Chemotherapy in pregnant women

Chemotherapy in pregnant women is a sensitive issue and depends on the type of cancer, the stage of the disease, the trimester of pregnancy, and the type of medication used. Here are some key points about this treatment:

Trimesters of pregnancy:

1. First trimester (0-12 weeks):

• During this stage, the baby’s main organs develop (organogenesis), which increases the risk of birth defects if the mother receives chemotherapy.
• Chemotherapy is generally avoided during this period due to the high risk of harm to the fetus, miscarriage, or birth defects.

2. Second and third trimester (13-40 weeks):

• After the first trimester, the placenta offers some protection to the fetus, and some chemotherapy drugs can be given with less risk.
• Although the risks of birth defects decrease, there is still a risk of complications such as low birth weight or premature birth.

Types of chemotherapy:

• Some drugs are safer than others during pregnancy, especially in the second and third trimesters. For example, agents such as cyclophosphamide, doxorubicin, and some platinum derivatives may be used with caution.

• Others, such as methotrexate, are absolutely contraindicated because they interfere with fetal growth.

Risks and considerations:

• It is important to balance the risks to the mother and the baby. If chemotherapy is essential for the mother’s health, it may be postponed until the second trimester when the risks to the fetus are lower.

• The growth and well-being of the fetus is monitored continuously using ultrasound and other prenatal examinations.

After delivery:

• In some cases, if feasible, early delivery may be induced once the fetus is viable (starting at 32-34 weeks), allowing the mother to receive more aggressive treatments that are not considered safe during pregnancy.

In summary:

Chemotherapy in pregnant women may be feasible, but requires a multidisciplinary team including oncologists, obstetricians specialized in high-risk pregnancies, and neonatologists to maximize safety for both mother and fetus.