Pregnancy health centre

Children exposed to chemo in the womb 'develop normally'

10th February 2012 - The children of women exposed to chemotherapy while pregnant develop as well as children in the general population, according to a new study.

Chemotherapy for treating mothers with cancer has become more acceptable over the past few years, and although its use in the first trimester is known to increase the risk of birth defects, there has also been some concern that it could hinder development of the brain and heart, even when given later in pregnancy.

The study

Researchers led by Dr Frédéric Amant of the Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium, assessed 68 pregnancies in three European countries.

These pregnancies produced 70 children, during which 236 cycles of chemotherapy were administered. An average of three or four cycles of chemotherapy were administered for each pregnancy.

Brain and heart tests

Children were assessed at ages ranging from 18 months to 18 years using a number of tests to check brain and heart function. Older children, aged five or more, also underwent tests for hearing, learning ability, memory and concentration.

The authors found that brain development of children who had been exposed to chemotherapy in the womb was comparable to those who had not been exposed to the treatment. Although they found that scores were lower for children born pre-term than for those born at full term, they point out that this difference is found in any group of children born prematurely.

The measurements of the children’s behaviour, general health, hearing, and growth corresponded with those of the general population. Heart dimensions and function were within normal ranges.

'No need to induce'

"We show that children who were prenatally exposed to chemotherapy do as well as other children," the authors write, adding that they see no reason to protect the fetus by inducing expectant mothers before chemotherapy treatment begins.

They add: "The decision to administer chemotherapy should follow the same guidelines as in non-pregnant patients. In practice, it is possible to administer chemotherapy from 14 weeks gestational age onwards with specific attention to prenatal care."

The authors say that further larger-scale studies are needed to increase certainty that chemotherapy in pregnancy does not harm the health of the unborn child.

Future clinical practice

In a linked Comment, Dr Elyce Cardonick from Cooper University Hospital, Cooper Medical School of Rowan University, in the US, says: “The study by Amant and colleagues has the potential to affect clinical practice: if we can present this reassuring data to pregnant women with cancer, women might be more likely to accept treatment during pregnancy when indicated."

Safia Danovi, Cancer Research UK’s science information officer, said in an emailed statement: "It’s good to see more research being done in this area.  Every patient’s situation is unique though, so we still urge women to seek individual advice from their doctors before making any decisions regarding their treatment."