Does maternal cancer affect offspring development?

Children exposed to maternal cancer and its treatment show no significant disruptions in their cardiac, neurocognitive, or physical development during adolescence, reveals a study.

Other vulnerabilities observed, such as lower verbal memory and attentions scores, are associated with prematurity and maternal death rather than maternal cancer and its treatment.

“This study provides important insights into the developmental trajectories of children exposed to maternal cancer and its treatment, contributing to the growing body of evidence on the long-term impacts of such exposures,” the investigators said.

Overall, 166 children aged 12 and/or 15 years, who were prenatally exposed to maternal cancer and its treatment, were included in this multicentre cohort study. They underwent clinical, echocardiographic, and neurocognitive evaluations.

The investigators used standardized assessments and explored the relationships between neurocognitive outcomes and covariates using one-way and multivariable analysis of covariance. They also performed further analyses to examine the need for extra support and the impact of chemotherapy exposure on puberty onset.

Of the children, 122 were exposed to chemotherapy, 17 to surgery alone, 14 to radiotherapy, one to trastuzumab, one to rituximab, and 21 to no treatment. [Ann Oncol 2025;36:1025-1034]

Participants showed cardiac function within normal ranges, with a median ejection fraction of 56.7 percent (z score, –1.6), while two children exhibited mild systolic dysfunction (ejection fraction <50 percent). Likewise, neurocognitive outcomes, including memory, attention, and intelligence, were within normal limits.

However, nine children demonstrated lower verbal memory scores associated with exposure to chemotherapy (β, –0.52; p=0.044). Visuospatial memory was negatively associated with maternal death (β, –0.55; p=0.019), while attention correlated with prematurity (β, 0.034 per gestational week; p=0.020) and male sex (β, –0.17; p=0.024).

Extra support

Twenty-one children required extra support, mainly because of lower intelligence, attention, and executive function scores, as well as prematurity. 

“This likely reflects the proactive identification and intervention for developmental problems through participation in the child follow-up study,” the investigators said. “Commonly reported types of support included extra school guidance and psychological support for conditions such as ADHD and autism.”

On the other hand, pubertal development was normal, with no significant associations noted between chemotherapy exposure and puberty onset.

“Although this is reassuring, further follow-up of these children is necessary to assess the risk of specific fertility disorders, particularly for chemotherapy exposure before 20 weeks of gestation, which could affect oocyte production,” the investigators said. [Reproduction 2012;143:151-163]

“Therefore, although we did not find a significant association between gestational age at start of chemotherapy exposure with puberty onset, further follow-up for potential fertility issues, such as gonadal dysfunction and premature menopause, is necessary,” they added. 

Other factors, such as birth weight, must be considered as well, since these may impact the reproductive health outcomes among children.

“While these children generally exhibit normal cognitive, behavioural, cardiac, and physical health outcomes, specific risk factors like maternal death, prematurity, and prenatal chemotherapy exposure require further investigation and targeted interventions,” the investigators said.