Friday, March 31, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for hematologists/oncologists, family medicine/primary care clinicians, obstetricians/gynecologists/women’s health clinicians, pediatricians, public health and prevention officials, nurses, pharmacists, physician assistants, and other members of the health care team for pregnant women with cancer and their offspring.
The goal of this activity is for learners to be better able to describe short- and long-term somatic and psychiatric outcomes in children exposed to maternal cancer in utero, alone or with chemotherapy, based on a nationwide cohort study identifying all children in Denmark who were live-born between January 1978 and December 2018.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.
Medscape, LLC designates this enduring material for a maximum of 0.25
AMA PRA Category 1 Credit(s)™
. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-23-069-H01-P).
Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 02/24/2024. PAs should only claim credit commensurate with the extent of their participation.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive
AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC / CE Released: 2/24/2023
Valid for credit through: 2/24/2024
processing....
Cancer diagnosed during pregnancy period affects approximately 2 in 10,000 live births. Many intrauterine exposures, including teratogenic drugs, radiation, smoking, alcohol, placental hypoperfusion during surgery, maternal illness, and poor maternal nutritional state, may affect fetal development, which plays an essential role in the offspring’s general health and neurocognitive development.
Children exposed to cancer in utero are at increased risk for prematurity. Outcomes in children exposed to maternal cancer in utero have been reported in case-based studies. In Denmark, a shift in treatment strategy of cancer in pregnancy occurred around 2000, when recommendations were introduced regarding use of chemotherapy during pregnancy.
Children who were exposed in utero to maternal cancer and treatment do not appear to have any long-term health consequences as a result of this exposure, a nationwide Danish study suggests.
The study evaluated live-born children between January 1978 and December 2018 whose mothers were diagnosed with cancer during pregnancy. Compared with unexposed fetuses, children exposed in utero had no higher overall mortality and no increased risk for congenital malformations.
Researchers also determined that exposure to chemotherapy was not associated with somatic diseases and congenital malformations when compared with in utero exposure to maternal cancer without chemotherapy.
“These findings suggest that fetal exposure to maternal cancer and treatment did not have implications for the long-term somatic and psychiatric health of the children, which is reassuring for the affected families and their health care providers,” the researchers commented.
The article was published online July 7, 2022, in the Journal of Clinical Oncology.
Approached for comment, Katherine Van Loon, MD, MPH, director of the Global Cancer Program at the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, said that the results offer “promising news.”
“In the balance between administering needed oncologic therapy to save a mother’s life versus considering potential risks to the fetus, this data is reassuring that there is not an increased risk of catastrophic outcomes for the fetus,” Dr Van Loon said. She noted, however, that the exposed children were not prospectively evaluated for adverse outcomes, which may have been more subtle than this study could detect.
The authors used data from the Danish Civil Registration System and Danish Medical Birth Register. They found that of 2,526,163 live-born children, 690 (0.03%) were exposed to maternal cancer in utero. Children born to mothers younger than 15 years or older than 54 years and children with an outcome diagnosis were excluded from the study.
Researchers found that children exposed to maternal cancer in utero did not demonstrate a higher overall mortality than the unexposed reference group (adjusted hazard ratio [aHR] 0.8; 95% CI, 0.4-1.5). There was also no excess of congenital malformations (aHR, 1.0; 95% CI, 0.8-1.2). In addition, there were no excesses of puberty disturbances or respiratory, cardiovascular, urinary tract, or neurologic disease.
Researchers also conducted a subgroup analysis on in utero exposure to chemotherapy, which involved 1,053,109 children born after 2002. There were 378 (0.03%) children exposed to maternal cancer in utero, 42 (12.5%) of whom were exposed to chemotherapy. Chemotherapy was given during the second trimester in 73.8% of the mothers and during the third trimester in 26.2%.
No deaths or events of cancer, autism spectrum disorder, attention-deficit hyperactivity disorder, hearing loss, or suppressed myelopoiesis were identified during follow-up of the 42 children exposed to chemotherapy in utero.
Dr Van Loon said that many cancer treatments are safe during pregnancy, but added that every situation is nuanced, with a number of variables to consider.
“All treatment decisions must take into account the diagnosis and prognosis of the mother, the gestational age of the fetus, and the potential teratogenic effects of the proposed treatments,” she said.
The study was supported by grants from The Research Fund of Rigshospitalet, Copenhagen University Hospital, The Novo Nordisk Foundation, Johannes Clemmesen Research Foundation, Helsefonden, Holm Memorial Foundation, and the Danish Cancer Research Foundation. Researcher disclosures are listed in the study paper.
J Clin Oncol. 2022; 40(34):3975-3984.[1]
