Pregnancy and maternal outcomes in women with prior or current gastrointestinal malignancies.
OBJECTIVE
To review the fetal and maternal outcomes of women with a diagnosis of gastrointestinal (GI) cancer before or during pregnancy.


METHODS
We conducted a retrospective cohort study of pregnant women referred to a single tertiary care centre with a current or previous diagnosis of GI malignancy. Maternal, obstetric, and infant data were recorded.


RESULTS
We identified 18 pregnancies in 13 women. Nine women were found to have a GI malignancy during pregnancy (group 1). There was an indirect maternal death in this group in a woman with advanced gastric adenocarcinoma. Nine unique pregnancies occurred in eight women with diagnosis and management of GI malignancies before their pregnancies (group 2).


CONCLUSIONS
GI malignancies are difficult to diagnose and manage during pregnancy and are usually advanced at the time of diagnosis. Surgery can be performed during pregnancy if necessary, with chemotherapy and radiotherapy usually deferred to the postpartum period. Women who have had a prior GI malignancy have special circumstances related to the type of surgery performed and previous exposure to chemotherapy. These patients may benefit from a multidisciplinary team effort to optimize their care.
Maternal Disease in Pregnancy Program, Mount Sinai Hospital, University of Toronto, Toronto ON.
Ali
A
Al-Ibrahim
Department of Biology, University of Toronto, Toronto ON.
Jacqueline
J
Parrish
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Evelyn
E
Dunn
Division of General Surgery, Mount Sinai Hospital, University of Toronto, Toronto ON.
Carol
C
Swallow
Maternal Disease in Pregnancy Program, Mount Sinai Hospital, University of Toronto, Toronto ON.
Cynthia
C
Maxwell
D000230:Adenocarcinoma / Q000150:complications; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001724:Birth Weight; D002585:Cesarean Section; D015331:Cohort Studies; D017809:Fatal Outcome; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D015931:Intensive Care, Neonatal; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy / Q000601:surgery; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms; D062606:Tertiary Care Centers; D055815:Young Adult
D000970:Antineoplastic Agents
GIST; anal melanoma; colorectal carcinoma; gastric carcinoma; gastrointestinal stromal tumour; hepatocellular carcinoma; pregnancy; rectal carcinoma