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 Female cancer survivors who got abdominal radiation are more than
three times more likely to develop diabetes during pregnancy as
their peers who received different tumor treatments, the study
found. After radiation, these cancer survivors are also more than
twice as likely to develop anemia during pregnancy.
Survivors of Wilms tumors, a rare type of childhood kidney cancer,
had more than three times the risk of high blood pressure during
pregnancy when their treatment included abdominal or pelvic
radiation.
When they didn’t get radiation, however, female cancer survivors
didn’t appear to have any greater risk of labor complications than
women who never had cancer, the study also found.
“It is reassuring that the majority of women who survived childhood
cancer and who became pregnant are not at increased risk of
developing specific adverse labor complications compared to the
general population,” said lead study author Raoul Reulen of the
Center for Childhood Cancer Studies at the University of Birmingham
in the UK.
Survival from childhood cancer has improved dramatically in recent
decades, and roughly four in five kids diagnosed with tumors survive
at least five years, researchers note.
“It is important that women who have been treated for childhood
cancer and who want to become pregnant or are pregnant are aware of
the specific treatments (e.g. radiotherapy, chemotherapy) they
received as a child and discuss the potential implications of the
treatment on the pregnancy with their obstetrician,” Reulen said by
email.
For the study, researchers examined data on a total of 2,783
singleton pregnancies among 1,712 childhood cancer survivors. All of
the women were diagnosed with tumors by age 14.
Women were typically around 29 years old when they delivered their
babies. The majority of them had survived leukemia, central nervous
system tumors or Wilms.
A total of 1,183 women received any radiation as part of their
cancer treatment, and 205 of them had abdominal radiation.
Women who got abdominal radiation were 46 percent more likely to
have elective cesarean deliveries compared to the general population
of pregnant women who didn’t have childhood cancer. Cancer survivors
who didn’t have abdominal radiation were 39 percent more likely to
have elective cesareans.
Emergency cesarean rates were similar regardless of cancer history.
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While the study wasn’t a controlled experiment designed to prove
whether or how radiation leads to pregnancy complications, it’s
possible radiation causes kidney damage that contributes to anemia
and elevated blood pressure, or increases the risk of diabetes by
harming the pancreas, the authors note.
One limitation of the study is that researchers lacked records on
the doses of radiation or chemotherapy patients received, and they
also didn’t know the site of radiation for some survivors.
Still, the study offers fresh insight into pregnancy complications
that may follow childhood cancer, said Dr. Daniel Green of St. Jude
Children’s Research Hospital in Memphis, Tennessee.
“We already knew about pregnancy related hypertension after
abdominal irradiation, and about diabetes (but not pregnancy related
diabetes) after abdominal irradiation,” Green, who wasn’t involved
in the study, said by email. “We did not know there was an increased
risk for anemia during pregnancy.”
Ideally, cancer survivors should consider these risks before trying
to conceive, said Dr. Kutluk Oktay, director of the Innovation
Institute for Fertility Preservation in New York.
“Cancer survivors should seek preconception evaluation from maternal
fetal specialists before attempting pregnancy,” Oktay, who wasn’t
involved in the study, said by email.
SOURCE: http://bit.ly/2qeExEZ Journal of the National Cancer
Institute, online April 17, 2017.
[© 2017 Thomson Reuters. All rights
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