Pregnancy and neonatal outcomes in 25 pregnant women diagnosed with new-onset acute myeloid leukemia during pregnancy

Pregnancy and neonatal outcomes in 25 pregnant women diagnosed with new-onset acute myeloid leukemia during pregnancy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pregnancy and neonatal outcomes in 25 pregnant women diagnosed with new-onset acute myeloid leukemia during pregnancy Jing Ding, Yihan Xiao, Jie Fu, Guoli Liu, Shanyamei Huang, Xiaodong Mo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3348961/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Mar, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 5 You are reading this latest preprint version Abstract Purpose The aim was to analyze the pregnancy and neonatal outcomes of pregnant women with new- onset acute myeloid leukemia (AML) diagnosed during pregnancy. Methods In this retrospective study 25 pregnant women who were diagnosed with new-onset AML during pregnancy from January 2010 to January 2021 were enrolled. Results A total of 4, 13 and 8 pregnant women with new-onset AML were diagnosed during the first, second, and third trimesters, respectively. Twelve of the 25 pregnant women underwent therapeutic abortion and 13 gave birth (9 preterm and 4 full-term newborns). The gestational age at initial clinical manifestations (13.4 ± 3.7 vs. 27.7 ± 5.6 weeks, P < 0.01) and diagnosis (16.9 ± 4.4 vs. 29.7 ± 5.5 weeks, P < 0.01) was lower in the pregnant women who underwent therapeutic abortion than in those who gave birth. Eighty-four percent (21/25) of the pregnant women with new-onset AML during pregnancy survived and were in remission and all the newborns were born alive. Three of the 13 newborns were exposed to chemotherapy, but no congenital malformations were observed. Eight newborns were admitted to the neonatal intensive care unit (NICU), and then all recovered. The complete blood counts and biochemical examinations of the 8 newborns were normal. Conclusions New-onset AML during an earlier stage of pregnancy may increase the risk of poor pregnancy outcomes. The neonatal outcomes of pregnant women with new-onset AML during pregnancy are good with proper treatment. Acute myeloid leukemia pregnancy newborn outcomes What does this study adds to the clinical work? New-onset AML during an earlier stage of pregnancy may increase the risk of poor pregnancy outcomes. The neonatal outcomes of pregnant women with new-onset AML during pregnancy are good with proper treatment. Introduction Leukemia during pregnancy is uncommon and its incidence is estimated to be 1 in 75000 to 100000 [ 1 ]. Most cases of leukemia during pregnancy are acute, and acute myeloid leukemia (AML) accounts for approximately two-thirds of cases [ 2 ]. The actual incidence of new-onset AML during pregnancy is not well known. However, new-onset AML during pregnancy is extremely rare. The diagnosis of new-onset AML during pregnancy is devastating for pregnant women, who need to be counseled on the risks of termination, early delivery and chemotherapy administration. The main goal is to reach the end of pregnancy with a viable healthy newborn and to cause as little impairment as possible to the pregnant woman. The maternal and fetal risks must be carefully assessed before treatment. AML, especially new-onset AML, may increase the risk of complications for pregnant women, affect the growth and development of the fetuses, and increase the mortality of them [ 3 ]. Some studies reported that pregnant women with acute leukemia were more likely to experience postpartum hemorrhage, suffer from disseminated intravascular coagulation (DIC), have wound complications and experience venous thromboembolism [ 4 ]. In addition, maternal death, preterm delivery, and intrauterine fetal death are more common in pregnant women with acute leukemia [ 4 , 5 ]. However, there is limited information regarding the pregnancy and neonatal outcomes of pregnant women with AML, especially those diagnosed with new-onset AML during pregnancy. The available literature regarding AML during pregnancy is composed mainly of small retrospective studies and case reports [ 6 , 7 ]. In the current study, we included 25 pregnant women who were initially diagnosed with AML during pregnancy at our institution over the past 11 years (January 2010- January 2021). To our knowledge, this is the largest retrospective cohort of pregnant women with new-onset AML during pregnancy in China. We analyzed the pregnancy and neonatal outcomes to provide some hints for the prognosis and management of new-onset AML during pregnancy. Materials and Methods Patients In this retrospective study, information was collected using the electronic medical records of patients with AML who were diagnosed during pregnancy at our institution between January 2010 and January 2021. Patients with AML that was diagnosed before or after pregnancy were excluded. All procedures followed were in accordance with the ethical standards of the Helsinki Declaration of 1975, as revised in 2013. The diagnostic evaluation and morphological classification of leukemia were carried out using WHO (2008/2016) criteria. Treatment Obstetricians who had experience treating women with complicated pregnancies followed all pregnant women with new-onset AML throughout their pregnancies. The treatment was individualized. In general, for pregnant women who were diagnosed with AML in the first trimester, elective termination was recommended. For pregnant women who were diagnosed