Leukemia in Pregnancy

For clinical consideration, leukemia in association with pregnancy can be divided into acute and chronic forms. Maternal mortality in acute leukemia is 100%, and in the chronic form it is 36.5%. Perinatal mortality is 34-36% in acute leukemia and 16.2% in chronic leukemia. The incidence of postpartum hemorrhage is 15-19%; however, in a recent study it was 83%. Chemotherapy and irradiation usually do not produce gross abnormalities of the fetus if given only during the second and third trimesters; however, the subsurface genetic damage that may be done and new mutants that may be produced are unknown. Caution must be used in radiation therapy because of possible late carcinogenic effects and increase in subsequent mortality and leukemia in infants exposed to radiation in utero. Transmission of leukemia from the mother to the fetus is rare. The main objective in management is to maintain the disease in remission long enough to obtain an infant that will survive outside of the uterine environment. The liberalization of abortion, improved methods of birth control, and the improvement in survival rates with new drug combinations and immunotherapy may make the association of leukemia and pregnancy even more rare.