Assessment of fetal risk associated with exposure to cancer chemotherapy during pregnancy: a multicenter study

The objective of the present study was to evaluate and quantify fetal risks involved in the administration of cancer chemotherapy during gestation, as well as to assess the long-term effects on the exposed children. In this retrospective, cohort study, we reviewed the records of women aged 15 to 45 years with a diagnosis of malignancy or benign tumors with malignant behavior at three reference services in the State of Rio Grande do Sul, Brazil, from 1990 to 1997. All patients with a diagnosis of pregnancy at any time during the course of the disease were selected, regardless of whether or not they received specific medication. Fetal outcomes of 14 pregnancies with chemotherapy exposure were compared to that of 15 control pregnancies in which these drugs were not used. Long-term follow-up of the exposed children was carried out. Fisher's exact test was used to compare the groups. Continuous variables were compared by the Wilcoxon-Mann-Whitney test. We found an increased rate of prematurity (6/8 vs 2/10; RR: 3.75; CI: 1.02-13.8; P = 0.03) in the exposed group. There was a trend to an increased fetal death rate (4/12 vs 0/10; P = 0.07) in the group exposed to chemotherapy. No malformations were detected in any child, which can be related to our small sample size as well as to the fact that most exposures occurred after the first trimester of pregnancy. Other larger, controlled studies are needed to establish the actual risk related to cancer chemotherapy during pregnancy

Alfafetoproteína: valores normais no líquido amniótico entre 14 e 21 semanas / Alphafetoproteín: amniotic fluid normal values between 14 and 21 weeks

Objetivo. Definir uma curva de normalidade dos valores de alfafetoproteína (AFP) no líquido amniótico em gestantes entre 14 e 21 semanas de gravidez no Hospital de Clínicas de Porto Alegre. Materiais e Métodos. Nas 137 mulheres que procuraram o diagnóstico pré-natal e tiveram indicaçao de coleta de líquido amniótico. A alfafetroproteína foi dosada em todas as amostras por enzima imunoensaio. Foram selecionadas 109 gestaçoes normais (sem malformaçoes, cariótipo normal, nao-gemelares) e cujas amostras de líquido amniótico nao eram sanguinolentas. Essas foram divididas quanto à idade gestacional e tiveram calculadas as medianas dos valores de AFP e seus múltiplos. Resultados. As medianas da alfafetoproteína (KUI/ml) para cada idade gestacional foram as seguintes: 14 semanas: 16,32; 15 semanas: 14,36; 16 semanas: 13,43; 17 semanas: 10,93; 18 semanas: 8,22; 19 semanas: 7,35; 20 semanas: 5,62; 21 semanas: 4,47. Conclusao. O estabelecimento de uma curva normal de AFP em nosso serviço permite a utilizaçao deste exame para pacientes em risco de defeitos de fechamento de tubo neural. Permite também que sejam analisadas amostras enviadas para estudos citogenéticos ou metabólicos de maneira a identificar fetos com níveis elevados de AFP que necessitarao de estudos ultrasonográficos mais detalhados pela possibilidade de defeitos morfológicos.