Pregnancy outcome after treatment for Wilms tumor: a report from the national Wilms tumor long-term follow-up study.
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.
Green
Daniel M
DM
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
Lange
Jane M
JM
Peabody
Eve M
EM
Grigorieva
Natalia N
NN
Peterson
Susan M
SM
Kalapurakal
John A
JA
Breslow
Norman E
NE
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*
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