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      Psychological issues and construction of the mother-child relationship in women with cancer during pregnancy: a perspective on current and future directions

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          Abstract

          Background

          Cancer during pregnancy is a rare event. However, knowledge about treatment has progressed in recent years with improved maternal and neonatal outcomes. The number of women who decide to continue their pregnancy and undergo cancer treatment is increasing.

          Main body

          Women face two critical events simultaneously; oncological illness and pregnancy, with different and conflicting emotions. In addition, the last trimester of gestation sets the ground for construction of the mother-child relationship, which is of great importance for the child’s development. Studies have showed that maternal exposure to stressful events during pregnancy is linked to adverse outcomes in children. Although several authors consider cancer to be a ‘critical life event’, studies that address the psychosocial implications of cancer in expecting mothers are scarce. There are no studies addressing the possible negative impact of a cancer diagnosis during pregnancy on the mother-child relationship and on the child’s development. It is important to emphasize the need for in-depth knowledge of the contributing psychological factors involved in order to provide holistic, individualised, and supportive care.

          Conclusion

          An analysis of cognitive aspects, emotional processes, and maternal attachment in cases of cancer during pregnancy may contribute to the development of a model of care, both in an evolutionary and in a psycho-oncology context, with implications for clinical practice.

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          Most cited references19

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          Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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            Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy.

            Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking.
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              Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes.

              The aim of this study was to assess the management and the obstetrical and neonatal outcomes of pregnancies complicated by cancer. In an international collaborative setting, patients with invasive cancer diagnosed during pregnancy between 1998 and 2008 were identified. Clinical data regarding the cancer diagnosis and treatment and the obstetric and neonatal outcomes were collected and analyzed. Of 215 patients, five (2.3%) had a pregnancy that ended in a spontaneous miscarriage and 30 (14.0%) pregnancies were interrupted. Treatment was initiated during pregnancy in 122 (56.7%) patients and postpartum in 58 (27.0%) patients. The most frequently encountered cancer types were breast cancer (46%), hematologic malignancies (18%), and dermatologic malignancies (10%). The mean gestational age at delivery was 36.3 +/- 2.9 weeks. Delivery was induced in 71.7% of pregnancies, and 54.2% of children were born preterm. In the group of patients prenatally exposed to cytotoxic treatment, the prevalence of preterm labor was increased (11.8%; P = .012). Furthermore, in this group a higher proportion of small-for-gestational-age children (birth weight below 10th percentile) was observed (24.2%; P = .001). Of all neonates, 51.2% were admitted to a neonatal intensive care unit, mainly (85.2%) because of prematurity. There was no increased incidence of congenital malformations. Pregnant cancer patients should be treated in a multidisciplinary setting with access to maternal and neonatal intensive care units. Prevention of iatrogenic prematurity appears to be an important part of the treatment strategy.
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                Author and article information

                Contributors
                federica.ferrari@ieo.it
                39-0257489731 , flavia.faccio@ieo.it
                fedro.peccatori@ieo.it
                gabriella.pravettoni@ieo.it
                Journal
                BMC Psychol
                BMC Psychol
                BMC Psychology
                BioMed Central (London )
                2050-7283
                16 March 2018
                16 March 2018
                2018
                : 6
                : 10
                Affiliations
                [1 ]ISNI 0000 0004 1757 0843, GRID grid.15667.33, Applied Research Division for Cognitive and Psychological Science, , European Institute of Oncology, ; Via Ripamonti 435, 20141 Milan, Italy
                [2 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Department of Oncology and Hemato-Oncology, , University of Milan, ; Via Festa del Perdono 7, 20141 Milan, Italy
                [3 ]ISNI 0000 0004 1757 0843, GRID grid.15667.33, Fertility and Procreation Unit, Gynecologic Oncology Division, , European Institute of Oncology, ; Via Ripamonti 435, 20141 Milan, Italy
                Author information
                http://orcid.org/0000-0002-0231-9707
                Article
                224
                10.1186/s40359-018-0224-5
                5857118
                29548301
                4e154862-17fd-4ca5-a09d-1f1ecdc0427d
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 January 2018
                : 11 March 2018
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                © The Author(s) 2018

                cancer,pregnancy,mother-child relationship,mothers,psychological factors

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