Pregnancy and chemotherapy

Chemotherapy is the most common treatment given during pregnancy. You usually start chemotherapy after you are 14 weeks pregnant. At this stage research shows these babies don’t seem to have problems any different to babies whose mothers did not have chemotherapy.

The drugs you have will also depend on the type of cancer you have. Your doctor will avoid giving you certain drugs that could be harmful to the baby.

You will have a break between the last dose of chemotherapy and your expected delivery date. This is so that your blood cells have time to recover. Some women may continue with chemotherapy after the baby is born.

Having chemotherapy during pregnancy

Chemotherapy is the most common treatment given during pregnancy. The drugs destroy cancer cells but also affect healthy cells.

The thought of having chemotherapy during pregnancy can seem frightening. It is natural to worry about the possible effects on the baby. But at the same time, you may feel you want to get on with treatment.

The results of research looking at babies whose mothers had chemotherapy after the first trimester are reassuring. There may be a small risk the baby will be born earlier or have a slightly lower birth weight. But there do not seem to be any other problems that are different to those of babies born to mothers who have not had chemotherapy. Their development compared with other children does not seem any different either.

Your doctor will avoid giving you certain chemotherapy drugs during pregnancy. This is because they are harmful to the baby. Or because there is not enough evidence to show that they are safe in pregnancy.


When chemotherapy is given

You will not usually have chemotherapy during the first trimester. This is because it can increase the risk of a miscarriage or of the baby being born with a birth defect. The baby’s organs are still forming at this early stage.

You can usually start chemotherapy after you are 14 weeks pregnant. At this stage, research shows that most chemotherapy drugs will not harm the baby. The placenta acts as a barrier between you and the baby. Some drugs cannot pass through the placenta. Others can only pass through in very small amounts. Your cancer doctor and specialist nurse will explain this to you.

You may also want to talk to another woman who has been through chemotherapy while pregnant. Mummy’s Star may be able to arrange this for you. Your cancer doctor or nurse may also be able to help you do this.

Your doctors will talk to you about when you will stop chemotherapy. You will have a break between your last dose of chemotherapy and your expected delivery date.

This is to try to avoid having the baby delivered when your blood cells are at a low level. Having a low number of blood cells is a temporary side effect of chemotherapy.

If your baby is delivered soon after you stop having chemotherapy, doctors can give you drugs to support your immune system while you blood cells are low.

Less than a month after being diagnosed, I had a mastectomy. A few weeks later, I began chemotherapy. It made me tired and left me feeling down.

Polly


Different cancers and chemotherapy

You will usually have chemotherapy as an injection or a drip into a vein, or as tablets. This is the same as for women who are not pregnant.

We have more general information about chemotherapy.

Breast cancer

You may have chemotherapy before or after an operation to remove the cancer. Doctors use the same drugs as in women with breast cancer who are not pregnant.

If you need further treatment, such as radiotherapy, trastuzumab (Herceptin®) or hormonal therapies, you will have these after the baby is born.

Cancer of the cervix

If you need chemotherapy, doctors will give you the same drugs they give to women who are not pregnant. You can have further treatment such as surgery or radiotherapy after the baby is born. Some women may have more chemotherapy after the birth.

Non-Hodgkin lymphoma (NHL)

Chemotherapy can be used to treat fast growing NHL during pregnancy. CHOP is the standard combination of chemotherapy drugs used and can be given in pregnancy. It is made up of:

  • Ccyclophosphamide
  • H – doxorubicin (hydroxydaunomycin)
  • O – vincristine (Oncovin®)
  • Pprednisolone (a steroid).

Rituximab is a targeted therapy drug that is usually given with CHOP (R-CHOP). Doctors usually avoid giving it until after the baby is born.

Hodgkin lymphoma (HL)

You can have treatment with a combination of drugs called ABVD. This is a common treatment for Hodgkin lymphoma and it can be given in pregnancy. It is made up of:

  • A – doxorubicin (Adriamycin®)
  • Bbleomycin
  • Vvinblastine (Velbe®)
  • Ddacarbazine (DTIC).

Acute leukaemia

If you need induction chemotherapy for acute myeloid leukaemia (chemotherapy that aims to destroy all the cancer cells), you can have the chemotherapy drugs that are normally given. These are daunorubicin and cytarabine. We have more information about induction chemotherapy in our section on acute myeloid leukaemia (AML).

If you have a type of AML called acute promyelocytic leukaemia (APL), you will usually be given a drug called ATRA, also known as tretinoin (Vesanoid®).

ATRA is based on vitamin A and is not a chemotherapy drug. You cannot take it when you are under 12 weeks pregnant. After this, it is safe to have. But you will not have it at the same time as your chemotherapy. This is safer for the baby and works just as well.

As my cancer wasn’t triggered by hormones, I had chemotherapy while pregnant and was told I could have further treatment once the baby was born.

Polly