Frédéric Amant1, Tineke Vandenbroucke, Magali Verheecke, Monica Fumagalli, Michael J Halaska, Ingrid Boere, Sileny Han, Mina Mhallem Gziri, Fedro Peccatori, Lukas Rob, Christianne Lok, Petronella Witteveen, Jens-Uwe Voigt, Gunnar Naulaers, Lore Vallaeys, Frank Van den Heuvel, Lieven Lagae, Luc Mertens, Laurence Claes, Kristel Van Calsteren. 1. From the Department of Gynecologic Oncology, University Hospitals Leuven and Department of Oncology, Katholieke Universiteit Leuven (F.A., T.V., M.V., S.H.), Departments of Cardiology (J.-U. V.), Pediatrics (G.N., L.V., L.L.), and Obstetrics (K.V.C.), University Hospitals Leuven, and the Department of Growth and Regeneration (G.N., L.L., K.V.C.) and the Faculty of Psychology and Educational Sciences (L.C.), Katholieke Universiteit Leuven, Leuven, and the Department of Obstetrics, Cliniques Universitaires St. Luc, Brussels (M.M.G.) - all in Belgium; Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Università degli Studi di Milano (M.F.) and Fertility and Reproduction Unit, European Institute of Oncology (F.P.) - both in Milan; the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic (M.J.H., L.R.); the Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam (I.B.), Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A., C.L.), and the Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht (P.W.) - all in the Netherlands; the Departments of Physics, Nuclear Physics, and Medical Physics, University of Oxford, Oxford, United Kingdom (F.V.H.); and the Department of Cardiology, Hospital for Sick Children, University of Toronto, Toronto (L.M.).
Abstract
BACKGROUND: Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking. METHODS: In this multicenter case-control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months. RESULTS: A total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P=0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P=0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings. CONCLUSIONS: Prenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment. (Funded by Research Foundation-Flanders and others; ClinicalTrials.gov number, NCT00330447.).
BACKGROUND: Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking. METHODS: In this multicenter case-control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months. RESULTS: A total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P=0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P=0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings. CONCLUSIONS: Prenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment. (Funded by Research Foundation-Flanders and others; ClinicalTrials.gov number, NCT00330447.).
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