Maternal Cancer Diagnosis and Treatment During Pregnancy:a Database for Maternal, Fetal, and Neonatal Outcomes
Maternal Cancer Diagnosis and Treatment During Pregnancy:a Database for Maternal, Fetal, and Neonatal Outcomes
The objective of this study is to follow the treatment options offered to pregnant women
 diagnosed with cancer and study the impact that their treatment or delay of treatment has on
 their own health and that of their children.
Approximately 1:1000 pregnancies are complicated by cancer. Breast cancer is the most common
 type diagnosed during pregnancy. Termination of pregnancy has not demonstrated an improvement
 in survival. Results of an international collaborative study reported similar overall
 survival for patients diagnosed with breast cancer in pregnancy compared to nonpregnant
 patients. The consensus medical opinion supports the option to start treatment with
 continuation of the pregnancy. The purpose of this Cancer and Pregnancy Registry study is to
 prospectively follow the women diagnosed with cancer during pregnancy-collecting information
 about the method of diagnosis, treatment options and maternal and neonatal outcomes at
 delivery and yearly at follow up.

 The majority of fetal organogenesis is completed by 12 weeks of pregnancy, consistent with
 the literature showing no increased malformation rate for chemotherapy use after the first
 trimester of pregnancy. The central nervous system continues to develop throughout gestation
 and after birth. Whether chemotherapy given after the first trimester affects central nervous
 system maturity and results in developmental delays requires further study. The first authors
 to provide detailed follow up on children exposed to chemotherapy in utero were Aviles and
 Niz in 1988. At that time 17 children ranging in age from 4-22 years born to mothers with
 acute leukemia who received chemotherapy during pregnancy were examined for physical health,
 growth and development. Each child demonstrated normal growth and development, school
 performance, intelligence testing, neurological examination, and hematologic evaluation
 including bone marrow biopsies. This study was expanded twice. First in 1991, to 43 children
 ranging in age from 3 to 19 years, also after exposure in utero to chemotherapy for maternal
 hematologic malignancies. All children were normal physically and neurologically. School
 performances and standardized intelligence testing were not significantly different from
 controls (unrelated matched children and unexposed siblings). The same authors expanded their
 study again to a final report of 84 children in 2001, confirming their previous reports that
 chemotherapy at full doses for an aggressive hematological malignancy can be safely
 administered. Standardized testing on children exposed to chemotherapy was not repeated for
 11 years. Drs. Amant, et al reported developmental outcomes of 70 children in Europe exposed
 to cancer treatment in utero. The children with developmental delays were concentrated in the
 group delivered preterm. In this study there was not a control group of unexposed children.

 Cardonick also performed developmental testing on 57 children of women diagnosed with cancer
 during pregnancy. Ninety-five percent of children scored within normal limits on cognitive
 assessments; 71% and 79% of children demonstrated at or above age equivalency in mathematics
 and reading scores respectively.

 Tooth formation of the primary teeth begins at 11 to 14 weeks of fetal life and is completed
 postnatally. The enamel of the primary teeth begins to develop at 10 weeks and gradually
 continues to develop throughout pregnancy; enamel development on the permanent teeth starts
 in week 28 and begins to mineralize at the time of birth. It is known that both tetracycline
 and antiepileptic medications use during pregnancy can affect tooth development. For example,
 prenatal exposure tetracycline induces discoloration of deciduous teeth, while exposure to
 antiepileptic drugs increases the risk of enamel opacities and hypoplasia. Enamel hypoplasia
 increases susceptibility for primary dental caries due to an increased risk for bacterial
 colonization. Peretz et al in 2003 reported the dental examination of 2 children exposed to
 Doxorubicin+/-Cyclophosphamide during the third trimester for breast cancer. Both children at
 18 and 30 months of age had normal primary teeth. Three women in the Cancer and Pregnancy
 Registry have reported dental issues in their young children including under developed
 primary teeth and early childhood caries. The effect of in utero exposure to chemotherapy on
 amelogenesis requires further study.

 Women diagnosed with cancer of any type during pregnancy can enroll voluntarily in the Cancer
 and Pregnancy Registry. Signed medical release forms allow the investigator to review cancer
 diagnostic studies and treatment course. Records are requested yearly from the treating
 pediatrician and dentist to follow the growth and development of the child. All information
 is kept confidential. Oncologic follow up on the women is also requested yearly.
Inclusion Criteria:

 -  Any pregnant woman diagnosed with cancer within 6 weeks before her last menstrual
 period or 6 months after her end of pregnancy either by delivery or miscarriage.

 Exclusion Criteria:

 -  Women diagnosed with cancer more than 6 months after the end of a pregnancy.