Chemotherapy during pregnancy

Most critical period for teratogenicity is between 3 and 10 weeks gestation.

The occurrence of teratogenicity when chemotherapy is administered during the first trimester is reportedly 10-20%.

Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic effects on the fetus, with higher risks for multiple drug treatments.

Studies reveal that 86% of fetuses exposed to alkylating agents, 81% of fetuses exposed to antimetabolites, and 83% of fetuses exposed to vinca alkaloids and antitumor antibiotics during the first trimester were not associated with malformations.

Combination chemotherapy during the first trimester increases the risk of teratogenicity.

Utilization of chemotherapy after the second trimester is not associated with increased risk of fetal malformations.

Associated with increased risk of prematurity and stillbirth.

Because of myelosuppression in the mother and neonate chemotherapy should not be administered around the anticipated date of delivery.

Adjuvant chemotherapy for breast cancer may be given beyond the first trimester.

Prenatal exposure to maternal malignancy with or without treatment not impaired cognitive, cardiac, or general development of children in early childhood (Amant F et al).

The International Network on Cancer, Infertility, and Pregnancy registry: reported follow-up on children with antenatal chemotherapy exposure and found no clinical difference in neurocognitive or cardiac development between the treatment and control group.

Some studies suggest, but not all, is associated with small for gestational age children.

Pregnant patients with cancer who receive multi-drug chemotherapy in the first trimester have an increased risk of spontaneous abortion, fetal demise and fetal malformations (Pereg D).

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