RETIRED: Cancer Chemotherapy and Pregnancy

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…166 Chemotherapy should be avoided during the first trimester because of greater risk of teratogenic effects, which include major congenital malformations, impaired organ function, spontaneous abortions, and fetal death. 167,[170][171][172][173] Although the use of chemotherapy during the second and third trimesters has not been associated with significant teratogenic effects, it may be associated with low birth weight, preterm labor, and intrauterine growth restriction. 157,170,172,[174][175][176] However, a multicenter, prospective case-control study of children born to mothers with cancer (129 cases, 129 controls) showed no significant impact of chemotherapy treatment on cognitive, cardiac, and general development of the offspring.…”

“…157 Due to the severe teratogenic effects of methotrexate, it should not be used for the treatment of cancer in women at any stage of pregnancy. 172 Older-generation alkylating agents (eg, procarbazine, busulfan), thalidomide, lenalidomide, pomalidomide, and tretinoin are also considered teratogenic and are contraindicated during pregnancy. 166 The safety and efficacy of hormonal agents and targeted therapies have not yet been evaluated in well-controlled studies including pregnant women.…”

Pregnancy Screening in Patients With Cancer

“…The consequences of unknowingly exposing a fetus to cancer treatment can be devastating and depend on multiple variables, such as dosage, duration and timing of exposure, placental permeability, and gestational age. 5 For example, pregnant patients with cancer who receive multidrug chemotherapy in their first trimester have an increased risk of spontaneous abortion, fetal demise, and fetal malformations. 6 Radiation therapy can result in lowered IQ and fetal malformation, depending on gestational age of the fetus and exposure level.…”

Chemotherapy during Pregnancy: Cases of Hodgkin's and Non-Hodgkin's Lymphoma, Chronic Myeloid Leukemia, Breast Cancer, Nasopharyngeal Cancer, and Choriocarcinoma

“…Chemotherapy exposure during pregnancy is a great concern for both the mother and the physician. Due to their relatively low molecular weight, chemotherapeutic agents can cross the placenta and adversely affect the fetus [2][3][4]. Teratologic and other adverse fetal effects are dependent on dosage and the gestational age [5].…”