Pregnancy with a blood cancer
A new diagnosis of a blood cancer or blood disorder during pregnancy is a rare and traumatic experience.
Being pregnant with a blood cancer or blood disorder poses challenges for you and your unborn baby. In addition, there are unique challenges for you, your baby, your loved ones and your treating medical team in managing both your pregnancy and your blood cancer or blood disorder.
Some of the sections below may not apply to you or your particular circumstance. We recommend you refer to the sections that apply to you. Please seek clarification from your treating doctor if you are unsure whether the information below applies to you.
A blood cancer or blood disorder diagnosis can have a significant impact on your wellbeing, creating feelings of shock, fear and uncertainty. When a blood cancer or disorder develops during pregnancy, the effect on your psychological and emotional wellbeing is increased and your ability to cope with day to day activities and responsibilities is challenged.
Pregnancy in itself can be a time of increased stress and worry. This is due to a range of physical, psychological and emotional changes that occur during pregnancy. Worry and fear of childbirth or concerns about the healthy development of your baby are normal emotions experienced during pregnancy. Lack of sleep or nausea and vomiting can also increase stress levels and decrease your coping abilities.
It is important for you to talk about how you are feeling with your loved ones and your medical team. Sharing your feelings can help ease your concerns and can help you to understand that your fears and worries are normal. There are a number of strategies you can use to help you increase your ability to cope. These can include light exercise such as walking, adequate sleep, a balanced diet, meditation or talking to other pregnant women. Remember to use strategies that work best for you.
If you are experiencing a sense of hopelessness or you feel you are not coping it is important to speak to your medical team. Your health professionals are the best people to help you get the support you need so that you are able to manage all the challenges that pregnancy and a blood cancer/disorder diagnosis will present. Support will increase your overall physical and psychological wellbeing. If you are feeling overwhelmed, or just feel like you are not coping, you are not alone.
A counsellor or a psychologist may be helpful and are best placed to provide you with the coping strategies you need to manage your way through your pregnancy and diagnosis. It is important for the wellbeing of both yourself and your baby that you speak to your GP, haematologist or other treating medical specialist about getting the support you need.
Scans and Tests
Your treating medical team are the best people to advise you of the tests available to you and of any risks relevant to your specific circumstances.
Treatment options may vary depending on the stage of your pregnancy and the type of blood cancer or blood disorder you have been diagnosed with.
Your health is at the forefront of all treatment options with the primary aim being to reduce any treatment side-effects to you and your baby.
In the first trimester of pregnancy your baby’s organs are developing and as such, your medical team will adopt a cautious approach when considering the use of chemotherapy agents and medications that may interrupt or interfere with your baby’s development.
However, there are a number of chemotherapy agents and medications that can be used during the first trimester of pregnancy. Small doses of radiotherapy have also been reported to be relatively safe. It is important to discuss the risks and benefits with your medical team so that you are able to make an informed decision about the treatment options available to you.
In the early stages of your pregnancy, particularly in the first trimester, considering whether or not to continue with your pregnancy may be a decision you and your loved ones face and will work through with your medical team. In some circumstances, withholding treatment for the blood cancer or disorder for the sake of the health of your unborn baby may have life-threatening consequences for you. This is of a particular concern with some acute and aggressive blood cancers and blood disorders.
Second and Third Trimesters
In the second and third trimester of your pregnancy, treatment options may include reducing or delaying treatment for a short time until after your baby is delivered.
Alternatively, your medical team may recommend that you proceed with the usual course of treatment. Treatments during the latter trimester have fewer reported side-effects on the baby.
When providing treatment options, your treating team will weigh up the risk to you and your baby and they will assess any potential complications that may arise. Early delivery may be considered so that your treatment can commence or continue as soon as possible.
Acute Blood Cancers and Blood Disorders
An acute blood cancer or blood disorder often means the disease is ‘fast growing’, causing many serious symptoms and consequences, and treatment may need to begin straight away.
