Pregnancy and Hodgkin's disease with a report of three cases.

Abstract A review and analysis of the available published literature on Hodgkin's disease and pregnancy with a report of three cases are presented. The need for such a study is clearly indicated by the complete absence of comprehensive information in the modern literature. It is obvious from the reports of the multiple gestations during Hodgkin's disease that fertility is not grossly affected by the process. Spontaneous abortion, contrary to earlier statements, is also apparently unrelated to the presence of Hodgkin's disease in the light of but three occurences in forty gestations. Hemorrhages occurring ante, intra, or post partum show no increased incidence in Hodgkin's disease. In spite of evidence to the contrary, there is considerable doubt that estrogens play a significant part in either the onset or severity of Hodgkin's disease. Study of the age incidence reveals little of significance. The youngest patient was 20 years and the oldest 39 years of age, with an average of 28.3 years. There are 10 primi- and 16 multigravidous women. In sixteen of the twenty-nine cases in which sufficient information can be obtained, pregnancy occurred after the onset of lymphogranulomatosis. It is probable that the disease was present in some, if not in all, of the remaining cases before gestation developed. There does not appear to be any interference with ovulation or fertility by Hodgkin's disease from this fact alone, in contrast to the aberrations in ovarian activity which have been reported in leucemia. 32 In all, thirty-two of a total of forty-two gestations were delivered at term. There were seven interruptions of pregnancy before viability of the fetus, and three spontaneous abortions which were not considered to be related to the lymphogranulomatosis. The largest number, twenty-eight of thirty, delivered naturally and spontaneously at term. One patient was induced medically, and one patient was delivered by cesarean section because of excessive vulvar edema. The latter indication for hysterotomy may have been related to the presence of Hodgkin's disease, but is an exceedingly rare complication in a rare complication of pregnancy. The problem of placental transmission of Hodgkin's disease to the fetus should be considered as a possibility. Of the three reported instances of Hodgkin's disease in young infants, the diagnosis of Hodgkin's disease is unquestioned in two of the mothers. On the other hand, all other viable children born of mothers with Hodgkin's disease have been found to be free of the disease. It can be stated that Hodgkin's disease is transmitted from the mother to the fetus across the placenta in 9 per cent of reported cases. Lymphogranulomatosis has not been reported in the placenta or membranes. Adequate shielding has prevented the occurrence of radiation injury to the fetus in all cases where roentgen therapy was employed in exacerbations of Hodgkin's disease. Thus far there have been no reports of pregnancy in Hodgkin's disease treated with nitrogen mustards. Evaluation of this new therapeutic tool in the management of lymphogranulomatosis must await further study. Of greatest significance is the evidence which can be applied to the establishment of an attitude which will determine the management of pregnancy in Hodgkin's disease. In view of the fact that exacerbations in the process occurred in but eighteen of forty-two gestations during Hodgkin's disease, it is felt that this is little more than the incidence of exacerbations in Hodgkin's disease which one would expect without pregnancy in a comparable group of women. Of the eighteen patients who developed exacerbations during the gestational and puerperal period, thirteen occurred after parturition. This is of real but as yet undetermined significance, especially in the light of the freedom from exacerbations in all patients in whom interruption of their pregnancies, either spontaneously or by induction, occurred before term. It is therefore felt that pregnancy has no demonstrable effect on the over-all incidence of exacerbations in Hodgkin's disease. If there is any tendency whatsoever for exacerbations in Hodgkin's disease to occur during pregnancy, they most likely follow delivery at term. It is therefore considered that there is little evidence from this study to advocate interruption of pregnancy during the course of Hodgkin's disease. When specific and definite obstetrical indications for interruption of pregnancy not related to the Hodgkin's process are present, there is certainly no contra-indication to interruption of pregnancy as far as the Hodgkin's disease is concerned. On the other hand, Hodgkin's disease has little or no effect on the occurrence, course, duration, complications, or end results of gestation.