title: Pregnancy outcome after treatment for Wilms tumor: a report from the national Wilms tumor long-term follow-up study.
abstract: OBJECTIVE
  This study was undertaken to evaluate the effect of prior treatment with radiation therapy or chemotherapy for unilateral Wilms tumor (WT) diagnosed during childhood on pregnancy complications, birth weight, and the frequency of congenital malformations in live-born offspring.
  
  
  METHODS
  We reviewed pregnancy outcomes among female survivors and partners of male survivors of WT treated on National Wilms Tumor Studies 1, 2, 3, and 4 by using a maternal questionnaire and a review of both maternal and offspring medical records.
  
  
  RESULTS
  We received reports of 1,021 pregnancies with duration of 20 weeks or longer, including 955 live-born singletons, for whom 700 sets of maternal and offspring medical records were reviewed. Rates of hypertension complicating pregnancy (International Classification of Diseases [ICD] code 642), early or threatened labor (ICD-644) and malposition of the fetus (ICD-652) increased with increasing radiation dose in female patients. The percentages of offspring weighing less than 2,500 g at birth and of those having less than 37 weeks of gestation also increased with dose. There was no significant trend with radiation dose in the number of congenital anomalies recorded in offspring of female patients.
  
  
  CONCLUSIONS
  Women who receive flank radiation therapy as part of the treatment for unilateral WT are at increased risk of hypertension complicating pregnancy, fetal malposition, and premature labor. The offspring of these women are at risk for low birth weight and premature (ie, < 37 weeks gestation) birth. These risks must be considered in the obstetrical management of female survivors of WT.
authors.affiliation: Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Way, Mail Stop 735, Memphis, TN 38105-2794, USA. Daniel.green@stjude.org
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Jane M
authors.initials: JM
authors.lastname: Lange
authors.forename: Eve M
authors.initials: EM
authors.lastname: Peabody
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Grigorieva
authors.forename: Susan M
authors.initials: SM
authors.lastname: Peterson
authors.forename: John A
authors.initials: JA
authors.lastname: Kalapurakal
authors.forename: Norman E
authors.initials: NE
authors.lastname: Breslow
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology; D008297:Male; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000209:etiology*; D011256:Pregnancy Outcome; D011832:Radiation Injuries / Q000209:etiology; D017741:Survivors; D009396:Wilms Tumor / Q000188:drug therapy* / Q000532:radiotherapy*
references.citation: N Engl J Med. 1991 Jul 18;325(3):141-6
references.pmid: 2052058
references.citation: J Obstet Gynaecol Br Commonw. 1963 Oct;70:871-7
references.pmid: 14071853
references.citation: Matern Child Health J. 2007 Nov;11(6):540-8
references.pmid: 17279323
references.citation: Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):542-52
references.pmid: 15380591
references.citation: J Natl Cancer Inst. 1991 Nov 20;83(22):1643-50
references.pmid: 1749017
references.citation: Ann Epidemiol. 2006 Jan;16(1):1-10
references.pmid: 16039875
references.citation: Acta Obstet Gynecol Scand. 2004 Jan;83(1):96-102
references.pmid: 14678092
references.citation: N Engl J Med. 1998 May 7;338(19):1339-44
references.pmid: 9571253
references.citation: Br J Cancer. 2002 Nov 4;87(10):1092-8
references.pmid: 12402147
references.citation: Am J Hum Genet. 1998 Jan;62(1):45-52
references.pmid: 9443870
references.citation: Med Pediatr Oncol. 1999 Jul;33(1):9-14
references.pmid: 10401491
references.citation: Lancet. 1958 Jan 25;1(7013):178-81