Treatment for acute blood cancers and blood disorders may involve chemotherapy, radiotherapy or other types of medications. It is important for you to be supported and provided with all the relevant information that you and your loved ones need so that you are able to make informed decisions about the treatment options available to you.
Your treating medical team may include a number of different healthcare specialists such as haematologists, obstetricians, gynaecologists, a neonatologist, nurses, psychologists and other allied health professionals such as social workers and dietitians. These healthcare specialists understand that this is a difficult time for you and your loved ones and are there to talk through any concerns you or your loved ones may have.
Chronic Blood Cancers or Blood Disorders
Chronic blood cancers or blood disorders present a different set of challenges for you, your baby, your loved ones and your medical team. A chronic blood cancer or blood disorder often means the disease is slower in developing or ‘slow growing’. Management and treatment of your condition will depend on your diagnosis type, stage and how well controlled your disease is.
Some chronic conditions may mean you will require more regular check-ups with your treating specialist than usual during pregnancy. More regular check-ups and closer monitoring are done by your medical team to ensure you and your developing baby is progressing through your pregnancy safely.
If you are on medication for blood cancer or a blood disorder, your doctor will provide you with the best advice about the treatment options available to you and how often you will be required to attend a check-up.
In some cases, patients who are already being treated with medication for a chronic blood cancer or blood disorder may be advised by their medical team to consider an alternative drug that may have fewer side-effects on the baby during pregnancy. This may not always be an option for you and your treating doctor is the best person to provide you with advice in this circumstance.
‘Watch and Wait’
Some less aggressive forms of blood cancer or blood disorders may mean you are given the choice to keep a close watch on the disease without starting any treatments. This is called the ‘watch and wait’ approach. Here, your disease will be closely monitored by your medical team throughout and after your pregnancy. Treatment may commence in the second or third trimester if your medical team feels it’s necessary to control your disease at this time.
Risk of Clots
The risk of blood clots to the mother can increase during pregnancy and, when combined with some blood cancers, this risk may increase further. The use of anti-clotting medications to reduce your risk of developing blood clots may be recommended by your doctor during pregnancy.
Despite there being some anti-clotting medications that are not recommended for use in pregnancy, there are many that are safe to use. The use of any medication will be closely monitored by your treating medical team during pregnancy, during labour, and after the birth.
Risks to the baby
Risks to the baby following the mother’s treatment for blood cancer may include, but are not limited to: bone marrow suppression (low red cells, platelets and white cells), birth defects, low birth weight, abnormal neurological function, stillbirth, and the potential development of childhood cancers. These risks vary from being extremely low to fairly significant depending on the medications used in the treatment regimen. Your medical treating team considers all potential risks to you and your baby when weighing up your treatment options.
If you are in the later stages of your pregnancy your medical team may induce an early birth, but will delay this as long as possible, considering all the risks to both mother and baby. A gestation period of 32 weeks is common for induction in this situation, but this is not always possible. Your treating medical team will advise accordingly.
If your baby is delivered prematurely, you may require certain medications to help develop your baby’s lungs in preparation for his or her birth. Your treating medical team will provide you with the most appropriate advice for your circumstance in this situation.
Labour may be induced early in order to provide you and your baby with the best possible outcomes. Sometimes it is potentially very difficult to induce labour. This may mean considering a caesarean section as an alternative. If a caesarean section is determined to be the most appropriate mode of delivery for your baby, your medical team will discuss this option with you.
In some instances, it may be recommended that your baby is delivered in between your treatment cycles. Your medical team will weigh up all the risks and benefits to you and your baby and they will advise you accordingly.
Breastfeeding may not be appropriate for your baby during or after certain treatments for blood cancer or blood disorders, as some medications may be present in the breast milk and passed on to your child. However, there are many circumstances in which breastfeeding may still be an option, even if for a brief period. The possibility of being able to breastfeed should be discussed with your treating medical team.