Chemotherapy treatment in pregnant women

In pregnant women with cancer , chemotherapy treatment is always a concern. We have read so many things that affect the fetus during pregnancy that it is difficult to imagine how an invasive treatment such as chemotherapy could not affect it. Is it really possible?

Until recently, even some doctors were skeptical about the use of chemotherapy and radiation therapy in pregnant women. Many oncologists preferred not to risk it. However, the latest studies carried out by the ESMO (Congress of the European Society for Medical Oncology) show that chemotherapy in pregnant women does not pose a danger to the general development of the baby, neither cardiac nor cerebral. The study on which this idea was based was carried out by the University Hospital of Leuven in Belgium. In it, children who had been exposed to chemotherapy during pregnancy were compared with a control group of children who did not receive it. Their brain functions, cognitive and cardiac development were measured. It was seen thatthere were no statistically significant differences between the two groups , they were followed up to two years of age and it was verified that the results were maintained. There were also no signs of congenital malformations.

WHAT EXPLANATION IS BEHIND?

Apparently, during chemotherapy sessions, many of the chemicals used fail to cross the placenta (approximately 80% of them), so they do not come into direct contact with the baby. Others such as platinum, which are drugs in the form of smaller molecules, do, but so far no damage has been seen to the fetus or the baby at the time of birth.

On the other hand, something that did call attention is that a high percentage of babies were born with a low weight due to premature birth, approximately the probability of premature birth is 61% if they receive chemotherapy or if they do not receive it (8%) . However, we must look at these data with a magnifying glass because in many cases , labor was induced believing that advancing it would benefit the child by preventing him from receiving more chemotherapy sessions than necessary, although it is also true that chemotherapy can accelerate the rupture of the membranes, accelerating delivery. But regardless of the reason, these babies were found to quickly regain their weight without affecting their later development.

IF WE ARE DIAGNOSED WITH CANCER, IT IS BETTER TO CONTINUE WITH THE PREGNANCY

Finally, the safety of the fetus during chemotherapy was demonstrated with the techniques that have been used until now, the most conventional , therefore, caution must be exercised with the new techniques that are developed in the following years. Chemotherapy is also not recommended during the first trimester of pregnancy, which coincides with the formation of the internal organs in the baby and surely if it would be harmful.

WHAT IS THE TREATMENT IN WOMEN DIAGNOSED WITH CANCER?

First of all, it must be pointed out that in the Belgian study carried out at the University of Leuven , conception is not recommended in women who have already been diagnosed , because although it has already been shown that there seem to be almost no risks, it is an issue that must be keep investigating. But if they have become pregnant before diagnosis it is better to go ahead with the delivery . There are women who believe that it is better to interrupt the pregnancy but the truth is that the women who aborted after knowing the diagnosis of breast cancer got worse, according to the data provided by the doctor Sánchez-Mendez of the La Paz hospital in Madrid (the reasons are unknown).

The cancer most commonly diagnosed in pregnant women is breast cancer, approximately 25%, and therefore it is the one that has been most investigated. In these cases, the treatment that is followed is normal , even when surgery is needed with general anesthesia, it does not pose a risk to the baby.

In the case of women who were diagnosed later or who have no choice but to undergo chemotherapy, they can rest assured that their child’s health is not in danger in principle as long as the sessions are not started before the first trimester of pregnancy (that is, , between the third and tenth week). The benefit to the mother is always greater than the effects that the baby may have in the future, which have been seen to be negligible in the long term. Pregnancy will also not produce a greater risk for the mother than not being , only greater discomfort because the discomfort suffered by the mother during pregnancy is added to those of chemotherapy .

On the other hand, if the mother decides to breastfeed, she does not have any problem if she does so before receiving chemotherapy but it could be dangerous if she breastfeeds at the same time that she is receiving the sessions because there may be a danger that the toxicity of the drugs will be transmitted to the baby through breast milk. Breastfeeding can also be an inconvenience when it comes to doing follow-up tests for breast cancer, the images can be hampered.

IS IT THE SAME WITH ALL TYPES OF CANCER?

Not really, it has been seen that in hematologic cancer (specifically Hodgkin’s lymphoma and acute leukemia ) the treatment is complicated in part because when a woman is pregnant the signs can overlap with those of the cancer and are more difficult to detect. detect. Even in women who have already overcome the cancer, the search for pregnancy is not recommended at least until 2 years after treatment and without remission of the cancer because in these cases the probability of reappearance of the tumor is high and it is better not to risk it.