Novel guidance aims to balance effective cancer treatment with protecting a developing baby, offering clarity for clinicians managing complex cases.
Detailed recommendations for managing cancer during pregnancy have been released in a new report from the Society for Maternal-Fetal Medicine (SMFM), endorsed by the American College of Obstetricians and Gynecologists (ACOG). The guidance, published in the March issue of Pregnancy, provides a framework for evaluation, treatment, and obstetric decision-making, emphasizing individualized care.
The report comes as cancer incidence continues to rise among people of reproductive age. Authors emphasize the need for evidence-based recommendations to guide both medical and obstetric management of these patients. This increase in diagnoses impacts approximately one in every 1,000 pregnancies.
For pregnant patients suspected of having cancer, ultrasound and magnetic resonance imaging (MRI) without contrast are recommended as first-line diagnostic tools.
When medically necessary, other imaging techniques such as computed tomography (CT) scans—with or without contrast—MRI with gadolinium, or positron emission tomography-computed tomography (PET-CT) scans using fluorodeoxyglucose labeled with fluorine-18, combined with CT, can also be utilized. Pregnancy should not be a reason to exclude these tests when they are crucial for diagnosis.
Prophylaxis for thrombosis is recommended for all patients with active hematologic or gynecologic cancers during pregnancy.
For other cancer types—non-hematologic or non-gynecologic—this preventative measure should be considered based on individual risk factors.
Surgical treatment for cancer should not be delayed or refused in a pregnant patient, regardless of gestational age.
If a patient desires to continue the pregnancy, and delaying chemotherapy does not significantly alter the prognosis compared to initiating treatment immediately after diagnosis, chemotherapy is generally administered after the first 12 weeks of gestation.
Medically induced preterm birth should be avoided whenever possible to improve long-term neurodevelopmental outcomes in children exposed to chemotherapy in utero.
The authors stress that cancer treatment during pregnancy must be tailored to each case, considering the type and stage of the disease, the progression of the pregnancy, and the patient’s desire to continue the pregnancy. This personalized approach is critical for optimizing both maternal and fetal health.
