Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients

Anthracyclines are essential for the treatment of malignancies observed in pregnant patients. Knowledge of the potential side-effects of chemotherapy on the developing fetus is essential for patient counseling.

We collected information concerning patients treated with anthracyclines during pregnancy from a review of literature between 1976 and 2001 and our experience. The events analyzed were malformations, fetal death and spontaneous abortion. A chi(2) test with a Yates correction was used to compare the distribution of severe events.

A total of 160 patient pregnancies were analyzed. The fetal outcome was frequently normal (73%). Abnormalities included malformations (3%), fetal death (9%), spontaneous abortion (3%), fetal complications (8%) and prematurity (6%). Fetal death was often directly consecutive to maternal death (40%). Unfavorable fetal outcome was significantly more frequent in leukemia patients (P = 0.001). In patients with solid tumors, the first trimester was significantly associated with more complications (P = 0.029). The risk of severe fetal toxicity was increased 30-fold when the dose of doxorubicin per cycle exceeded 70 mg/m(2) (P = 0.037).

Anthracyclines may induce embryo-fetal toxicity. Nevertheless the risk seems low, especially after the first trimester and using doses of doxorubicin below 70 mg/m(2).