Effects of Fetal Exposure to Maternal Chemotherapy

Overview

Journal Paediatr Drugs

Specialties Pediatrics
Pharmacology

Date 2013 Jul 17

PMID 23856754

Citations 6

Authors

Jana Dekrem

Kristel Van Calsteren

Frederic Amant

Affiliations

Soon will be listed here.

Abstract

Approximately 1 in 1,000-2,000 pregnancies are complicated by cancer. Today, different treatment options are considered as safe during pregnancy: chemotherapy, radiotherapy, surgery, or a combination of these. Surgery is considered safe during all trimesters of pregnancy; radiotherapy can be administered during the first and the second trimester, and chemotherapy after the first trimester of pregnancy. The placenta, acting as a barrier between the mother and the fetus, plays a key role in the safe administration of chemotherapy during pregnancy. A few studies have investigated the short- as well as the long-term health, general development, and cognitive and cardiac outcomes on children exposed to chemotherapy in utero. In general, these results were reassuring. Nevertheless, better safety data are required. This means data with longer follow-up periods and comparison with appropriate control groups. Moreover, important biasing factors should be taken into account when interpreting these results. Firstly, a great proportion of children were born prematurely due to the maternal condition. Preterm birth in general has been associated with cognitive impairment. Secondly, cancer during pregnancy is clearly a stressful situation, and maternal stress is associated with attention deficits. In sum, we state that chemotherapy can be administered safely after the first trimester of pregnancy. Moreover, iatrogenic prematurity in order to start postpartum administration of chemotherapy should be avoided. Nonetheless, decisions concerning treatment in these specific cases should always be made in a multidisciplinary setting with internationally recognized expertise in the coexistence of cancer and pregnancy.

Citing Articles

Desmoplastic Small Round Cell Tumor in a Pregnant Woman: A Case Report and Literature Review.

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Pregnancy and Cancer: Cellular Biology and Mechanisms Affecting the Placenta.

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Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy.

Korakiti A, Zografos E, van Gerwen M, Amant F, Dimopoulos M, Zagouri F Cancers (Basel). 2020; 12(12).

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Management of Hematologic Malignancies: Special Considerations in Pregnant Women.

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Sexual dysfunction and infertility as late effects of cancer treatment.

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References

Azim Jr H, Azim H, Peccatori F . Treatment of cancer during pregnancy with monoclonal antibodies: a real challenge. Expert Rev Clin Immunol. 2010; 6(6):821-6. DOI: 10.1586/eci.10.77. View

Yazdani Brojeni P, Matok I, Bournissen F, Koren G . A systematic review of the fetal safety of interferon alpha. Reprod Toxicol. 2011; 33(3):265-8. DOI: 10.1016/j.reprotox.2011.11.003. View

Aviles A, Neri N . Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2002; 2(3):173-7. DOI: 10.3816/clm.2001.n.023. View

van Baar A, Vermaas J, Knots E, de Kleine M, Soons P . Functioning at school age of moderately preterm children born at 32 to 36 weeks' gestational age. Pediatrics. 2009; 124(1):251-7. DOI: 10.1542/peds.2008-2315. View

Gedeon C, Koren G . Designing pregnancy centered medications: drugs which do not cross the human placenta. Placenta. 2005; 27(8):861-8. DOI: 10.1016/j.placenta.2005.09.001. View

Amant F, Van Calsteren K, Halaska M, Beijnen J, Lagae L, Hanssens M . Gynecologic cancers in pregnancy: guidelines of an international consensus meeting. Int J Gynecol Cancer. 2009; 19 Suppl 1:S1-12. DOI: 10.1111/IGC.0b013e3181a1d0ec. View

Van Calsteren K, Verbesselt R, Van Bree R, Heyns L, De Bruijn E, de Hoon J . Substantial variation in transplacental transfer of chemotherapeutic agents in a mouse model. Reprod Sci. 2010; 18(1):57-63. DOI: 10.1177/1933719110379650. View

Grohard P, Akbaraly J, Saux M, Gimenez S, Robert J, Leng J . [Transplacental passage of doxorubicin]. J Gynecol Obstet Biol Reprod (Paris). 1989; 18(5):595-600. View

Gralla R, Osoba D, Kris M, Kirkbride P, Hesketh P, Chinnery L . Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol. 1999; 17(9):2971-94. DOI: 10.1200/JCO.1999.17.9.2971. View

10.

van Calsteren K, Verbesselt R, Beijnen J, Devlieger R, De Catte L, Chai D . Transplacental transfer of anthracyclines, vinblastine, and 4-hydroxy-cyclophosphamide in a baboon model. Gynecol Oncol. 2010; 119(3):594-600. DOI: 10.1016/j.ygyno.2010.08.019. View

11.

Isaacs R, Hunter W, Clark K . Tamoxifen as systemic treatment of advanced breast cancer during pregnancy--case report and literature review. Gynecol Oncol. 2001; 80(3):405-8. DOI: 10.1006/gyno.2000.6080. View

12.

Wapner R, Sorokin Y, Mele L, Johnson F, Dudley D, Spong C . Long-term outcomes after repeat doses of antenatal corticosteroids. N Engl J Med. 2007; 357(12):1190-8. DOI: 10.1056/NEJMoa071453. View

13.

Decker M, Rothermundt C, Hollander G, Tichelli A, Rochlitz C . Rituximab plus CHOP for treatment of diffuse large B-cell lymphoma during second trimester of pregnancy. Lancet Oncol. 2006; 7(8):693-4. DOI: 10.1016/S1470-2045(06)70797-5. View

14.

Makol A, Wright K, Amin S . Rheumatoid arthritis and pregnancy: safety considerations in pharmacological management. Drugs. 2011; 71(15):1973-87. DOI: 10.2165/11596240-000000000-00000. View

15.

Chakravarty E, Murray E, Kelman A, Farmer P . Pregnancy outcomes after maternal exposure to rituximab. Blood. 2010; 117(5):1499-506. DOI: 10.1182/blood-2010-07-295444. View

16.

Syme M, Paxton J, Keelan J . Drug transfer and metabolism by the human placenta. Clin Pharmacokinet. 2004; 43(8):487-514. DOI: 10.2165/00003088-200443080-00001. View

17.

Van den Bergh B, Mennes M, Stevens V, van der Meere J, Borger N, Stiers P . ADHD deficit as measured in adolescent boys with a continuous performance task is related to antenatal maternal anxiety. Pediatr Res. 2005; 59(1):78-82. DOI: 10.1203/01.pdr.0000191143.75673.52. View

18.

Amant F, Loibl S, Neven P, Van Calsteren K . Breast cancer in pregnancy. Lancet. 2012; 379(9815):570-9. DOI: 10.1016/S0140-6736(11)61092-1. View

19.

Garland M . Pharmacology of drug transfer across the placenta. Obstet Gynecol Clin North Am. 1998; 25(1):21-42. DOI: 10.1016/s0889-8545(05)70356-9. View

20.

Ebert U, Loffler H, Kirch W . Cytotoxic therapy and pregnancy. Pharmacol Ther. 1997; 74(2):207-20. DOI: 10.1016/s0163-7258(97)82004-9. View