Long-term outcomes of children exposed to antineoplastic agents in utero

The long-term outcomes of children exposed to antineoplastic agents in utero are not well-defined. Existing data are significantly limited by small numbers, heterogeneous patient populations and regimens, brief and unsystematic assessments in follow-up, and substantial publication bias. Larger, prospective analyses are necessary to draw definitive conclusions. Potential long-term effects include transplacental carcinogenesis, gonadal dysfunction and infertility, compromised physical and neurologic growth and development, transplacental mutagenesis of germ-line tissue, and teratogenicity and carcinogenesis in subsequent generations. Ideally, chemotherapy should be delayed until the fetus is as fully developed as possible. If maternal outcome would be significantly compromised with deferral until delivery, choice and timing of agents should be based on current knowledge of the most effective, least teratogenic drugs. Knowledge of agent-specific toxicities and their potential for late manifestation in the progeny may be prudent in the vigilant long-term follow-up of children exposed to antineoplastic agents in utero.