Study: Effects of cancer diagnosis and treatment during pregnancy on the health and development of the child
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This study is about:
Whether a woman’s diagnosis of cancer during pregnancy affects the future development and health of her child.
Why is this study important?
Mothers who are diagnosed with cancer during a pregnancy may have many questions, such as:
- Will the cancer affect my baby?
- Will the chemotherapy and/or radiation treatments I receive affect my baby?
- Should I delay treatment until my baby is born?
- Should I consider terminating my pregnancy?
These are all important questions because external factors like drugs, alcohol, and smoking are known to affect fetal development.
This study takes a general look at how cancer during pregnancy affects the health and development of the children during early childhood.
- No differences in , cardiac, or general development were found between 3-year old children of mothers who were diagnosed with cancer while pregnant with them, and 3-year old children of mothers without cancer.
What does this mean for me?
While the results of this study are positive and promising, more work needs to be done to fully understand the effect of cancer diagnosis and treatment on a developing fetus. These results only look at children up to age 3, so long-term follow-up from this study will be important to understand whether prenatal exposure to maternal cancer and treatments may affect children as they grow.
Amant F, Vandenbroucke T, Verheecke M, et al. “Pediatric Outcome after Maternal Cancer Diagnosed During Pregnancy.” The New England Journal of Medicine Vol. 373, No. 19, pp. 1824-34, November 5, 2015. (must have a subscription to access)
Greene, MF and Longo, DL. “Cautious Optimism for Offspring of Women with Cancer During Pregnancy,” New England Journal of Medicine, Vol 373, No. 19, pp. 1875-76, November 5, 2015. (must have a subscription to access)
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
This article is relevant for:
Women who were diagnosed with breast cancer while pregnant
This article is also relevant for:
Triple negative breast cancer
Her2+ breast cancer
People with a genetic mutation linked to cancer risk
Breast cancer survivors
Women under 45
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IN DEPTH REVIEW OF RESEARCH
Research on how cancer diagnosis in a pregnant woman and any subsequent chemotherapy and/or radiation therapy affect the fetus and its development after birth has been limited. Dr. Frédéric Amant of the University Hospitals, Leuven, Belgium and colleagues from the International Network on Cancer, Infertility, and Pregnancy collaborated on this multicenter international study of children born to mothers who were diagnosed with cancer during their pregnancy. The study was published in The New England Journal of Medicine in November.
Researchers of this study wanted to know:
Are there developmental effects in babies born to mothers who were diagnosed with cancer during their pregnancy?
Population(s) looked at in the study:
The researchers compared 129 children born to mothers diagnosed with cancer during their pregnancy to 129 children of mothers who did not have cancer while pregnant. The children from mothers without cancer were the same gestational age (born at the same number of weeks) as the children born to mothers diagnosed with cancer. Mothers with all types of cancers were included in this study, but notably more than half the women in the study had breast cancer during pregnancy.
The mothers in the study who had cancer had the following treatments:
- 13 had surgery
- 41 had chemotherapy
- 1 had radiation therapy
- 48 had surgery and chemotherapy
- 3 had surgery and radiation therapy
- 3 had chemotherapy and radiation therapy
- 4 had surgery, chemotherapy, and radiotherapy
- 1 had Herceptin, a for HER2+ breast cancer
- 1 had Interferon β, an immune therapy
14 had no treatment while pregnant
- About 61% of the children whose mothers were diagnosed with cancer while pregnant were born before their due date. However, most were less than 2 weeks early, meaning the babies were close to full term.
- Medical issues and surgical needs were similar between the children whose mothers were diagnosed with cancer and those who were not.
- No overall difference was found in development at 18 months or 3 years between the children of mothers diagnosed with cancer and the children with mothers who did not have cancer.
- Researchers also looked at children of mothers who had chemotherapy while pregnant; they also found no differences in development between them and the children of mothers who did not have cancer.
- Three-year-olds whose mothers were diagnosed with cancer while pregnant with them had no differences in heart rate, blood pressure, or other indicators of heart health when compared with three year olds of mothers who did not have cancer while pregnant.
While promising, this study has several limitations.
- The authors note that age 3 may be too soon to see heart, , or other problems that may develop in the future.
- These results may not apply equally to all chemotherapy treatments—researchers did not look at separate chemotherapy treatments; rather, they combined all types of chemotherapy treatments into one analysis.
- Few women in the study received radiation, so it is difficult to make conclusions about this form of treatment.
- Because women were treated at different points of their pregnancy, conclusions cannot be drawn about the timing of treatment during pregnancy.
- The study did not include newer “targeted” therapies, so no conclusions can be made about these types of treatments.
Because the prenatal exposure group contained children who were born to mothers with very different treatments (including those who had no treatment), it was not possible to determine whether the cancer itself or the cancer treatment affects the developing child.
The researchers were quoted in some reports saying that they plan to expand this study to add more participants, and follow them until age 18 to see what effects prenatal exposure to cancer may cause as they grow older. This is an important follow-up because this current study is relatively small and has no data on children older than 3 years.
