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Can the fetus survive chemotherapy or must there be a termination?
The fetus is not unduly harmed by chemotherapy, unless the diagnosis was made and treatment commenced in very early pregnancy. As a matter of fact, chemotherapy ensures the survival of the fetus through the survival of the mother, who stands no chance without it. Termination of pregnancy does not offer any advantage to the treatment.
What if acute leukaemia is diagnosed before conception?
In such a case, the woman will be advised not to embark on pregnancy and effective contraception should be taken. It is inadvisable to conceive whilst on chemotherapy, since this will expose the embryo to these noxious agents at its most sensitive and vulnerable stage.
Will a woman who has been treated for acute leukaemia retain her ability to have children?
A majority of affected women retain their fertility. Nor will a future pregnancy carry any special risk because of her history.
If acute leukaemia is diagnosed in the first trimester of pregnancy (the first 12 to 13 weeks), should termination be contemplated then?
In acute leukaemia, there is no time to lose. Once the diagnosis is made, treatment has to commence promptly. If the pregnancy is in its early part, when the embryo is quite vulnerable, there is an increased risk of miscarriage as a result of chemotherapy. There is also a risk of fetal abnormalities as a direct result of this. This risk is estimated to be in the region of 10 per cent.
The stark reality is there is no dilemma posed. Chemotherapy has to be given and one hopes for the best for the fetus. The alternative to this is to withhold treatment, where the outcome is not in doubt: both mother and baby will be lost. Termination of pregnancy simply doesn't feature in the scheme of things.
If a child was exposed to chemotherapy in the womb as a result of leukaemia treatment for the mother, what are his or her long-term prospects?
Leukaemia in pregnancy is a rare condition and whatever we know about children is necessarily based on this very small sample. As such, we have to be cautious in our pronouncements. Insofar as we know, there are no long-term adverse effects on the child as a result of exposure to these drugs in the womb. More information may emerge in the future, which might alter this perception.
Can acute leukaemia be transmitted from the mother to the fetus in the womb?
This is so exceedingly rare that it should, to all intents and purposes, be ignored. In the last hundred years, only two cases of maternal to fetus transmission of leukaemia have been reported worldwide.
We have discussed acute leukaemias, what about chronic leukaemias and pregnancy?
There are relatively few cases of chronic leukaemia associated with pregnancy in the medical literature. One type of chronic leukaemia is mainly found in the elderly, so it is exceedingly rare to be associated with pregnancy. This is the chronic lymphocytic leukaemia (CLL).
Overall, chronic leukaemias are much less aggressive and can run a very long course, often with long spells without need for treatment. When chemotherapy is required, if the woman is not pregnant yet but planning to conceive, thorough counseling is mandatory to explore the options. Options should include effective contraception during the time of treatment. Chemotherapy immediately before conception or in the early trimester is considered a risk factor (for the fetus).
If the woman is already pregnant and chemotherapy begins later on in pregnancy, the only anticipated problems for the fetus are preterm delivery and low birthweight. These are the same problems encountered with chemotherapy use in acute leukaemias.
Last update: February 1, 2013