Maternal Cancer and its Impact on Infants

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Varshit Dusad

Cancer by no stretch of the imagination is a rare disease. It affects a significant population worldwide, and every year millions of dollar are spent investigating the causes of cancer and searching for a potential cure. However, a rarely discussed topic is the adverse impact on the health of infants when their mother suffers from cancer during pregnancy (or maternal cancer). Often, cancer is associated with old age, because our DNA control machinery tends to break down (a leading cause of cancer) as our age progresses. However, there are unfortunate children who may have to suffer from dire consequences due to cancer at a very young age.

A recent study published based on Swedish medical records in the Journal of Clinical Oncology investigated the relationship between maternal cancer and the subsequent impact on the health of fetus as well as the infants [1]. The study found an increased risk of  stillbirth (death of a baby during delivery) and neonatal death (death of an infant in first 28 days of their life) with their mothers’ cancer diagnosis or cancer treatment during pregnancy.  or undergoing cancer treatment during or just after the pregnancy. These results refuted the previous assumption that the presence of maternal cancer does not adversely affect birth outcomes apart from the premature birth of a child [2].

Damage to the fetus may stem from either the mother’s disease or the treatment she receives. A growing fetus requires plenty of nutrition, and the presence of a tumor can divert resources away from it. After all, cancer devours a huge amount of nutrition to maintain its rapid growth. Some evidence suggests they may even restrict oxygen from reaching the fetus. There are many well-documented studies on how lack of oxygen can harm the development of a fetus and even cause death [3]. One can say that the presence of cancer leads to toxicity in the environment of the mother’s womb, which may create problems for the fetus. A fetus requires a healthy and nurturing environment to grow and survive.  Another way by which fetal growth suffers is tumor-induced inflammation [4]. Inflammation is the body’s stressful response against germs and diseases, which often results in abnormal physiological conditions such as high fever, swelling, and pain. Inflammation is particularly active during cancer and is also one of the causes of cancer. According to this study, inflammation can cause damage to fetal growth. This can be observed in the case of cervical cancer, which when managed by inflammatory measures still results in fetal growth disruption. The study also found that even if the mother is diagnosed with cancer after the delivery, there is a significant association with the mortality of the newborn child [1]. One potential reason, as suggested by the authors, is that it is quite possible that even though the mother was diagnosed with cancer after the delivery the disease itself predates the delivery and was thus affecting the mortality of the infant.

However, the treatment of cancer can also lead to rare but fatal events such as stillbirth and neonatal mortality. First of all, cancer treatment, particularly chemotherapy, can put a lot of strain on the body. In a pregnant woman, the effects of treatment may be even more severe as their health can be compromised more easily during pregnancy. Since their physiology directly affects the growth of fetus, it can significantly aggravate the likelihood of unfavorable outcomes. The study also discovered that treatment in different trimesters of pregnancy has different effects. Overall, the second trimester of pregnancy is most vulnerable to side-effects of cancer treatment on childbirth.

This study is vital for both clinicians and patients, as it helps them prepare for very difficult situations. For a mother, it is challenging enough to deal with pregnancy, let alone pregnancy as well as cancer. The thought of mortality for their unborn child can cause severe psychological repercussions to the mothers, but most would agree that it is vital to know the risks before fully consenting to a procedure of any kind, particularly when two lives are on the line. It is also a very challenging situation for clinicians to support the ailing mother and ensure the delivery of a healthy baby, which can be complicated by the presence of cancer. It is known from many previous studies that premature birth, which is associated with neonatal mortality, is a very common consequence of maternal cancer [2]. While a lot of work has been done to study the increased risk of preterm birth among pregnancies complicated with cancer, far little has been done to systematically understand the cause or the correlation between cancer and stillbirth or neonatal mortality.  This study was focused on diminishing that gap in our knowledge. However, since the data sample was entirely based out of Sweden, it may not apply directly to the rest of the world. However, this methodology and the presence of reliable data can help in making informed clinical decisions for oncologists all across the world.

References:

1. Lu, D, Ludvigsson, JF, Smedby, KE, Fall, K, Valdimarsdóttir, U, Cnattingius, S, Fang, F (2017). Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality. J. Clin. Oncol., 35, 14:1522-1529
2. Van Calsteren, K, Heyns, L, De Smet, F, Van Eycken, L, Gziri, MM, Van Gemert, W, Halaska, M, Vergote, I, Ottevanger, N, Amant, F (2010). Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J. Clin. Oncol., 28, 4:683-9.
3. Ream, M, Ray, AM, Chandra, R, Chikaraishi, DM (2008). Early fetal hypoxia leads to growth restriction and myocardial thinning. Am. J. Physiol. Regul. Integr. Comp. Physiol., 295, 2:R583-95.
4. Vohr, BR, Poggi Davis, E, Wanke, CA, Krebs, NF (2017). Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings. Pediatrics, 139, Suppl 1:S38-S49.