Association of Chemotherapy Timing in Pregnancy With Congenital Malformation.


Ressource 1Download: 34106263_BIB_B47C7AD90A82.pdf (171.55 [Ko])
State: Public
Version: Final published version
License: Not specified
Serval ID
Article: article from journal or magazin.
Association of Chemotherapy Timing in Pregnancy With Congenital Malformation.
JAMA network open
van Gerwen M., Maggen C., Cardonick E., Verwaaijen E.J., van den Heuvel-Eibrink M., Shmakov R.G., Boere I., Gziri M.M., Ottevanger P.B., Lok CAR, Halaska M., Shao L.T., Struys I., van Dijk-Lokkart E.M., Van Calsteren K., Fruscio R., Zola P., Scarfone G., Amant F.
Working group(s)
International Network on Cancer, Infertility and Pregnancy
Richards A., Polterauer S., Pletnev A., Altintas S., Han S., Verheecke M., Tummers P., van Oostveldt T., Rigo V., Paulino E., Klát J., Cibula D., Hjorth Ingerslev K., Storgaard L., Woetmann Pedersen B., Sørensen-Hjortshøj C.M., Aarenstrup Karlsen M., Berveiller P., Denschlag D., Haidopoulos D., Makris G.M., Kalogiannidis I., Novak Z., Ceppi L., Fumagalli M., Mangili G., Peccatori F., Masturzo B., Fagotti A., Lambertini M., Petraglia F., Vaitkiene D., Gaurilcikas A., Cabrera Garcia A., Bjorge L., Lindemann K., Fedorcsak P., Stennsheim H., Wojciech K., Pitynski K., Balajewicz-Nowak M., Sajdak S., Kalinka E., Lampka E., Skrzypczyk-Ostaszew A., Duarte P., Cardoso F., Butureanu T., Porokonnaya A., Bezrukkikh V., Ulrikh E., Govorov I., Belyaey A., Alonso Salvador S., Zapardiel I., Gil-Ibáñez B., Baulies S., Gómez-Hidalgo N.R., Gonzalez-Mesa E., Mendizábal E., Rodriguez-Wallberg K., Achtari C., Brambs C., Bekkers R., de Haan J., de Groot C., Gordijn S., Kroep J., Painter R., Schröder C., Schuurman T., Vriens I., Thijs A., van Grotel M., Witteveen E., Armstrong A., Scasso S., Thomas A., Bonanno C., Hoegl J.
2574-3805 (Electronic)
Publication state
Issued date
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Chemotherapy during the first trimester of pregnancy should be avoided owing to the risk of congenital malformations. However, the precise gestational age at which chemotherapy can be initiated safely remains unclear.
To assess congenital malformation rates associated with gestational age at initiation of chemotherapy among pregnant women with cancer.
This multicenter cohort study evaluated all pregnant women who received chemotherapy between 1977 and 2019 registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database. Data were analyzed from February 15 to June 2, 2020.
Cancer treatment with chemotherapy during pregnancy.
Analysis was focused on major and minor structural malformations in offspring, defined by EUROCAT, detected during pregnancy or at birth.
A total of 755 women in the INCIP database who underwent cancer treatment with chemotherapy during pregnancy were included in analysis. The median (range) age at cancer diagnosis was 33 (14-48) years. Among offspring, the major congenital malformation rate was 3.6% (95% CI, 2.4%-5.2%), and the minor congenital malformation rate was 1.9% (95% CI, 1.0%-3.1%). Chemotherapy exposure prior to 12 weeks gestational age was associated with a high rate of major congenital malformations, at 21.7% (95% CI, 7.5%-43.7%; odds ratio, 9.24 [95% CI, 3.13-27.30]). When chemotherapy was initiated after gestational age 12 weeks, the frequency of major congenital malformations was 3.0% (95% CI, 1.9%-4.6%), which was similar to the expected rates in the general population. Minor malformations were comparable when exposure occurred before or after gestational age 12 weeks (4.3% [95% CI, 0.1%-21.9%] vs 1.8% [95% CI, 1.0-3.0]; odds ratio, 3.13 [95% CI, 0.39-25.28]). Of 29 women who received chemotherapy prior to 12 weeks gestation, 17 (58.6%) were not aware of pregnancy, and 6 (20.7%) experienced a miscarriage (3 women [10.3%]) or decided to terminate their pregnancy (3 women [10.3%]).
This cohort study found that chemotherapy was associated with an increased risk of major congenital malformations only in the first 12 weeks of pregnancy. The risk of congenital malformations when chemotherapy was administered during the first trimester and the high number of incidental pregnancies during cancer treatment in the INCIP registry underscore the importance of contraceptive advice and pregnancy testing at the start of chemotherapeutic treatment in young women with cancer.
Abnormalities, Drug-Induced/etiology, Adolescent, Adult, Antineoplastic Agents/adverse effects, Antineoplastic Agents/therapeutic use, Cohort Studies, Drug Administration Schedule, Female, Fetal Development/drug effects, Gestational Age, Humans, Middle Aged, Neoplasms/drug therapy, Odds Ratio, Pregnancy, Pregnancy Trimester, First, Pregnant Women, Time Factors, Young Adult
Web of science
Open Access
Create date
15/06/2022 17:02
Last modification date
25/01/2024 8:43
Usage data