From Survival to Motherhood: Pregnancy Outcomes After Treatment for Malignancy

Introduction: Around 2 million women of reproductive age are diagnosed with cancer annually. With improved survival and advances in fertility preservation, pregnancies following malignancy treatment are increasing. These pregnancies present unique challenges due to potential effects of prior chemotherapy, radiotherapy and surgery on reproductive and obstetric outcomes. Indian data on such pregnancies is limited. Evaluating maternal and neonatal outcomes in cancer survivors can guide counselling and management. Objectives: To evaluate clinical profile, management strategies and maternal and neonatal outcomes in pregnancies following malignancy treatment. Methodology: A prospective observational study was conducted at a teaching institution over a period of 46 months. Eight pregnancies following malignancy treatment were analyzed. Data on age at diagnosis, type and treatment of malignancy, age at conception, mode of delivery, obstetric and neonatal outcomes were recorded. Results: Prevalence of pregnant women with history of malignancy treatment was about 2.6 per 10,000 (0.026 percent) pregnancies. Mean age at cancer diagnosis was 20.3 years. Five patients (62.5%) had history of germ cell tumours; one each had history of adenocarcinoma colon, gestational trophoblastic neoplasia and epithelial ovarian tumor. The mean interval between diagnosis and conception was 5.8 years. Three patients (37.5%) had preterm delivery, five (62.5%) underwent cesarean section, and one had oncologic complication with ICU admission. Conclusion: Maternal outcomes in pregnancies following treatment of malignancy are largely reassuring. However, these pregnancies are associated with increased number of preterm births, low birth weight babies and NICU admissions. Adequate interval between malignancy treatment and pregnancy is associated with better outcomes.