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Women diagnosed with cancer during pregnancy will no longer face the dilemma of whether to defer treatment to avoid harming their babies. A series of studies published in The Lancet and Lancet Oncology shows that children born to women given chemotherapy while they were growing in the womb developed as well as children in the general population. About one in 1,000 pregnancies is affected by cancer and in the past women have faced a terrible choice: delay treatment until the baby is born, putting their own life at risk or start treatment while pregnant and risk damaging the baby. Some mothers in that situation have chosen to abort their babies.
 
Chemotherapy involves administering toxic drugs to kill the cancer but which also kill healthy cells in the mother’s body. Its effects on the foetus have been unclear but a study of 68 women who each had three to four cycles of chemotherapy during pregnancy showed their children were unaffected. Tests of cognitive ability on the children were “within normal ranges”, the researchers from Leuven Cancer Institute in Belgium say. Only those born prematurely had lower scores of cognitive ability but the researchers say this applies in the general population too.
 
“Our findings do not support a strategy of delay in chemotherapy or [induced] pre-term delivery with [subsequent] chemotherapy to avoid harm to the foetus,” the authors write.
 
In a second paper, researchers from the Institut Gustave Roussy say women must not have chemotherapy in early pregnancy when it can harm the foetus but from the second trimester (12 weeks) onwards evidence shows it is safe. “The use of chemotherapy during pregnancy helps increase the chance of foetal preservation. Children exposed to chemotherapy in utero after the first trimester do not seem to have more congenital abnormalities,” the authors say. However, they admit that women with advanced cervical cancer would benefit most from a combination of chemotherapy and radiotherapy which would be harmful to the baby.
 
The authors of a third paper in the series say chemotherapy for breast cancer can be given in the second and third trimesters and that abortion “does not seem to improve maternal outcome”.
 
In a comment article in the journal, researchers Philippe Morice, Catherine Uzan, and Serge Uzan of the Roussy Institute said, “Treatment of malignancy in pregnancy is still associated with unacceptable errors: e.g., the sometimes unjustified termination of pregnancies or the choice of an inadequate strategy for treatment of a tumour with the risk of compromised survival.”
 
Lead author on two of the studies, Dr Frédéric Amant, of the Leuven Institute said, “The situation remains challenging since in some situations an advanced cancer can be fatal for mother and foetus. In other situations we were able to save the child though we lost the mother immediately after the delivery, for example by keeping her alive with a terminal brain tumour.”
 
“Importantly, the new insights we gained during our research facilitate cancer treatment and provide hope for mother and child in most cases. Most mothers feel stronger and are even more motivated to undergo the cancer treatment and its side effects, since she is fighting for her child as well.”
 
One twin in the study did have significant neurodevelopmental problems and it cannot be ruled out that this was connected to the chemotherapy, the researchers said, however they thought it unlikely due to the exact nature of the issues. There were also six children who showed differences in their intelligence and behavioural scores but the cause of this needs further clarification, experts said.
 
An article on breast cancer in pregnancy by Dr Amant and others said abortion does not improve the mother’s prognosis and that in most cases normal treatment can be used. Pregnancy can mask many of the signs of breast cancer meaning it is more likely to be diagnosed at a later stage, he said.
The Daily Telegraph. February 9. The Independent. February 10. The Lancet. February 11. The Lancet Oncology. February 10.