with AML in the second or third trimester, chemotherapy was optional. The time of chemotherapy initiation depended on the aggressiveness of AML, the subtype of AML and the therapy-attributable risks for the mother and fetus. In addition, treatment strategies were also planned and carried out considering each pregnant woman’s decisions. AML induction treatment consisted of all trans retinoic acid (ATRA) and daunorubicin (DNR) with or without arsenic trioxide (ATO). Statistical analysis Continuous variables, expressed as the mean ± standard deviation, were compared using independent samples t tests. Categorical variables were compared using the χ 2 test or Fisher’s test. All analyses were carried out using computer software (SPSS 20.0 for Windows). A p values less than 0.05 was considered statistically significant. Results Characteristics of the pregnant women with new-onset AML We identified 25 pregnant women with AML initially diagnosed during pregnancy. Fourteen, 7 and 4 of the 25 pregnant women had the maturation (M2), acute promyelocytic leukemia (APL) and active monocytic leukemia (M5) subtypes, respectively. The median age at new-onset AML diagnosis was 28 years (range, 18–41 years). Eighteen of the 25 pregnant women with new-onset AML were primiparous, and 7 were multiparous. Four, 13 and 8 pregnant women were diagnosed during the first, second, and third trimesters, respectively. The median gestational age at initial clinical manifestations and diagnosis of AML was 20 (range, 7-36.6) and 23.4 (range, 10.9–37.1) weeks respectively. The median time between initial clinical manifestations and diagnosis was 0.5 (range, 0-16.4) weeks. Four pregnant women with new-onset AML received chemotherapy during pregnancy, and 21 did not. Three of the 4 pregnant women who received chemotherapy were diagnosed in the second trimester, and one was diagnosed in the third trimester. All the 4 pregnant women who received treatment had the APL subtype. The details of the 25 pregnant women with new-onset AML are shown in Table 1 . Table 1 Clinical characteristics of the 25 pregnant women with new-onset AML diagnosed during pregnancy Patient No. Age at diagnosis (years) Pregnancy No. Subtype of new-onset leukemia Gestational age at initial clinical manifestation (weeks) Gestational age at diagnosis (weeks) Treatment Interval between diagnosis and chemotherapy (days) Delivery or abortion 1 31 G3P0 AML-M2 16w 18w + 2d / / Abortion 2 18 G1P0 AML-M2 9w + 1d 10w + 6d / / Abortion 3 26 G2P1 APL 30w 30w + 3d ATRA + DNR 1d Delivery 4 20 G1P0 AML-M5 7w 23w + 3d / / Abortion 5 18 G1P0 AML-M2 36w + 4d 37w + 1d / / Delivery 6 21 G1P0 AML-M2 13w 19w / / Abortion 7 29 G1P0 AML-M5 18w + 5d 19w + 2d / / Abortion 8 23 G1P0 APL 24w 24w + 3d ATRA 1d Delivery 9 28 G3P0 AML-M2 10w 11w / / Abortion 10 27 G1P0 AML-M2 17w + 2d 18w + 5d / / Abortion 11 41 G5P1 AML-M2 22w 22w / / Delivery 12 28 G3P1 AML-M5 31w + 1d 31w + 1d / / Delivery 13 38 G1P0 AML-M2 21w 21w + 3d / / Delivery 14 35 G3P1 APL 10w 13w / / Abortion 15 23 G1P0 APL 31w + 5d 31w + 5d / / Delivery 16 25 G3P1 APL 34w + 6d 34w + 6d / / Delivery 17 35 G1P0 AML-M2 25w 36w / / Delivery 18 25 G2P1 AML-M2 17w 17w + 1d / / Abortion 19 37 G2P1 APL 15w + 6d 16w + 1d ATRA + ATO 3d Abortion 20 33 G1P0 APL 24w + 2d 24w + 2d ATRA + DNR 7d Delivery 21 36 G5P0 AML-M5 20w 31w + 6d / / Delivery 22 33 G1P0 AML-M2 34w 34w + 4d / / Delivery 23 32 G1P0 AML-M2 25w + 6d 25w + 6d / / Delivery 24 28 G1P0 AML-M2 14w 24w / / Abortion 25 41 G2P0 AML-M2 12w + 2d 12w + 2d / / Abortion Acute promyelocytic leukemia (APL), ATRA: all- trans retinoic acid ; DNR: daunorubicin ; ATO: arsenic trioxide Pregnancy outcomes Of the 25 pregnant women with new-onset AML, 12 underwent therapeutic abortion (abortion group), and 13 gave birth (delivery group). Five pregnant women had vaginal deliveries, 7 delivered by cesarean section and 1 underwent forceps delivery. The gestational age at initial clinical manifestation and diagnosis was lower in the abortion group than those in the delivery group (Table 2 ). Nine pregnant women with new-onset AML delivered prematurely, and 4 delivered at term. The initial clinical manifestations and diagnosis times of the preterm and full-term delivery groups are shown in Table 3 . Table 2 The characteristic differences between pregnant women with new-onset AML in the abortion and delivery groups Characteristics Abortion (n = 12) Delivery (n = 13) χ 2 /t P Maternal age (years) 28.3 ± 6.9 30.1 ± 6.8 -0.634 0.532 Initial clinical manifestation time (weeks) 13.4 ± 3.7 27.7 ± 5.6 -7.482 0.000 Diagnosis time (weeks) 16.9 ± 4.4 29.7 ± 5.5 -6.381 0.000 G 1.8 ± 0.9 2.0 ± 1.5 -0.497 0.624 P Maternal death 0.3 ± 0.5 0 0.3 ± 0.5 4 -0.309 4.396 0.760 0.036 G: gravida; P: parity Table 3 The clinical features of pregnant women with new-onset AML in the preterm and full-term delivery groups Characteristics Preterm delivery (n = 9) Full-term delivery (n = 4) Maternal age (years) 32.1 ± 5.9 25.5 ± 7.1 Initial clinical manifestation time (weeks) 27.2 ± 5.8 28.9 ± 5.8 Diagnosis time (weeks) 28.6 ± 5.3 32 ± 5.8 G 2.3 ± 1.7 1.3 ± 0.5 P 1.3 ± 0.5 1.3 ± 0.5 Chemotherapy 1 2 Postpartum hemorrhage 6 1 Prenatal infection 1 0 DIC 1 0 G: gravidity; P: parity; DIC: disseminated intravascular coagulation Seven pregnant women with new-onset AML experienced postpartum hemorrhage, 2 suffered from disseminated intravascular coagulation (DIC) and 3 had prenatal infection. The 2 pregnant women who suffered DIC both had the APL subtype. All pregnant women with