Pre-eclampsia following chemotherapy for breast cancer during pregnancy: case report and review of the literature

There has been some discussion about the effect of antineoplastic agents on the trophoblast, and whether this is associated with abnormal placental function such as an increased risk of pre-eclampsia/eclampsia. We discuss a possible causal relationship between chemotherapy for breast cancer during pregnancy and the development of pre-eclampsia based on the occurrence of both in a recent pregnancy. We report the case of a 34-year-old gravida 4, para 1 with unilateral ductal invasive breast cancer, treated by surgery and subsequent chemotherapy during pregnancy. At 36 + 2 weeks of gestation a growth restricted male infant (1,680 g, < 5th percentile) was born by urgent caesarean section because of acute pre-eclampsia, pathologic CTG and umbilical end-diastolic reverse flow. This case is reported in detail, and literature and databases reviewed. So far there have been no reports suggesting an increased risk of pre-eclampsia following chemotherapy for breast cancer in pregnancy from the second trimester onwards, and the most probable is an accidental occurrence from pre-eclampsia and chemotherapy. Whenever possible, pregnant patients with breast cancer should receive the same treatment as those who are not pregnant. Should chemotherapy for breast cancer be indicated in pregnancy from the second trimester onwards only, contraindications would be other risks for pre-eclampsia and intrauterine growth restriction, such as smoking and gestational diabetes.