Counseling and surveillance of obstetric risks for female childhood, adolescent, and young adult cancer survivors: recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group.
Am J Obstet Gynecol. 2020 Jun 02;:
Authors: van der Kooi ALF, Mulder RL, Hudson MM, Kremer LCM, Skinner R, Constine LS, van Dorp W, van Dulmen-den Broeder E, Winther JF, Wallace WH, Waugh J, Woodruff TK, Anderson RA, Armenian SH, Bloemenkamp KWM, Critchley HOD, Demoor-Goldschmidt C, Ehrhardt MJ, Green DM, Grobman WA, Iwahata Y, Krishna I, Laven JSE, Levitt G, Meacham LR, Miller ES, Mulders A, Polanco A, Ronckers CM, Samuel A, Walwyn T, van den Heuvel-Eibrink MM, Levine JM
OBJECTIVE: Female childhood, adolescent, and young adult (CAYA) cancer survivors have an increased risk of adverse pregnancy outcomes related to their cancer or treatment-associated sequelae. Optimal care for CAYA cancer survivors can be facilitated by clinical practice guidelines that identify specific adverse pregnancy outcomes and the clinical characteristics of at-risk subgroups. However, national guidelines are scarce and vary in content. Here, the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) offers recommendations for the counselling and surveillance of obstetric risks of CAYA survivors.
DATA SOURCES: A systematic literature search in MEDLINE (through PubMed) to identify all available evidence published between January 1990 and December 2018.
STUDY ELIGIBILITY CRITERIA: Published articles on pregnancy, perinatal or congenital risks in female cancer survivors were screened for eligibility. Study designs with a sample size larger than 40 pregnancies in CAYA cancer survivors (diagnosed before age 25, not pregnant at that time) were eligible.
STUDY APPRAISAL AND SYNTHESIS METHODS: This guideline from the IGHG systematically appraised the quality of available evidence for adverse obstetric outcomes in CAYA cancer survivors using GRADE methodology, and formulated recommendations to enhance evidence-based obstetric care and preconception counseling of female CAYA cancer survivors.
RESULTS: Healthcare providers should discuss the risk of adverse obstetric outcomes based on cancer treatment exposures with all female CAYA cancer survivors of reproductive age, before conception. Health care providers should be aware that there is no evidence to support an increased risk of giving birth to a child with congenital anomalies (high quality evidence). Survivors treated with radiotherapy to volumes exposing the uterus and their health care providers should be aware of the risk of adverse obstetric outcomes including miscarriage (moderate quality evidence), premature birth (high quality evidence) and low birth weight (high quality evidence); therefore, high risk obstetric surveillance is recommended. Cardiomyopathy surveillance is reasonable prior to pregnancy or in the first trimester for all female survivors treated with anthracyclines and/or chest radiation.
CONCLUSIONS: Female cancer survivors have increased risks of premature delivery and low birth weight associated with radiotherapy targeting the lower body and thereby exposing the uterus, which warrant high-risk pregnancy surveillance.
PMID: 32502557 [PubMed - as supplied by publisher]