In utero exposure to chemotherapy : effect on cardiac and neurologic outcome.

This study consisted of two parts. Firstly, in a multicenter retrospective study women who received chemotherapy during pregnancy were recruited from four different Belgian centers. Clinical data were obtained through a questionnaire. Obstetric and perinatal data did not differ from earlier reported larger series and suggest morbidity after intrauterine exposure to cytotoxic drugs mainly appears to be related to (induced) prematurity. Nine pregnant women, 25 years to 39 years of age (median, 31 years), of whom one was having a twin pregnancy, had been treated with chemotherapy for different malignant disorders (four breast cancer, two acute myeloid, one lymphoblastic leukemia, one cervical cancer, and one undifferentiated oropharyngeal tumor). Cancer was diagnosed between 12 weeks and 24 weeks (median, 17 weeks) of pregnancy. Thirty-three cycles of antineoplastic drugs were administered between 15 weeks and 35 weeks (median, 25 weeks). Different types of chemotherapeutic regimens were administered. In seven cases, anthracyclines were used with a mean total cumulative dose of 240 mg/m*2. In the second and prospective part of the study, all children were invited for a full neurologic and cardiologic assessment. This assessment consisted of neurologic clinical evaluations by the same pediatric neurologist (L.L.). Standard echocardiographic data acquisition consisted of a standard transthoracic echocardiogram (to measure ventricular dimensions, mass, wall thickness, and fractional shortening) and blood pool Doppler (to assess diastolic function). Color Doppler myocardial imaging was performed from the inferolateral wall, interventricular septum, the left ventricular lateral, and the right ventricular free wall as previously explained to calculate myocardial deformation (peak systolic strain and strain rate). The examinations were performed by the same pediatric cardiologist (L.M.). Echocardiographic data were compared with those of an age- and sex-matched control group consisting of 10 healthy children.