One of the most delicate and difficult dilemmas in medicine is whether or not a pregnant woman who has received a cancer diagnosis should begin treatment before her child is born.
Cautious doctors advise women to deliver preterm or even terminate the pregnancy first.
However, a recent study of more than 100 children who were exposed to cancer treatment during the last two trimesters of their mother’s pregnancy demonstrated that they had normal cognitive and cardiac function.
The study shows that termination of pregnancy is not necessarily warranted. It also shows that early preterm delivery in order to administer cancer treatments isn’t warranted.
The study was published in The New England Journal of Medicine. It was also presented at the European Cancer Congress in Vienna.
Researchers did not find any difference in cardiac functioning or cognitive function between children exposed to cancer treatment in utero and the control group.
Researchers are surprised by the findings because cancer treatment is toxic and most chemotherapy drugs are known to cross the placenta.
None of the participating women underwent chemotherapy in the first trimester because the risk of causing serious birth defects is greatest during that period. Researchers instead analyzed the mental development of 129 children who were exposed to chemotherapy, radiation or surgery later in pregnancy, as the fetal brain continues to develop.
The cognitive findings were based on a neurological exam and a test called the Bayley Scales of Infant Development that researchers conducted on children at 18 months old, 3 years old or both.
Over 50% of the participating women have breast cancer and 16% had blood cancer.
Researchers found that the degree of prematurity was related to worse cognitive outcome in both study groups. The study was adjusted for factors such as parental education, every added week in the womb led to about two more points on the Bayley test.
The study unfortunately had limitations. Not all chemotherapy drugs were studied and no novel targeted anti-cancer drugs were examined. Additionally, the participant pool was not large, however cancer in pregnancy is rare.
It remains to be seen if the study sways doctors.