General Obstetrics and Gynecology: Obstetrics
Pregnancy outcome of female survivors of childhood cancer: A report from the childhood cancer survivor study,☆☆,

Presented in part at the 31st Annual Meeting of the International Society of Paediatric Oncology, Montreal, Quebec, Canada, September 13-19, 1999.
https://doi.org/10.1067/mob.2002.126643Get rights and content

Abstract

Objective: This study was undertaken to determine the effect, if any, of prior treatment with radiation therapy or chemotherapy for cancer diagnosed during childhood or adolescence on pregnancy loss, live births, and birth weight. Study Design: We reviewed pregnancy outcome among female participants in the Childhood Cancer Survivor Study (CCSS) who returned a questionnaire. Eligibility for the CCSS included 5-year survivors who were <21 years old at diagnosis and who were diagnosed with an eligible cancer between January 1, 1970, and December 31, 1986, at the 25 participating CCSS institutions. The questionnaire included items regarding attempts to become pregnant, the occurrence of pregnancy, and the outcome of pregnancy (ie, live birth, stillbirth, miscarriage, abortion). Medical records of all members of the cohort were abstracted to obtain chemotherapeutic agents administered, the cumulative dose of drug administered for several drugs of interest, and the doses, anatomic regions, and dates of administration of all radiation therapy. Results: One thousand nine hundred fifteen females reported 4029 pregnancies (63% live births, 1% stillbirths, 15% miscarriages, 17% abortions, 3% unknown or in gestation). There were no significant differences in pregnancy outcome by treatment. A higher, but not statistically significant, risk of miscarriage was present among women whose ovaries were in the radiation therapy field (relative risk [RR] 1.86, P =.14), were near the radiation therapy field (RR 1.64, P =.06), or were shielded (RR 0.90, P =.88). The rate of live birth was not lower for the patients treated with any particular chemotherapeutic agent. The offspring of the patients who received pelvic irradiation were more likely to weigh <2500 g at birth (RR 1.84, P =.03). Conclusions: This large study did not identify adverse pregnancy outcomes for female survivors treated with most chemotherapeutic agents. The offspring of women who received pelvic irradiation are at risk for low birth weight. (Am J Obstet Gynecol 2002;187:1070-80.)

Section snippets

Patients and methods

A cohort of 20,319 previously untreated patients who were <21 years old at diagnosis and who were diagnosed with an eligible cancer between January 1, 1970, and December 31, 1986, was identified at the 25 participating institutions of the Childhood Cancer Survivor Study (CCSS). The study design and cohort characteristics are presented in detail elsewhere.11 Briefly, all members of the cohort, or a proxy, if the cohort member was deceased, completed a baseline questionnaire that included items

Results

Six thousand four hundred ninety-four women returned a baseline questionnaire. One thousand nine hundred fifteen indicated that they had ever been pregnant and reported 4029 pregnancies. The gender ratio (male/female) was 1.09:1.0 for the offspring of the female survivors compared with 1.09:1.0 for the offspring of the female siblings of all the male and female survivors.

Comment

The survival rate of pediatric cancer patients has improved dramatically during the past two decades,1 with many former patients now achieving young adulthood and beginning to make decisions regarding marriage and reproduction. Because radiation therapy and many of the chemotherapeutic agents that are used alone or as a component of successful treatment programs for a variety of cancers in children and adolescents are mutagenic, these long-term survivors are concerned about the potential effect

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    Supported by National Cancer Institute grant No. U24 CA55727 from the National Institutes of health. Support was provided to the University of Minnesota Cancer Center from the Children's Cancer Research Fund.

    ☆☆

    An abstract of this paper was published in Med Pediatr Oncol 1999;33:146.

    Reprint requests: Daniel M. Green, MD, Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263. E-mail: [email protected]

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