Syndactyly

NEW ORLEANS -- Women who are diagnosed with cancer while pregnant can be reassured that they are not at increased risk for preterm delivery or intrauterine growth restriction, even if chemotherapy is required.

"They do well and their babies do well," Dr. Elyce Cardonick said at the annual meeting of the Society for Maternal-Fetal Medicine.

Reporting on a group of 48 pregnant women diagnosed with several different types of malignancy and followed prospectively, Dr. Cardonick said that the mean gestational age at delivery was 37.4 weeks, and the mean birth weight was 2,798 g. Only two infants (4.2%) were below the 10th percentile for weight, and only four patients (8.3%) delivered before 35 weeks.

The most common diagnosis was breast cancer (21 women), followed by melanoma (5), thyroid cancer (4), central nervous system malignancy (4), and Hodgkin's lymphoma (4). There were two cases each of ovarian cancer and leukemia, and one each of lung, vulvar, cervical, colon, and bladder cancer as well as one non-Hodgkin's lymphoma.

Chemotherapy proved to be safe in this group of patients "and should not be avoided in indicated cases of cancer diagnosed in pregnancy," Dr. Cardonick said, noting that 22 women underwent chemotherapy after the first trimester, beginning at a mean gestational age of 20.7 weeks.

Agents used included doxorubicin, cyclophosphamide, pad taxel, bleomycin, cisplatin, and vinblastine. The mean number of treatments was 4.4, said Dr. Cardonick of the division of maternal-fetal medicine, department of obstetrics and gynecology, Jefferson Medical College, Philadelphia.

None of the neonates was neutropenic at delivery, and none had alopecia. There also were no stillbirths or cases of neonatal myocarditis.

Aside from maternal dehydration and uterine contractions that did not result in preterm birth, there were no maternal or perinatal complications, Dr. Cardonick said in a poster session at the meeting, which was cosponsored by the American College of Obstetricians and Gynecologists.

Among patients who had chemotherapy, the mean gestational age at delivery was 36.9 weeks; the mean birthweight was 2,742 g.

One neonate whose mother had undergone multiagent chemotherapy for Hodgkin's lymphoma beginning at 14.6 weeks had syndactyly of the right hand.

There also was one case of neonatal respiratory distress syndrome.

None of the children has developed cancer or other serious illness thus far, with an average follow-up of 17.4 months.

"The first thing pregnant women assume when they are diagnosed with cancer is that they have to terminate the pregnancy," Dr. Cardonick said.

In this series, only six women were advised to terminate; four did so.

"If they terminate the pregnancy and undergo chemotherapy they may stop having periods and won't be able to have any more children," Dr. Cardonick told this newspaper. "So it's not just a matter of survival, it's also an issue of quality of life if they want to have a family," she said.

None of the women underwent radiation during pregnancy.

Seven patients have experienced recurrences of their cancer, and three have died, she said.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2002 Gale Group