new-onset AML were alive during pregnancy, but 4 died 2.3–18.7 months after delivery due to AML or its complications (Table S1 ). The 4 pregnant women who died were diagnosed in the second or third trimester. None of the dead patients received induction chemotherapy during pregnancy and they all chose to deliver their babies before treatment. The other 21 pregnant women with new-onset AML are currently alive and in remission. Neonatal outcomes Nine of the 13 newborns were premature, and 4 were full-term. The average birth weights were 2166g (range, 1520–2860 g) and 3120 g (range, 2340–3950 g) for the newborns born preterm and at term, respectively. One newborn was small for gestational age, and all newborns were born alive. The 1-minute Apgar scores for 2 newborns were less than 8, and those of the other 11 newborns were greater than or equal to 8. The 5-minute Apgar scores of all newborns were greater than 8. Three of the 13 newborns had been exposed to chemotherapeutic agents (the newborns of 2 women diagnosed in the second trimester and 1 woman diagnosed in the third trimester). No congenital malformations were observed. The clinical characteristics of the 13 newborns at birth are shown in Table 4 . Table 4 Clinical features of the 13 newborns whose mothers had new-onset AML during pregnancy Neonate No. Maternal leukemia subtype Delivery mode GA (weeks) Sex Weight (g) Apgar score (1min) Apgar score (5min) Chemotherapy before delivery Neonatal outcome 1 AML-M3 CS 38 + 4 Male 3340 10 10 Yes Alive 2 AML-M2 Forceps 37 + 2 Female 2850 10 10 No Alive 3 AML-M3 CS 41 Female 3950 10 10 Yes Alive 4 AML-M2 SVD 32 + 6 Male 2350 10 10 No Alive 5 AML-M5 SVD 32 + 2 Female 1720 9 10 No Alive 6 AML-M2 SVD 29 + 6 Female 1520 8 9 No Alive 7 AML-M3 CS 32 + 3 Male 1990 6 9 No Alive 8 AML-M3 CS 36 + 3 Female 2720 10 10 No Alive 9 AML-M2 SVD 37 Female 2340 10 10 No Alive 10 AML-M3 CS 36 + 6 Female 1700 10 10 Yes Alive 11 AML-M5 CS 32 Female 2010 5 10 No Alive 12 AML-M2 SVD 35 + 5 Female 2620 10 10 No Alive 13 AML-M2 CS 35 + 1 Male 2860 10 10 No Alive GA: gestational age; SVD: spontaneous vaginal delivery; CS: cesarean section Eight newborns developed one or more neonatal complications and were admitted to the NICU in our institution (Supplementary Table S2). The other 5 newborns were healthy. The complete blood count and levels of alanine transaminase (ALT), aspartate transaminase (AST), urea nitrogen, creatinine, albumin, cholesterol, triglycerides and blood glucose were normal in the 8 newborns (Supplementary Table S3 and Table S4). All the 8 newborns admitted to the NICU were discharged after 4–38 days. Discussion In this study, we retrospectively reviewed and analyzed the data of 25 pregnant women with new-onset AML diagnosed during pregnancy. We showed that most cases of new-onset AML were diagnosed during the last two trimesters of pregnancy and that M2 was the main subtype. The clinical manifestations or diagnosis at an earlier gestational stage may be risk factors for poor pregnancy outcomes. In addition, the neonatal outcomes are good if pregnant women with new-onset AML diagnosed during pregnancy are treated properly. Acute leukemia ranks third after breast and cervical cancer in association with pregnancy, and AML accounts for more than two-thirds of leukemia cases that are diagnosed during pregnancy [ 8 ]. However, there is no report about the main subtype of new-onset AML diagnosed during pregnancy. In our study we found that M2 was the main subtype. A previous report showed that most cases of acute leukemia are diagnosed during the second and third trimesters [ 9 ]. We showed that 16% of cases of new-onset AML diagnosed during pregnancy were detected in the first trimester, 52% were detected in the second trimester, and 32% were detected in the third trimester. Most cases of new-onset AML were also diagnosed during the last two trimesters, which is similar to the diagnosis of acute leukemia during pregnancy. The early symptoms of AML such as fatigue and weakness, are nonspecific [ 10 ]. The physiological changes associated with pregnancy can also mask certain laboratory abnormalities that are typically present in AML patients, such as anemia, leukocytosis or thrombocytopenia [ 11 ]. For the above reasons, pregnancy often results in delayed diagnosis. The median time between initial clinical manifestation and diagnosis was 2 weeks in our study. Most of the pregnant women with new-onset AML in our study were diagnosed shortly after clinical manifestations appeared. Early diagnosis is key for good pregnancy and neonatal outcomes. There is no standard approach for the treatment of new-onset AML diagnosed during pregnancy. Decision-making according to gestational age, the choice of the therapeutic approach and the balance of maternal and fetal risk in this clinical dilemma is extremely complex, sometimes including ethical considerations [ 12 ]. If AML is diagnosed during the first trimester, the teratogenic risks due to chemotherapy are significant because this period correlates with the stage of active organogenesis. Therefore, it is advisable to consider termination of pregnancy [ 13 , 14 ]. When AML is diagnosed in the second and third trimesters, chemotherapy can be administered, because the risks of malformation are minimal and treatment delays may compromise maternal outcomes without improving fetal outcomes [ 15 , 16 ]. All the 4 pregnant women with new-onset AML diagnosed in the first trimester chose to undergo therapeutic abortion and