The International Federation of Gynecology and Obstetrics (FIGO) has released a best practice guideline addressing cancer in pregnancy, a condition with limited data and complex diagnostic challenges. This new guidance—published by Nanda et al in the International Journal of Gynecology & Obstetrics—is based on a comprehensive narrative review and offers critical recommendations for managing cancer during pregnancy.
Cancer during pregnancy is relatively rare but is expected to increase globally as maternal age rises and cell-free DNA testing becomes more widespread. The guidance’s authors highlight that physiologic changes in pregnancy may delay diagnosis, and the lack of experience among health-care providers in managing such cases may lead to suboptimal outcomes for both mother and fetus. This paper emphasizes that, in most cases, the principles of cancer management in pregnant patients do not significantly differ from those in nonpregnant patients; however, special care must be taken to assess fetal risks from diagnostic imaging, surgery, chemotherapy, and radiation.
Treatment Approaches
Highlights from the guidance include the following:
- Surgery may be performed at any gestational age when indicated, though the early second trimester is preferable. Laparoscopic approaches are recommended when suitable.
- Chemotherapy should be avoided in the first trimester but can be administered from the second trimester onward using standard regimens.
- Radiotherapy should generally be avoided, particularly pelvic radiation, though it may be considered in the first trimester with careful planning.
Pregnancy-Specific Considerations
The paper highlights several important pregnancy-related factors:
- Thromboprophylaxis with low–molecular-weight heparin is recommended for all pregnant women with active cancer.
- Noninvasive prenatal testing should be avoided, as maternal cancer can cause false-positive results.
- Fetal surveillance requires regular growth scans and monitoring for complications.
- Vaccination should follow standard pregnancy guidelines.
The paper also provides evidence-based guidance on delivery planning, postnatal care, outcomes, and prognosis, while addressing the ethical and psychological challenges of cancer during pregnancy. The authors stress the importance of multidisciplinary care involving oncologists, surgeons, radiologists, obstetricians, neonatologists, and other specialists. This coordinated approach is essential for ensuring both maternal health and fetal well-being. They also touch on the need for psychological support for pregnant women with cancer and their families during and after pregnancy.
Designed for use in all health-care settings—from high-income countries to low- and middle-income regions—this best practice advice aims to provide recommendations on the diagnosis and management of cancer in pregnancy, which can be adopted in all resource settings.
The guidance authors concluded: “It is important to empower the pregnant and recently pregnant women to have the same quality of care as any nonpregnant person, to be properly informed, and to be involved in all decisions relating to their care.”
Disclosure: For full disclosures of the study authors, visit obgyn.onlinelibrary.wiley.com.
