Cancer Chemotherapy and Pregnancy

Objective: To promote careful education, administration, monitoring and restricted distribution when prescribing and dispensing chemotherapeutic and potentially teratogenic medications, as well as to develop clinical recommendations for the use of cancer chemotherapy in pregnant women and women of child-bearing age. Outcomes: To ensure that women of child-bearing age receiving chemotherapy can be appropriately counselled on the risks of becoming pregnant during treatment, and to provide guidance for health care practitioners treating pregnant women with antineoplastic agents. Evidence: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2011, using appropriate controlled vocabulary (e g, antineoplastic agents, neoplasms, pregnancy) and key words (e g, cancer, neoplasms, pregnancy, chemotherapy, antineoplastic agents) Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies Studies were restricted to those with available English abstracts or text. Searches were updated on a regular basis and incorporated in the guideline to October 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and from national and international medical specialty societies. Values: The quality of evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs: This guideline highlights the need to prevent pregnancy in women who are being treated for cancer and informs health care professionals treating pregnant women with chemotherapy of the potential risks of the therapy or ameliorated treatment protocols. SUMMARY STATEMENTS AND RECOMMENDATIONS: Summary Statements1.As women are postponing child-bearing, more of them are experiencing cancer in pregnancy (II-2)2.Chemotherapeutic agents used to combat cancer cross the placenta and may adversely affect embryogenesis by affecting cell division (II-1)3.Exposure to such agents after the first trimester of pregnancy has not been associated with increased risk of malformations but is associated with increased risk of stillbirth, intrauterine growth restriction, and fetal toxicities. (II-2). Recommendations: 1.The health care provider should examine the patient's risk of pregnancy and desire to prevent pregnancy during chemotherapy. (I-A)2.Decisions about the best course of management in pregnancy, including timing of delivery, should balance maternal and fetal risks Most authorities concur that maternal health and well-being must prevail (I-A)3.Women diagnosed with cancer in pregnancy should be optimally managed by a multidisciplinary team that includes oncologists and/or hematologists (depending on the malignancy), perinatologists, family physicians, psychologists, social workers, and spiritual advisors, if sought by the family (I-A).