all the 8 pregnant women diagnosed in the third trimester continued their pregnancies. Among the 13 pregnant women diagnosed in the second trimester, 8 chose to undergo therapeutic abortion, and 5 continued their pregnancies. More than half of the pregnant women with new-onset AML diagnosed in the second trimester opted for abortion, which may have been due to worry about the harmful effect of chemotherapy on the fetus. Except for term pregnancy, therapeutic abortion is often proposed after a careful evaluation of other parameters such as the urgency of treatment, the prognosis of the disease, the risks of therapy for the fetus and mother, and the psychosocial context [ 17 , 18 ]. Our study showed that the gestational age at initial clinical manifestations and diagnosis was lower in the abortion group than in the delivery group. New-onset AML with clinical manifestations or diagnosis at an earlier gestational stage may lead to increased risk for poor pregnancy outcomes. In addition, gravidity and parity may have an impact on pregnancy outcomes. However, our results showed that there were no differences in gravidity and parity between the abortion and delivery groups. Vaginal delivery is associated with a reduced risk of bleeding, and it is preferred (if no contraindication exists) to cesarean section. However, 53.8% of the pregnant women with new-onset AML underwent cesarean section in our study. This may be because most of the pregnant women with new-onset AML delivered prematurely. Obstetricians often choose cesarean section instead of vaginal delivery for the preterm delivery. AML may increase the risk of complications and mortality in pregnant women. The incidences of postpartum hemorrhage and DIC in the pregnant women with new-onset AML were 28% and 8%, respectively, which are higher than those of healthy pregnant women. Among the 4 pregnant women who died, 2 had the M2 subtype and the other 2 had the M5 subtype. All pregnant women with new-onset APL survived with early treatment and had a good prognosis. When pregnancy is sufficiently advanced to allow a reasonable chance of successful delivery, elective induction should be considered prior to the commencement of treatment [ 19 ]. However, none of the pregnant women with new-onset AML who died received chemotherapy before delivery in our study. In addition, we noticed that the mortality rate was increased in the delivery group compared to the abortion group. This may be because chemotherapy was delayed to wait for the fetus to develop. Modifications of therapy to ensure the birth of a healthy infant may adversely affect maternal prognosis. Therefore, it is challenging to balance the benefits of the mother and fetus. The usual treatment of AML consists of a combination of cytarabine with anthracycline for the induction course to achieve complete remission [ 20 ]. Congenital anomalies, including limb deformities, ventral septal defects, and cardiomyopathy, have been reported [ 21 ]. All pregnant women with the M2 and M5 subtypes chose to receive chemotherapy after abortion or delivery in our study. The pregnant women who received chemotherapy during pregnancy all had the APL subtype. ATRA is indicated for the treatment of APL [ 22 ]. When combined with chemotherapy, ATRA results in an excellent long-term outcomes in patients with APL. However, ATRA is associated with substantial toxic effects when used during the first trimester of gestation, including neurological and cardiovascular malformations [ 23 ]. ATRA administration during the second or third trimester of pregnancy seems to have no adverse effect on outcomes, although preterm deliveries and reversible cardiac symptoms have been reported [ 24 ]. In our study, 3 pregnant women with new-onset APL received ATRA and DNR to achieve complete remission during pregnancy. The other patient received ATRA and ATO in the second trimester. ATO, given its high potential embryotoxicity, cannot be recommended at any stage of pregnancy [ 25 ]. The reason that the pregnant women received ATO during pregnancy was that they had decided to terminate the pregnancy before treatment. All cases of APL diagnosed during pregnancy treated with ATRA in combination with DNR or ATO resulted in favorable maternal outcomes. Thirteen newborns were delivered and 3 of them had been exposed to chemotherapy in the second and third trimesters. No congenital malformations or neonatal deaths were reported. The incidence of prematurity was 69.2% for the pregnant women with new-onset AML. One of the 13 newborns was small for gestational age. This baby was exposed to ATRA and DNR in the second trimester. The reasons for the intrauterine growth restriction may be maternal anemia and nutritional deficiencies caused by AML [ 10 ]. Two of the 13 newborns suffered asphyxia, but they both recovered quickly without complications. A total of 61.5% of the newborns were admitted to the NICU, with prematurity and neonatal respiratory distress syndrome being the main reasons for the admission. Premature infants are a high-risk group for neonatal respiratory distress syndrome. Therefore, premature birth is the primary cause of admission to the NICU. Transient neonatal myelosuppression (TNM) is a rare but potentially life-threatening adverse effect of fetal exposure to maternal chemotherapy during pregnancy [ 26 ]. It gives rise to infections and/or hemorrhage. However, no newborns, who were admitted to the NICU suffered from TNM in our study. Transient dilated cardiomyopathy