An ongoing study finds no apparent neurological, cardiac, or other developmental ill effects on fetuses exposed to their mothers' chemotherapy.
The interim analysis, reported in the Lancet Oncology, surveys some 70 pregnancies followed for a median of two years after delivery, with assessments at birth and at 18 months and beyond. Chemotherapy, mostly with anthracycline drugs, had begun in all pregnancies after the first trimester.
Children generally showed normal growth and development. Those born prematurely (most often for nonobstetric reasons) had lower measures of cognitive development, but this was similar to the effect seen in other studies of premature infants without exposure to chemotherapy.
The authors conclude that their findings "do not support a strategy of delay in chemotherapy administration."
MY COMMENT is that induced preterm deliveries should be restricted to those cases where the mother's survival would otherwise be in jeopardy.
Summary of the study
Background
Chemotherapy for the treatment of maternal cancers during pregnancy has become more acceptable in the past decade; however, the effect of prenatal exposure to chemotherapy on cardiac and neurodevelopmental outcomes of the offspring is still uncertain. We aimed to record the general health, cardiac function, and neurodevelopmental outcomes of children who were prenatally exposed to chemotherapy.
Methods
Interim analysis of a multicentre observational cohort study assessing children who were prenatally exposed to maternal cancer staging and treatment, including chemotherapy. The assessed children at birth, at age 18 months, and at age 5—6, 8—9, 11—12, 14—15, or 18 years. We did clinical neurological examinations, tests of the general level of cognitive functioning (Bayley or intelligence quotient [IQ] test), electrocardiography and echocardiography, and administered a questionnaire on general health and development. From age 5 years, we also did audiometry, the Auditory Verbal Learning Test, and subtasks of the Children's Memory Scale, and the Test of Everyday Attention for Children, and we also completed the Child Behavior Checklist.
Findings
236 cycles of chemotherapy were administered in 68 pregnancies. We assessed 70 children, born at a median gestational age of 35·7 weeks (range 28·3—41·0; IQR 3·3; 47 women at <37 weeks), with a median follow-up period of 22·3 months (range 16·8—211·6; IQR 54·9). Although neurocognitive outcomes were within normal ranges, cognitive development scores were lower for children who were born preterm than for those born at full term. When controlling for age, sex, and country, the score for IQ increased by an average 11·6 points (95% CI 6·0—17·1) for each additional month of gestation (p<0·0001). Our measurements of the children's behaviour, general health, hearing, and growth corresponded with those of the general population. Cardiac dimensions and functions were within normal ranges. We identified a severe neurodevelopmental delay in both members of one twin pregnancy.
Interpretation
Fetal exposure to chemotherapy was not associated with increased CNS, cardiac or auditory morbidity, or with impairments to general health and growth compared with the general population. However, subtle changes in cardiac and neurocognitive measurements emphasise the need for longer follow-up. Prematurity was common and was associated with impaired cognitive development. Therefore, iatrogenic preterm delivery should be avoided when possible.
ORIGINAL ARTICLE: Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study.
by
Akshaya Srikanth
Pharm.D Internee
Hyderabad, India
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