Preconception and antenatal care for women with a history of haematopoietic stem cell transplantation: Results of a UK clinician survey

Abstract

Background Female childhood cancer survivors with history of bone marrow transplant with or without total body irradiation have increased pregnancy risks. Preconception counselling and early referral to appropriate clinical pathways may improve pregnancy outcomes. Methods UK-wide survey of clinicians, promoted via social media and conferences, jointly funded by Action Medical Research/Borne. Results Forty responses received between 22 October 2020 and 21 October 2021: 43% reviewed this group monthly, 15% annually, 15% less than annually, and 27% never (for O & G only: 13%, 13%, 26%, and 48%, respectively). Pre-pregnancy, most discussed potential fertility/pregnancy implications. Early pregnancy discussions included late miscarriage (34%), preterm birth (44%), fetal growth restriction (31%), and health risks other than cancer (30%). During pregnancy: 80% refer to specialist clinics; 87% offer extra investigations; 33% prescribed aspirin; 20% offered cervical cerclage; and 13% prescribed progesterone. Conclusions Evidence of variation in care. As previous observations suggest pregnancy outcomes improve when managed in specialist clinics, clearer guidance is required.