Pregnancy Screening Before Chemotherapy Unlikely in Young ALL Patients

Many adolescent girls with leukemia did not receive pregnancy screening before undergoing teratogenic exposure, according to the results of a study published in Cancer.

There are no standardized guidelines for pregnancy screening in adolescent patients, according to the study. To investigate whether adolescents with leukemia and the potential of exposure to chemotherapy are being screened for pregnancy, researchers examined pregnancy screening patterns among adolescents with acute lymphoblastic leukemia (ALL; n = 889) or acute myeloid leukemia (AML; n = 127) compared with adolescents with an emergency room (ER) visit who received CT scans of the abdomen or pelvis.

“This study found low proportions of pregnancy screening among adolescents with ALL, AML, and ER visits with abdominal/pelvic CT radiation exposures in a nationally representative sample of patients at freestanding pediatric hospitals,” wrote researchers led by Pooja Rao, MD, of the Children’s Hospital of Philadelphia. “This can lead to undetected pregnancies with serious downstream consequences for the adolescent mother and fetus.”

The study included 35,650 patients admitted from 1999 to 2011. Patients with ALL were younger and more likely to be white than patients with AML or ER patients. Appropriately timed pregnancy screens were conducted in 35% of patients with ALL, 64% of patients with AML, and 58% of ER patients, the study showed.

Patients with ALL were 30% less likely to have a pregnancy test compared with ER patients (adjusted prevalence ratio, 0.71 [95% CI, 0.65–0.78]). However, no significant difference was found between patients with AML and ER patients.

“The reason for the difference in ALL and AML pregnancy screening prevalences vs ER screening prevalences is not known,” the researchers wrote. “Because ALL therapy is less intensive than AML therapy, physicians may omit pregnancy screening in patients with ALL, even though both ALL chemotherapy and AML chemotherapy are Food and Drug Administration pregnancy category C or D.”

In addition, although increasing age was associated with increased pregnancy screening, the researchers noted that patient age did not seem to explain the higher rate of screening in patients with AML compared with the ER patients.

“Our findings highlight a need for standardized pregnancy screening practices for adolescent patients exposed to teratogens, including those with acute leukemia,” the researchers wrote. “Although pregnancy screening guidelines before chemotherapy initiation exist in some recent Children’s Oncology Group protocols, these recommendations are vague and inconsistent. This inconsistency may have contributed to the interhospital and intrahospital screening variation observed in our data.”