We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Association of Chemotherapy Timing in Pregnancy With Congenital Malformation.
- Authors
van Gerwen, Mathilde; Maggen, Charlotte; Cardonick, Elyce; Verwaaijen, Emma J.; van den Heuvel-Eibrink, Marry; Shmakov, Roman G.; Boere, Ingrid; Gziri, Mina M.; Ottevanger, Petronella B.; Lok, Christianne A. R.; Halaska, Michael; Shao, Long Ting; Struys, Ilana; van Dijk-Lokkart, Elisabeth M.; Van Calsteren, Kristel; Fruscio, Robert; Zola, Paolo; Scarfone, Giovanna; Amant, Frédéric
- Abstract
Key Points: Question: Is gestational age at initiation of chemotherapy during pregnancy associated with risk of congenital malformations? Findings: In this cohort study including 755 pregnant women with cancer, the risk of major congenital malformations was elevated when first chemotherapy exposure was prior to 12 weeks of gestation, whereas the occurrence of major congenital malformations was similar to expected rates in the general population when chemotherapy was initiated after 12 weeks of gestation. Meaning: The findings of this study could allow clinicians to better tailor chemotherapy during pregnancy and to inform patients on fetal risks of malformations. This cohort study assesses the association of gestational age at initiation of chemotherapy among pregnant women with cancer with congenital malformation rates among their offspring. Importance: Chemotherapy during the first trimester of pregnancy should be avoided owing to the risk of congenital malformations. However, the precise gestational age at which chemotherapy can be initiated safely remains unclear. Objective: To assess congenital malformation rates associated with gestational age at initiation of chemotherapy among pregnant women with cancer. Design, Setting, and Participants: This multicenter cohort study evaluated all pregnant women who received chemotherapy between 1977 and 2019 registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database. Data were analyzed from February 15 to June 2, 2020. Exposures: Cancer treatment with chemotherapy during pregnancy. Main Outcomes and Measures: Analysis was focused on major and minor structural malformations in offspring, defined by EUROCAT, detected during pregnancy or at birth. Results: A total of 755 women in the INCIP database who underwent cancer treatment with chemotherapy during pregnancy were included in analysis. The median (range) age at cancer diagnosis was 33 (14-48) years. Among offspring, the major congenital malformation rate was 3.6% (95% CI, 2.4%-5.2%), and the minor congenital malformation rate was 1.9% (95% CI, 1.0%-3.1%). Chemotherapy exposure prior to 12 weeks gestational age was associated with a high rate of major congenital malformations, at 21.7% (95% CI, 7.5%-43.7%; odds ratio, 9.24 [95% CI, 3.13-27.30]). When chemotherapy was initiated after gestational age 12 weeks, the frequency of major congenital malformations was 3.0% (95% CI, 1.9%-4.6%), which was similar to the expected rates in the general population. Minor malformations were comparable when exposure occurred before or after gestational age 12 weeks (4.3% [95% CI, 0.1%-21.9%] vs 1.8% [95% CI, 1.0-3.0]; odds ratio, 3.13 [95% CI, 0.39-25.28]). Of 29 women who received chemotherapy prior to 12 weeks gestation, 17 (58.6%) were not aware of pregnancy, and 6 (20.7%) experienced a miscarriage (3 women [10.3%]) or decided to terminate their pregnancy (3 women [10.3%]). Conclusions and Relevance: This cohort study found that chemotherapy was associated with an increased risk of major congenital malformations only in the first 12 weeks of pregnancy. The risk of congenital malformations when chemotherapy was administered during the first trimester and the high number of incidental pregnancies during cancer treatment in the INCIP registry underscore the importance of contraceptive advice and pregnancy testing at the start of chemotherapeutic treatment in young women with cancer.
- Subjects
RESEARCH; CONFIDENCE intervals; CANCER chemotherapy; FIRST trimester of pregnancy; GESTATIONAL age; HUMAN abnormalities; MEDICAL cooperation; RETROSPECTIVE studies; RISK assessment; CANCER patients; DESCRIPTIVE statistics; PREGNANCY complications; RESEARCH funding; DECISION making in clinical medicine; ODDS ratio; DATA analysis software; LONGITUDINAL method; DISEASE risk factors; PREGNANCY
- Publication
JAMA Network Open, 2021, Vol 4, Issue 6, pe2113180
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.13180