Chemotherapy and Pregnancy

From Pharmacy Drug Guide

The connection between chemotherapy and pregnancy varies depending on the type of drug used. Strictly speaking, chemotherapy is the treatment of any disorder, including mental illness, by medications.^[1] However, the term "chemotherapy", or "chemo", has become more specifically the treatment of cancer by the administration of a series of powerful medications.^[2] The side effects from most of these drugs can be severe. Chemotherapy typically works by slowing or stopping the growth of rapidly-dividing cells in the body, one of the primary characteristics of most cancer cells. Unfortunately, the therapy also damages cells that divide rapidly normally, such as hair follicles, bone marrow cells, and cells in the digestive tract.^[3]

Contents 1 Chemotherapy and Pregnancy 2 Chemotherapy and Breastfeeding 3 Chemotherapy and Pregnancy 4 References

Chemotherapy and Pregnancy

Couples hoping to have a baby are customarily told to avoid pregnancy while one of the parents is receiving chemotherapy for cancer. The type of cancer, whether breast, other solid tumor, or hematologic such as leukemia or lymphoma, is not usually a factor.^[3] There have been many investigations of cancer patients who have subsequently become pregnant. This warning applies to survivors of childhood, young adult, and adult cancers.^{[6] [7]} Specialists commonly recommend that the use of any drugs in pregnant and breastfeeding women, even ibuprophen and other common OTC drugs, be limited to those for which the benefits outweigh the potential harm to the fetus or child.^[8] Small European studies have shown that children born to women who had chemotherapy during their pregnancies were no more likely to have cardiac, neurological, or genetic defects than control groups of women.^[7][6][9] The studies have shown prematurely born children whose mothers receive chemotherapy during pregnancy are more likely to have these dificulties.^[7]. Researchers aren't sure whether the premature births are caused by the chemotherapy but note that some of those births were induced, suggesting that the drugs were not the deciding factor in the subsequent anomalies.^[7]

Women who are diagnosed with cancer during pregnancy face a different concern. Will the toxicity of the chemotherapy--as well as side effects of other treatments like radiation and surgery that might be part of the treatment protocol--hurt the baby? The FDA lists drugs used in pregnancy as categories:^[10]

• A: Controlled human studies show no risk to the fetus in the first trimester and no evidence of risk later in the pregnancy
• B: No well-controlled human studies exist but animal studies show no risk to humans
• C: No adequate human studies exist but animal studies have shown an adverse effect although the benefits to the mother may outweigh the potential dangers
• D: Positive evidence exists of fetal risk but the potential benefit to the mother may warrant its use
• X: Studies show the risk of fetal abnormalities outweighs the potential benefit to the mother.

Women who are diagnosed with cancer during pregnancy are advised to work with an experienced central clinic, since most general obstetricians see very few of these situations during a career and the central hospitals have more experience. ^[11] Specialists note that women treated for cancer during pregnancy can give birth to healthy babies.^[12] Xeloda is an example of a Category D drug that may harm a fetus.^[13] Actinlycin-D is a Pregnancy Category C drug.^[14] Thalidomide is a Pregnancy Category X drug.^[15]

Chemotherapy and Breastfeeding

Because the breasts of women who are pregnant or who are breastfeeding are often swollen and tender, a diagnosis of breast cancer may be delayed and the disease detected at a more advanced stage.^[16] Some specialists recommend that a lactating mother wean her child if she is to be treated with chemotherapy for breast cancer.^[17][18]

Chemotherapy and Pregnancy

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References

1. ↑ http://www.merriam-webster.com/dictionary/chemotherapy
2. ↑ http://www.cancer.gov/dictionary?cdrid=45214
3. ↑ ^{3.0 3.1} http://www.cancer.org/Treatment/TreatmentsandSideEffects/
4. ↑ ^{4.0 4.1} http://www.medicine.wisc.edu/~williams/chemodrugspregnancy.pdf
5. ↑ http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093311.htm
6. ↑ ^{6.0 6.1} http://www.ncbi.nlm.nih.gov/pubmed/22124106
7. ↑ ^{7.0 7.1 7.2 7.3} http://www.medscape.com/viewarticle/750446
8. ↑ http://women.webmd.com/pharmacist-11/pregnancy-medicine
9. ↑ http://www.pregnantwithcancer.org/full_story.php?recordID=25
10. ↑ http://www.fda.gov/ohrms/dockets/ac/02/slides/3902s1-09-miller/sld009.htm
11. ↑ http://www.cancerandpregnancy.com/
12. ↑ http://www.cancer.net/patient/Coping/Emotional+and+Physical+Matters/Sexual+and+Reproductive+Health/Pregnancy+and+Cancer
13. ↑ http://www.chemocare.com/bio/xeloda.asp
14. ↑ http://www.chemocare.com/BIO/actinomycind.asp
15. ↑ http://www.chemocare.com/BIO/thalidomide.asp
16. ↑ http://www.cancer.gov/cancertopics/pdq/treatment/breast-cancer-and-pregnancy/Patient#Keypoint2
17. ↑ http://www.cancer.gov/cancertopics/pdq/treatment/breast-cancer-and-pregnancy/Patient/page7
18. ↑ http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-treating-during-pregnancy