ABSTRACT
Seventeen children born to mothers with acute leukemia who received chemotherapy during pregnancy were examined for physical health, growth, and development. The hematologic and neurologic status and school performance were also evaluated. Chromosomal studies were done in the long-term survivors ranging in age from 4 to 22 years. The children had thorough history and physical examinations to detect any abnormal symptoms or signs. The mothers' previous treatment was documented. In each child growth and development, school performance, intelligence testing, neurologic examination, and hematologic evaluation including bone marrow were normal. Bone marrow cytogenetic studies were also normal. Chemotherapy was given during the pregnancy in each case, including 11 cases during the first trimester. No fetal malformations were found and no late side effects could be demonstrated. The results of this study indicate that pregnancy is not a counterindication for treatment of patients with acute leukemia, and in the cases described here chemotherapy is not associated with excessive risk to the fetus.
Subject(s)
Leukemia/complications , Pregnancy Complications, Neoplastic/drug therapy , Acute Disease , Antineoplastic Agents/therapeutic use , Female , Follow-Up Studies , Humans , Leukemia/drug therapy , PregnancyABSTRACT
Our prospective study attempted to better define the reciprocal relation between pregnancy and systemic lupus erythematosus (SLE), to reduce maternal morbidity/mortality, and fetal loss. Our protocol included all the pregnancies in our total of patients with SLE between the years 1974-1983. There were 102 pregnancies in 75 patients during this period; SLE was exacerbated in 59.7% that started with inactive disease, most with mild episodes. Hematologic manifestations and renal disease, however, required moderate or high doses of steroids. There were no maternal deaths. There were 49% premature newborns in the entire group and this increased to 59% in mothers with active SLE; 23% of newborns were small for gestational age in the entire group and the rate increased to 65% in mothers with active SLE. There was a 16% spontaneous abortion rate with no difference between mothers with active or inactive disease, 5 stillbirths and one neonatal death, with a total fetal loss of 22% (compared with 6.7% in the control group p less than 0.001). There were 32 cesarean sections with live outcomes and 14 newborn infants with a weight below 1.5 kg survived. Our study shows that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.
Subject(s)
Lupus Erythematosus, Systemic/complications , Pregnancy Complications/therapy , Abortion, Spontaneous/etiology , Adolescent , Adult , Female , Fetal Growth Retardation/etiology , Humans , Infant, Newborn , Infant, Premature , Lupus Erythematosus, Systemic/therapy , Pregnancy , Prospective StudiesABSTRACT
The hematologic and obstetric problems of nine pregnant patients with acute leukemia are analyzed. Seven patients received chemotherapy during various trimesters of pregnancy, four during the first 10 weeks, and there was no evidence of congenital malformations in any of their offspring. Six of nine babies are alive and healthy with a normal growth 2 months to 15 years after birth, one child was stillborn, and two children died 21 and 90 days after birth. These results were compared with others in the literature and the conclusions are that pregnancy is not a contraindication for treatment of acute leukemia, that cytotoxic drugs may not cause congenital malformations, and that the management of pregnant patients with acute leukemia should be carefully planned.
