly@duke.edu.
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