was reported in a newborn exposed to idarubicin and ATRA early in the second trimester of pregnancy [ 27 ]. However, no newborns born to mothers with new-onset AML who were admitted to the NICU showed creatine kinase (CK) elevation or dilated cardiomyopathy. Their renal and liver function tests were normal. All the newborns survived without obvious complications. Additionally, this study has certain limitations. The relatively small sample size of the study may have influenced the accuracy of our results. Moreover, the long-term neonatal outcomes were not included in our study. This is because we could not obtain the detailed growth development of each newborn due to the retrospective nature of the study. We will establish a prospective cohort study of newborns of mothers with new-onset AML in the future. Conclusions In summary, we provide a comprehensive description of the pregnancy and neonatal outcomes of new-onset AML diagnosed during pregnancy. Most pregnant patients with new-onset AML are diagnosed in the last two trimesters. Pregnant women with new-onset AML diagnosed earlier in pregnancy had worse pregnancy outcomes. However, the neonates of pregnant women with new-onset AML had good outcomes with appropriate treatment. Future work should expand this study to the long-term outcomes of the newborns born to mothers with new-onset AML diagnosed during pregnancy. Declarations Author contributions Dr. Ding: protocol/project development, data collection, data analysis, manuscript writing. Drs. Xiao, Fu, Liu and Huang: data collection, data analysis. Dr. Mo: project development, manuscript editing. All authors contributed to the study conception and design. The first draft of the manuscript was written by Jing Ding and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding This study was supported by the Foundation of 2018 Beijing Key Clinical Specialty Construction Project-Pediatrics (2199000726) Conflict of Interest The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethic Committee (EC) from the Peking University People’s Hospital. Informed consent Informed consent was obtained from all individual participants included in the study. References Salama M, Isachenko E, Ludwig S et al (2019) A successful multidisciplinary approach for treatment and for preserving the reproductive potential in a rare case of acute lymphocytic leukemia during pregnancy. Gynecol Endocrinol 35: 115-118. https:// doi. org/10. 1080/ 09513590. 2018. 1498833. Wang P, Yang Z, Shan M, et al (2021). Maternal and fetal outcomes of acute leukemia in pregnancy: a retrospective study of 52 patients. 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AJP Rep 11: e137-e141. https://doi. org/10.1055/S-0041-1740561. eCollection 2021 Oct. Siu BL, Alonzo MR, Vargo TA, et al (2002). Transient dilated cardiomyopathy in a newborn exposed to idarubicin and all-trans-retinoic acid (ATRA) early in the second trimester of pregnancy. Int J Gynecol Cancer 12: 399-402. https://doi.org/10.1046/j.1525-1438.2002.01128.x. Supplementary Files supplementalmaterial.docx Cite Share Download PDF Status: Published Journal Publication published 11 Mar, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Reviewers agreed at journal 03 Oct, 2023 Reviewers invited by journal 01 Oct, 2023 Editor invited by journal 15 Sep, 2023 Editor assigned by journal 13 Sep, 2023 First submitted to journal 12 Sep, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3348961","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":237189403,"identity":"402ff656-b604-46be-87b5-c4d6e5a8d316","order_by":0,"name":"Jing Ding","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Ding","suffix":""},{"id":237189404,"identity":"d2e7ab17-2c5a-46f8-b40f-70b3a4458373","order_by":1,"name":"Yihan Xiao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yihan","middleName":"","lastName":"Xiao","suffix":""},{"id":237189405,"identity":"1bed89dc-bc50-48e7-89f3-666347ff4b5b","order_by":2,"name":"Jie Fu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Fu","suffix":""},{"id":237189406,"identity":"0e4028ec-d132-40be-9ecf-713064fc94db","order_by":3,"name":"Guoli Liu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Guoli","middleName":"","lastName":"Liu","suffix":""},{"id":237189407,"identity":"6c2ef777-9687-43b7-8733-3158b0204fee","order_by":4,"name":"Shanyamei Huang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shanyamei","middleName":"","lastName":"Huang","suffix":""},{"id":237189408,"identity":"11dfaf3b-b523-4b4e-a77b-55bc15d2a0a3","order_by":5,"name":"Xiaodong Mo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYHACA+MfP2x4+PkbSNBSzNiTJiM54wAJWj4zsB22MWhIIFK97ozkjZsLeM7zGDAcYPzwMYcILWZnjhUbz7C4zWPO3MAsOXMbMVqO95gZ8PDc5rFsOMDGzEuUlsM85j942M7xGBxIIFbL8R4DYx62A6RoOXOswHBmTzKP5IyDzUT65UbyBoMPP+zs+fmbD374SIwWJMDYQJr6UTAKRsEoGAW4AQDLBTbfyT0o5QAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Xiaodong","middleName":"","lastName":"Mo","suffix":""}],"badges":[],"createdAt":"2023-09-12 14:29:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3348961/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3348961/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-024-07402-8","type":"published","date":"2024-03-11T15:00:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":52906793,"identity":"94308cd1-345a-4463-a842-1c64dde04930","added_by":"auto","created_at":"2024-03-18 15:04:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":373853,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3348961/v1/0229af9d-a90b-4952-baf6-95395e7bdd17.pdf"},{"id":44221818,"identity":"d3abffd8-77c9-4ae7-ab46-d05c80b6015d","added_by":"auto","created_at":"2023-10-07 02:31:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39523,"visible":true,"origin":"","legend":"","description":"","filename":"supplementalmaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-3348961/v1/6d9a04d46bb3e908e3fd882b.docx"}],"financialInterests":"","formattedTitle":"Pregnancy and neonatal outcomes in 25 pregnant women diagnosed with new-onset acute myeloid leukemia during pregnancy","fulltext":[{"header":"What does this study adds to the clinical work?","content":"\u003cp\u003eNew-onset AML during an earlier stage of pregnancy may increase the risk of poor pregnancy outcomes.