In an editorial in the The New England Journal of Medicine that accompanied the article, Drs. Michael Greene and Dan Longo of the Department of Obstetrics and Gynecology at the Massachusetts General Hospital suggested that it is still prudent to avoid cancer treatment in the first trimester of pregnancy. More work needs to be done to understand individual contributions of the cancer itself or different treatments that might affect a developing fetus to help women who are diagnosed during pregnancy make informed decisions.
The National Comprehensive Cancer Network (NCCN) provides guidelines for fertility in people diagnosed with cancer.
The NCCN recommends doctors discuss the following with adolescents and adults with cancer before treatment begins:
- fertility plans and preferences
- fertility preservation options, including:
- whether therapy can be delayed long enough for a cycle of egg stimulation
- medications like GnRH agonist therapy during to preserve ovarian function in premenopausal women with breast cancer
- importance of follow-up with a gynecologist or fertility specialist to monitor ovarian function over time
- risks for infertility due to cancer and related treatment
- affects of treatment on breastfeeding
- the importance of avoiding pregnancy and options for safe and effective birth control while in treatment
- safe timing for considering pregnancy after treatment
- emotional impact of discussions about fertility preservation
- financial resources for fertility preservation
- effects of treatment on sexual function during and after treatment
Doctors should refer patients as indicated for the following services:
- All patients who are interested in preserving their fertility should be referred to a fertility preservation clinic before starting treatment.
- Patients who need assistance with complex medical decision-making should be referred to a mental health professional.
- Patients who are experiencing sexual disfunction should be referred to a sexual health specialist.
- Is my cancer diagnosis going to affect my baby?
- Are there treatments I should consider while pregnant?
- Should I delay treatment until after I have the baby?
- Are there precautions I can take if I have to receive treatment during my pregnancy?
- Are there signs I should look for that would indicate my child was affected by my cancer diagnosis during pregnancy?
The following research studies related to fertility preservation are enrolling patients.
Fertility preservation studies for women
- NCT01503190: The Immune System's Response to Young Women's Breast Cancer. This an observational trial looking at tissue samples from patients with Pregnancy-Associated Breast Cancer (PABC) versus non-PABC to understand how the immune system responds.
- NCT05443737: Evaluation of a Telehealth Oncofertility Care Intervention in Adolescent and Young Adult Cancer Patients. The purpose of this study is to evaluate the effectiveness of an intervention to improve young cancer survivors' oncofertility care.
- NCT0301168: Fertility Preservation Using Tamoxifen and Letrozole in Estrogen Sensitive Tumors Trial (TALES). Infertility as a result of cancer treatment effects long-term quality of life in survivors of reproductive-age cancers. This trial will study different options for fertility preservation in patients with estrogen-receptor-positive breast cancer.
- NCT00823654: Serum Biomarkers to Characterize the Effects of Therapy on Ovarian Reserve in Premenopausal Women With Breast Cancer or Mutations. This study will look at how cancer treatment affects the ovaries. Researchers will review blood samples before, during and after cancer treatment to look at levels of hormones that are produced by the ovaries and ask patients to fill out questionnaires about their menstrual cycles (periods), overall health and pregnancies.
- NCT01788839: Longitudinal Sexual and Reproductive Health Study of Women With Breast Cancer and . This study looks at how cancer treatment affects sexual and reproductive function. The patient will be asked to give a blood sample to see if and how cancer treatment affects the ovaries and the ability to have children (fertility). These blood draws are optional; patients can participate in the study questionnaire even if they choose not to have their blood drawn.
- NCT01558544: Cryopreservation of Ovarian Tissue. The study hopes to contribute to the development of technologies of ovarian tissue freezing-thawing the preserve fertility. The study is open to women who will undergo treatment or surgery for cancer or women with an inherited mutation who are considering undergoing risk-reducing surgery.
- NCT01788839: This study's goal is to see how cancer treatment affects sexual and reproductive function. Participants will also be asked to participate in optional blood tests to see if and how cancer treatment affects the ovaries and the ability to have children.
Fertility preservation for men
- NCT02972801: Testicular Tissue Cryopreservation for Fertility Preservation. Testicular tissue cryopreservation is an experimental procedure where testicular tissue is retrieved and frozen. This technique is reserved for young male patients, with the ultimate goal that their tissue may be used in the future to restore fertility when experimental techniques emerge from the research pipeline.
If you are in your reproductive years and have been diagnosed with cancer, or you are considering steps to lower your cancer risk that will interfere with your fertility, you should request referral to a fertility expert.
- The Oncofertility Consortium maintains a national database of healthcare providers with expertise in fertility preservation and treatment of people who are diagnosed with cancer or at high risk for cancer due to an inherited mutation.
- Register for the FORCE Message Boards to get referrals from other members. Once you register, you can post on the Find a Specialist board to connect with other people who share your situation.
Who covered this study?
New York Times
Study offers support for cancer treatment during pregnancy This article rates 5.0 out of 5 stars
The Globe and Mail:
Pregnant cancer patients shouldn’t terminate or delay treatment: study This article rates 2.5 out of 5 stars
Cancer treatment DOESN'T harm an unborn baby: Pregnant women advised not to delay treatment after study finds chemo and radiotherapy are not unsafe This article rates 2.0 out of 5 stars