references.pmid: 13503249
references.citation: Natl Vital Stat Rep. 2007 Dec 5;56(6):1-103
references.pmid: 18277471
references.citation: Am J Epidemiol. 1984 Nov;120(5):727-33
references.pmid: 6541871
references.citation: Arch Intern Med. 1986 Apr;146(4):705-9
references.pmid: 3963952
references.citation: J Pediatr. 1986 Jan;108(1):105-9
references.pmid: 3003314
references.citation: Radiat Res. 2006 Jul;166(1 Pt 2):141-57
references.pmid: 16808603
references.citation: Arch Pediatr Adolesc Med. 1997 Apr;151(4):379-83
references.pmid: 9111437
references.citation: J Obstet Gynaecol Br Emp. 1958 Aug;65(4):536-9
references.pmid: 13576231
references.citation: J Natl Cancer Inst. 1979 May;62(5):1193-7
references.pmid: 286096
references.citation: Clin Oncol (R Coll Radiol). 1989 Nov;1(2):75-9
references.pmid: 2486484
references.citation: J Pediatr. 1991 May;118(5):698-702
references.pmid: 1850459
references.citation: Pediatr Nephrol. 1989 Oct;3(4):430-2
references.pmid: 2561996
references.citation: Int J Cancer. 1989 Mar 15;43(3):399-402
references.pmid: 2538400
references.citation: J Urol. 2005 Nov;174(5):1972-5
references.pmid: 16217371
references.citation: Urology. 1982 Feb;19(2):127-30
references.pmid: 6277068
references.citation: Acta Radiol Oncol. 1981;20(1):5-8
references.pmid: 6264743
references.citation: BMC Pediatr. 2003 Jul 8;3:6
references.pmid: 12848901
references.citation: Br J Cancer. 1992 Nov;66(5):877-82
references.pmid: 1329909
references.citation: Pediatr Surg Int. 1998 Dec;14(3):185-8
references.pmid: 9880744
references.citation: J Clin Oncol. 2002 May 15;20(10):2506-13
references.pmid: 12011129
references.citation: Med Pediatr Oncol. 1988;16(4):233-40
references.pmid: 2843733
references.citation: Br J Obstet Gynaecol. 1992 May;99(5):392-4
references.pmid: 1622911
references.citation: Bone Marrow Transplant. 1999 Feb;23(3):259-63
references.pmid: 10084257
references.citation: Cancer. 1982 Jun 1;49(11):2285-8
references.pmid: 6280837
references.citation: Br J Obstet Gynaecol. 1999 Dec;106(12):1265-72
references.pmid: 10609720
references.citation: J Natl Cancer Inst. 2006 Oct 18;98(20):1453-61
references.pmid: 17047194
references.citation: Cancer. 1976 Aug;38(2):633-46
references.pmid: 184912
references.citation: J R Coll Gen Pract. 1988 Mar;38(308):102-5
references.pmid: 3204576
references.citation: J Clin Oncol. 1998 Dec;16(12):3744-51
references.pmid: 9850017
references.citation: J Clin Oncol. 2009 May 10;27(14):2308-18
references.pmid: 19364948
references.citation: Am J Clin Oncol. 1993 Jun;16(3):201-5
references.pmid: 8393271
references.citation: Med Pediatr Oncol. 1996 May;26(5):325-8
references.pmid: 8614365
references.citation: Cancer. 1989 Jul 15;64(2):349-60
references.pmid: 2544249
references.citation: Biometrics. 2001 Sep;57(3):941-8
references.pmid: 11550948
references.citation: Cancer. 1981 May 1;47(9):2302-11
references.pmid: 6164480
references.citation: Pediatrics. 1969 Dec;44(6):912-21
references.pmid: 4312366
references.citation: Arch Dis Child. 1992 Dec;67(12):1462-6
references.pmid: 1336953
references.citation: Eur J Cancer. 1996 Mar;32A(3):465-9
references.pmid: 8814694
references.citation: Acta Paediatr Scand. 1986 May;75(3):408-14
references.pmid: 3014808
references.citation: Am J Obstet Gynecol. 2002 Oct;187(4):1070-80
references.pmid: 12389007
references.citation: JAMA. 1987 Jan 9;257(2):216-9
references.pmid: 3025465
references.citation: J Natl Cancer Inst. 1995 Sep 6;87(17):1323-4
references.pmid: 7658484
references.citation: J Clin Oncol. 1998 Jan;16(1):237-45
references.pmid: 9440748
references.citation: N Engl J Med. 1988 Jul 28;319(4):189-94
references.pmid: 3393170
references.citation: Epidemiology. 2000 Mar;11(2):161-6
references.pmid: 11021613