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe neonatal outcomes of pregnant women with new-onset AML during pregnancy are good with proper treatment.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eLeukemia during pregnancy is uncommon and its incidence is estimated to be 1 in 75000 to 100000 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Most cases of leukemia during pregnancy are acute, and acute myeloid leukemia (AML) accounts for approximately two-thirds of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The actual incidence of new-onset AML during pregnancy is not well known. However, new-onset AML during pregnancy is extremely rare.\u003c/p\u003e \u003cp\u003eThe diagnosis of new-onset AML during pregnancy is devastating for pregnant women, who need to be counseled on the risks of termination, early delivery and chemotherapy administration. The main goal is to reach the end of pregnancy with a viable healthy newborn and to cause as little impairment as possible to the pregnant woman. The maternal and fetal risks must be carefully assessed before treatment.\u003c/p\u003e \u003cp\u003eAML, especially new-onset AML, may increase the risk of complications for pregnant women, affect the growth and development of the fetuses, and increase the mortality of them [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Some studies reported that pregnant women with acute leukemia were more likely to experience postpartum hemorrhage, suffer from disseminated intravascular coagulation (DIC), have wound complications and experience venous thromboembolism [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, maternal death, preterm delivery, and intrauterine fetal death are more common in pregnant women with acute leukemia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, there is limited information regarding the pregnancy and neonatal outcomes of pregnant women with AML, especially those diagnosed with new-onset AML during pregnancy. The available literature regarding AML during pregnancy is composed mainly of small retrospective studies and case reports [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the current study, we included 25 pregnant women who were initially diagnosed with AML during pregnancy at our institution over the past 11 years (January 2010- January 2021). To our knowledge, this is the largest retrospective cohort of pregnant women with new-onset AML during pregnancy in China. We analyzed the pregnancy and neonatal outcomes to provide some hints for the prognosis and management of new-onset AML during pregnancy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eIn this retrospective study, information was collected using the electronic medical records of patients with AML who were diagnosed during pregnancy at our institution between January 2010 and January 2021. Patients with AML that was diagnosed before or after pregnancy were excluded. All procedures followed were in accordance with the ethical standards of the Helsinki Declaration of 1975, as revised in 2013. The diagnostic evaluation and morphological classification of leukemia were carried out using WHO (2008/2016) criteria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eTreatment\u003c/h2\u003e \u003cp\u003eObstetricians who had experience treating women with complicated pregnancies followed all pregnant women with new-onset AML throughout their pregnancies. The treatment was individualized. In general, for pregnant women who were diagnosed with AML in the first trimester, elective termination was recommended. For pregnant women who were diagnosed with AML in the second or third trimester, chemotherapy was optional. The time of chemotherapy initiation depended on the aggressiveness of AML, the subtype of AML and the therapy-attributable risks for the mother and fetus. In addition, treatment strategies were also planned and carried out considering each pregnant woman\u0026rsquo;s decisions. AML induction treatment consisted of all trans retinoic acid (ATRA) and daunorubicin (DNR) with or without arsenic trioxide (ATO).