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Pregnancy Considerations in Patients with Cancer and Cancer Survivors

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Textbook of Oncofertility Research and Practice

Abstract

Improvements in multimodality treatments have enabled many cancer patients to survive a malignancy. However, these treatments can result in gonadal dysfunction and infertility. This chapter focuses primarily on young female patients who are diagnosed with cancer prior to and during pregnancy and updates cancer care providers on how to educate patients about the correlation between cancer treatments and reproductive function of children, adolescents, and young adults. We also review the existing data on pediatric outcomes after maternal cancer treatment and summarized available data regarding cancer management during pregnancy.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Yuriko Iwahata, Hideyuki Iwahata & Nao Suzuki

  2. Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA

    Hideyuki Iwahata

Authors
  1. Yuriko Iwahata
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  2. Hideyuki Iwahata
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  3. Nao Suzuki
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Corresponding author

Correspondence to Nao Suzuki .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Northwestern University , Chicago, IL, USA

    Teresa K. Woodruff

  2. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Divya K. Shah

  3. Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA

    Wendy S. Vitek

Review Questions and Answers

Review Questions and Answers

  1. Q1.

    Why is it important to discuss treatment-related fertility risks and FP options prior to cancer therapy?

  2. A1.

    It may be possible to preserve fertility if cancer patients are provided the information of the risk of infertility and FP options prior to initiation of cancer treatment. And also, understanding the treatment’s effect on fertility and patients’ ability to make decision can improve the long-term QOL during cancer survivorship.

  3. Q2.

    Are patients who experience oligomenorrhea or amenorrhea after chemotherapy always infertile?

  4. A2.

    No. irregular menses or amenorrhea after cancer therapy does not always imply infertility. Reproductive-aged cancer patients should use contraceptives to avoid unintended pregnancy from the start of chemotherapy to at least 6 months after completion of chemotherapy.

  5. Q3.

    Does the age of exposure to chemotherapy matter to infertility?

  6. A3.

    Even though older women have a much higher reported incidence of acute POI, occurring during or immediately following treatment, chemotherapy may damage to follicles at all ages. The age-related difference may be because of older women having a smaller primordial follicle reserve at the start of treatment compared with young women, so that the loss from that already reduced follicle pool is more likely to induce POI.

  7. Q4.

    What are the consequences of cancer treatment on pregnancy outcomes in cancer survivors?

  8. A4.

    Female survivors exposed to abdominal irradiation had a significantly increased risk of low birth weight, preterm birth among their infant, and a small increased risk of miscarriage. The effects of chemotherapy in childhood cancer may vary among the reports, and it differs in each diagnosis and the kind of chemotherapeutic agents.

  9. Q5.

    What are the effects of cancer treatment during pregnancy on fetal and child development?

  10. A5.

    Chemotherapy in the first trimester is contraindicated because of an increased risk of congenital malformations and fetal death. The important risk of chemotherapy during second and the third trimester are preterm birth and low birth weight. Studies regarding radiation during pregnancy are insufficient.

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Iwahata, Y., Iwahata, H., Suzuki, N. (2019). Pregnancy Considerations in Patients with Cancer and Cancer Survivors. In: Woodruff, T., Shah, D., Vitek, W. (eds) Textbook of Oncofertility Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02868-8_15

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  • DOI: https://doi.org/10.1007/978-3-030-02868-8_15

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