Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients.
BACKGROUND
Anthracyclines are essential for the treatment of malignancies observed in pregnant patients. Knowledge of the potential side-effects of chemotherapy on the developing fetus is essential for patient counseling.


METHODS
We collected information concerning patients treated with anthracyclines during pregnancy from a review of literature between 1976 and 2001 and our experience. The events analyzed were malformations, fetal death and spontaneous abortion. A chi(2) test with a Yates correction was used to compare the distribution of severe events.


RESULTS
A total of 160 patient pregnancies were analyzed. The fetal outcome was frequently normal (73%). Abnormalities included malformations (3%), fetal death (9%), spontaneous abortion (3%), fetal complications (8%) and prematurity (6%). Fetal death was often directly consecutive to maternal death (40%). Unfavorable fetal outcome was significantly more frequent in leukemia patients (P = 0.001). In patients with solid tumors, the first trimester was significantly associated with more complications (P = 0.029). The risk of severe fetal toxicity was increased 30-fold when the dose of doxorubicin per cycle exceeded 70 mg/m(2) (P = 0.037).


CONCLUSIONS
Anthracyclines may induce embryo-fetal toxicity. Nevertheless the risk seems low, especially after the first trimester and using doses of doxorubicin below 70 mg/m(2).
Germann
N
N
Unité d'Oncologie Médicale, Service de Médecine Interne, Paris, France.
Goffinet
F
F
Goldwasser
F
F
D000014:Abnormalities, Drug-Induced / Q000145:classification* / Q000453:epidemiology; D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D003630:Daunorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005314:Embryonic and Fetal Development / Q000187:drug effects; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000145:classification / Q000188:drug therapy*; D011264:Pregnancy Trimesters; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
D018943:Anthracyclines; D004317:Doxorubicin; D003630:Daunorubicin