title: Specific congenital malformations after exposure to cyclophosphamide, epirubicin and 5-fluorouracil during the first trimester of pregnancy.
abstract: The treatment of pregnant women with chemotherapeutic drugs leads to congenital malformations in 10-20% of newborn children. We present a case of an ongoing 19-week-long pregnancy which was diagnosed in a 39-year-old woman who was being treated with CEF (cyclophosphamide, epirubicin, 5-fluorouracil) chemotherapy for an infiltrating ductal carcinoma of the breast. After termination of the pregnancy, subsequent examination of the fetus revealed micrognathia and bilateral malformations of the hands and feet. The peak exposure of the fetus to the chemotherapeutic agents was in the 5th to 6th week of the pregnancy. Both the nature of the malformations and the timing of the administration of chemotherapy are similar to another case reported previously. We conclude that chemotherapy treatments with CEF in the 5th to 6th week of pregnancy specifically generate hand and foot abnormalities and micrognathia, which is consistent with an inhibition of proliferation, leading to cell death at this embryonic stage.
authors.affiliation: Service of Prenatal Medicine, UZ Brussel, Brussels, Belgium. mina.leyder@uzbrussel.be
authors.forename: Mina
authors.initials: M
authors.lastname: Leyder
authors.forename: Monika
authors.initials: M
authors.lastname: Laubach
authors.forename: Maria
authors.initials: M
authors.lastname: Breugelmans
authors.forename: Katelijn
authors.initials: K
authors.lastname: Keymolen
authors.forename: Jacques
authors.initials: J
authors.lastname: De Greve
authors.forename: Walter
authors.initials: W
authors.lastname: Foulon
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D017880:Limb Deformities, Congenital / Q000139:chemically induced*; D008297:Male; D008844:Micrognathism / Q000139:chemically induced*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy; D011261:Pregnancy Trimester, First
chemical_list: D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil