Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Abstract

Background: Data on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. Methods: In a multicenter cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy were compared with the outcome of children born after an uncomplicated pregnancy. Assessment included clinical evaluation, comprehensive neuropsychological testing, electrocardiography and echocardiography. Results: In total, 132 study children and 132 controls were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, statistically significant differences were found in mean verbal IQ and visuospatial long-term memory, with lower scores in the study versus control group (98.1, 95% confidence interval [CI]: 94.5e101.8, versus 104.4, 95% CI: 100.4e108.4, P Z 0.001, Q < 0.001 [Q refers to the false discovery rate adjusted P value], and 3.9, 95% CI: 3.6e4.3, versus 4.5, 95% CI: 4.1 e4.9, P Z 0.005, Q Z 0.045, respectively). A significant difference in diastolic blood pressure was found, with higher values in chemotherapy-exposed (61.1, 95% CI: 59.0 to 63.2) versus control children (56.0, 95% CI 54.1 to 57.8) (P < 0.001, Q < 0.001) and in a subgroup of 59 anthracycline-exposed (61.8, 95% CI: 59.3 to 64.4) versus control children (55.9, 95% CI: 53.6 to 58.1) (P < 0.001, Q Z 0.02). Conclusions: Children prenatally exposed to maternal cancer and its treatment are at risk for lower verbal IQ and visuospatial long-term memory scores and for higher diastolic blood pressure, but other cognitive functions and cardiac outcomes were normal at the age of 6 years. Clinical trial registration: The study is registered at ClinicalTrials.gov, NCT00330447.

Cervical cancer in pregnancy at various gestational ages

“…Long-term follow-up data show that children perform like their age-and gender-matched controls. [10][11][12] However, a poor maternal outcome is linked to a lower verbal IQ, necessitating educational attention in the offspring. 12 Where possible so when the cancer is responding to the chemotherapy and in this case when there are no concurrent gestational complications, I would continue with chemotherapy beyond 32 weeks for the benefit of the fetus who will then suffer less from prematurity.…”

Management of pregnancy in women with cancer

“… 4 61 A recent study of 132 children born to women with cancer, of whom 97 were exposed to chemotherapy, showed normal development at the age of 6 years. 7 Subtle differences between these children and matched healthy controls were found in verbal intelligence in favor of the latter. Interestingly, in a post hoc analysis, the difference in verbal intelligence was more distinct in the group of children who lost their mother to cancer.…”

Neurocognitive outcomes following fetal exposure to chemotherapy for gestational breast cancer: A Canadian multi-center cohort study

“…A recent study investigated the impact of child development after maternal cancer diagnosis during pregnancy [ 37 ]. Among their cohort, 73.5% were exposed to chemotherapy (alone or in combination with other treatments) and 54% of mothers had a diagnosis of breast cancer.…”