Maggen Charlotte, van Gerwen Mathilde, Van Calsteren Kristel, Vandenbroucke Tineke, Amant Frédéric
Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
Department of Oncology, KU Leuven, Leuven, Belgium.
Int J Gynecol Cancer. 2019 Feb 4;29(2):404-416. doi: 10.1136/ijgc-2018-000061.
The diagnosis of cancer during pregnancy imposes a medical-ethical dilemma in weighing the risks of both mother and child. Increasing awareness of the feasibility of chemotherapy during pregnancy results in more pregnant patients receiving treatment for cancer. Information on obstetric and pediatric outcome of these high-risk pregnancies is greatly needed to guide physicians in patient counseling. In this review we present reported evidence for the incidence, diagnostic options, therapeutic management, obstetric risks, and neonatal outcome when cancer treatment is initiated during pregnancy. Decision-making when a cancer is diagnosed in a pregnant patient should be multidisciplinary, always taking the patient's perspective into account. Cancer treatment during pregnancy is associated with low birth weight and preterm delivery, therefore frequent obstetric follow-up during oncological treatment in a specialized center is mandatory. Short-term clinical, cardiac, and cognitive outcome of children pre-natally exposed to cancer treatment is overall reassuring. Long-term follow-up of children is warranted to define the possible effect of pre-natal cancer treatment on general health, fertility outcome, and the risk of secondary cancers.
孕期癌症的诊断在权衡母婴风险方面带来了医学伦理困境。对孕期化疗可行性的认识不断提高，使得更多的孕妇接受癌症治疗。非常需要有关这些高危妊娠的产科和儿科结局的信息，以指导医生为患者提供咨询。在本综述中，我们展示了有关孕期开始癌症治疗时的发病率、诊断选择、治疗管理、产科风险和新生儿结局的已报道证据。当孕妇被诊断出患有癌症时，决策应是多学科的，始终要考虑患者的观点。孕期癌症治疗与低出生体重和早产有关，因此在专门中心进行肿瘤治疗期间进行频繁的产科随访是必不可少的。总体而言，产前接触癌症治疗的儿童的短期临床、心脏和认知结局令人安心。有必要对儿童进行长期随访，以确定产前癌症治疗对总体健康、生育结局和继发性癌症风险的可能影响。
