title: Pregnancy-associated cardiomyopathy in survivors of childhood cancer.
abstract: OBJECTIVE
  Current information regarding pregnancy-associated cardiomyopathy among women treated for childhood cancer is insufficient to appropriately guide counseling and patient management. This study aims to characterize its prevalence within a large cohort of females exposed to cardiotoxic therapy.
  
  
  METHODS
  This is a retrospective cohort study of female cancer survivors treated at St. Jude Children's Research Hospital between 1963 and 2006, at least 5 years from diagnosis, ≥13 years old at last follow-up, and with at least one successful pregnancy. Pregnancy-associated cardiomyopathy was defined as shortening fraction <28 % or ejection fraction <50 % or treatment for cardiomyopathy during or up to 5 months after completion of pregnancy.
  
  
  RESULTS
  Among the 847 female cancer survivors with 1554 completed pregnancies, only 3 (0.3 %) developed pregnancy-associated cardiomyopathy and 40 developed non-pregnancy-associated cardiomyopathy either 5 months postpartum (n = 14) or prior to pregnancy (n = 26). Among those with cardiomyopathy prior to pregnancy (n = 26), cardiac function deteriorated during pregnancy in eight patients (three patients with normalization of cardiac function prior to pregnancy, three with persistently abnormal cardiac function, and two for whom resolution of cardiomyopathy was unknown prior to pregnancy). Patients that developed cardiomyopathy received a higher median dose of anthracyclines compared to those that did not (321 versus 164 mg/m(2); p < 0.01).
  
  
  CONCLUSIONS
  Pregnancy-associated cardiomyopathy in childhood cancer survivors is rare.
  
  
  CONCLUSIONS
  Most female childhood cancer survivors will have no cardiac complications during or after childbirth; however, those with a history of cardiotoxic therapies should be followed carefully during pregnancy, particularly those with a history of anthracycline exposures and if they had documented previous or current subclinical or symptomatic cardiomyopathy.
authors.affiliation: Department of Pediatric Critical Care, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.|Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap, Rm 461R, Memphis, TN, 38103, USA.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Hines
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap, Rm 461R, Memphis, TN, 38103, USA.|Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN, 38015-3678, USA.|Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mulrooney
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN, 38015-3678, USA.|Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN, 38015-3678, USA.|Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap, Rm 461R, Memphis, TN, 38103, USA.|Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN, 38015-3678, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Krasin
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap, Rm 461R, Memphis, TN, 38103, USA. monika.metzger@stjude.org.|Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN, 38015-3678, USA. monika.metzger@stjude.org.
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D018943:Anthracyclines / Q000009:adverse effects; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D009202:Cardiomyopathies / Q000453:epidemiology* / Q000209:etiology; D066126:Cardiotoxicity; D002648:Child; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000209:etiology; D011832:Radiation Injuries / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic
keywords: Cardiac toxicity; Cardiotoxic therapies; Childhood cancer survivor; Pregnancy-associated cardiomyopathy