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables, expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, were compared using independent samples t tests. Categorical variables were compared using the \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e test or Fisher\u0026rsquo;s test. All analyses were carried out using computer software (SPSS 20.0 for Windows). A \u003cem\u003ep\u003c/em\u003e values less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the pregnant women with new-onset AML\u003c/h2\u003e \u003cp\u003eWe identified 25 pregnant women with AML initially diagnosed during pregnancy. Fourteen, 7 and 4 of the 25 pregnant women had the maturation (M2), acute promyelocytic leukemia (APL) and active monocytic leukemia (M5) subtypes, respectively. The median age at new-onset AML diagnosis was 28 years (range, 18\u0026ndash;41 years). Eighteen of the 25 pregnant women with new-onset AML were primiparous, and 7 were multiparous. Four, 13 and 8 pregnant women were diagnosed during the first, second, and third trimesters, respectively. The median gestational age at initial clinical manifestations and diagnosis of AML was 20 (range, 7-36.6) and 23.4 (range, 10.9\u0026ndash;37.1) weeks respectively. The median time between initial clinical manifestations and diagnosis was 0.5 (range, 0-16.4) weeks. Four pregnant women with new-onset AML received chemotherapy during pregnancy, and 21 did not. Three of the 4 pregnant women who received chemotherapy were diagnosed in the second trimester, and one was diagnosed in the third trimester. All the 4 pregnant women who received treatment had the APL subtype. The details of the 25 pregnant women with new-onset AML are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of the 25 pregnant women with new-onset AML diagnosed during pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge at diagnosis (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSubtype of\u003c/p\u003e \u003cp\u003enew-onset\u003c/p\u003e \u003cp\u003eleukemia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGestational age at initial clinical\u003c/p\u003e \u003cp\u003emanifestation\u003c/p\u003e \u003cp\u003e(weeks)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGestational age at diagnosis\u003c/p\u003e \u003cp\u003e(weeks)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInterval between\u003c/p\u003e \u003cp\u003ediagnosis and\u003c/p\u003e \u003cp\u003echemotherapy (days)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003cp\u003eor\u003c/p\u003e \u003cp\u003eabortion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e 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\u003cp\u003e19w\u0026thinsp;+\u0026thinsp;2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24w\u0026thinsp;+\u0026thinsp;3d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eATRA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG3P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17w\u0026thinsp;+\u0026thinsp;2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18w\u0026thinsp;+\u0026thinsp;5d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG5P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG3P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31w\u0026thinsp;+\u0026thinsp;1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31w\u0026thinsp;+\u0026thinsp;1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21w\u0026thinsp;+\u0026thinsp;3d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG3P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31w\u0026thinsp;+\u0026thinsp;5d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31w\u0026thinsp;+\u0026thinsp;5d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG3P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34w\u0026thinsp;+\u0026thinsp;6d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34w\u0026thinsp;+\u0026thinsp;6d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG2P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17w\u0026thinsp;+\u0026thinsp;1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG2P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15w\u0026thinsp;+\u0026thinsp;6d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16w\u0026thinsp;+\u0026thinsp;1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eATRA\u0026thinsp;+\u0026thinsp;ATO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24w\u0026thinsp;+\u0026thinsp;2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24w\u0026thinsp;+\u0026thinsp;2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eATRA\u0026thinsp;+\u0026thinsp;DNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG5P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31w\u0026thinsp;+\u0026thinsp;6d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34w\u0026thinsp;+\u0026thinsp;4d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25w\u0026thinsp;+\u0026thinsp;6d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25w\u0026thinsp;+\u0026thinsp;6d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG1P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24w\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG2P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12w\u0026thinsp;+\u0026thinsp;2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12w\u0026thinsp;+\u0026thinsp;2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAcute promyelocytic leukemia (APL), ATRA: all-\u003cem\u003etrans\u003c/em\u003e retinoic acid ; DNR: daunorubicin ; ATO: arsenic trioxide\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePregnancy outcomes\u003c/h2\u003e \u003cp\u003eOf the 25 pregnant women with new-onset AML, 12 underwent therapeutic abortion (abortion group), and 13 gave birth (delivery group). Five pregnant women had vaginal deliveries, 7 delivered by cesarean section and 1 underwent forceps delivery. The gestational age at initial clinical manifestation and diagnosis was lower in the abortion group than those in the delivery group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Nine pregnant women with new-onset AML delivered prematurely, and 4 delivered at term. The initial clinical manifestations and diagnosis times of the preterm and full-term delivery groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe characteristic differences between pregnant women with new-onset AML in the abortion and delivery groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbortion (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelivery (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial clinical\u003c/p\u003e \u003cp\u003emanifestation time\u003c/p\u003e \u003cp\u003e(weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e27.