Fetal and neonatal effects of cytotoxic agents

Cytotoxic drugs provoke teratogenic and mutagenic effects in animals and humans. Particularly at risk is the developing fetus, which in the first trimester of pregnancy undergoes rapid cell division and organogenesis. Systemic antineoplastic chemotherapy given to a pregnant women at this time may involve fetal risk of abortion, death, stunting, malformation, and systemic toxicity. Other adverse effects may include hematopoietic depression, infection secondary to leukopenia or immunosuppression, hemorrhagic phenomena, and hormonal alterations such as adrenal insufficiency. Although chemotherapy should be withheld during the first trimester unless the health and life of the mother are compromised, a review of the literature reveals that fetal malformation is not inevitable. Furthermore, the risk of fetal malformation following chemotherapy in the second and third trimester is minimal. However, investigators caution that fetal damage, including genetic impairment resulting from chemotherapy throughout pregnancy, may ot appear until much later in life. Most investigators agree that women who have recently recovered from or are being treated for a malignancy should not breast-feed their infants.