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis time (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-6.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003cp\u003eMaternal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.309\u003c/p\u003e \u003cp\u003e4.396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eG: gravida; P: parity\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe clinical features of pregnant women with new-onset AML in the preterm and full-term delivery groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreterm delivery\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFull-term delivery\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial clinical manifestation time (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis time (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostpartum hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eG: gravidity; P: parity; DIC: disseminated intravascular coagulation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSeven pregnant women with new-onset AML experienced postpartum hemorrhage, 2 suffered from disseminated intravascular coagulation (DIC) and 3 had prenatal infection. The 2 pregnant women who suffered DIC both had the APL subtype. All pregnant women with new-onset AML were alive during pregnancy, but 4 died 2.3\u0026ndash;18.7 months after delivery due to AML or its complications (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). The 4 pregnant women who died were diagnosed in the second or third trimester. None of the dead patients received induction chemotherapy during pregnancy and they all chose to deliver their babies before treatment. The other 21 pregnant women with new-onset AML are currently alive and in remission.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eNeonatal outcomes\u003c/h2\u003e \u003cp\u003eNine of the 13 newborns were premature, and 4 were full-term. The average birth weights were 2166g (range, 1520\u0026ndash;2860 g) and 3120 g (range, 2340\u0026ndash;3950 g) for the newborns born preterm and at term, respectively. One newborn was small for gestational age, and all newborns were born alive. The 1-minute Apgar scores for 2 newborns were less than 8, and those of the other 11 newborns were greater than or equal to 8. The 5-minute Apgar scores of all newborns were greater than 8. Three of the 13 newborns had been exposed to chemotherapeutic agents (the newborns of 2 women diagnosed in the second trimester and 1 woman diagnosed in the third trimester). No congenital malformations were observed. The clinical characteristics of the 13 newborns at birth are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical features of the 13 newborns whose mothers had new-onset AML during pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonate\u003c/p\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal\u003c/p\u003e \u003cp\u003eleukemia\u003c/p\u003e \u003cp\u003esubtype\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003cp\u003emode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGA\u003c/p\u003e \u003cp\u003e(weeks)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003cp\u003e(g)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eApgar\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003cp\u003e(1min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eApgar\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003cp\u003e(5min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003cp\u003ebefore\u003c/p\u003e \u003cp\u003edelivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNeonatal\u003c/p\u003e \u003cp\u003eoutcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003csup\u003e+\u0026thinsp;4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eForceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003csup\u003e+\u0026thinsp;2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003csup\u003e+\u0026thinsp;2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003csup\u003e+\u0026thinsp;3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003csup\u003e+\u0026thinsp;3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML-M2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003csup\u003e+\u0026thinsp;1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eGA: gestational age; SVD: spontaneous vaginal delivery; CS: cesarean section\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEight newborns developed one or more neonatal complications and were admitted to the NICU in our institution (Supplementary Table S2). The other 5 newborns were healthy. The complete blood count and levels of alanine transaminase (ALT), aspartate transaminase (AST), urea nitrogen, creatinine, albumin, cholesterol, triglycerides and blood glucose were normal in the 8 newborns (Supplementary Table S3 and Table S4). All the 8 newborns admitted to the NICU were discharged after 4\u0026ndash;38 days.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we retrospectively reviewed and analyzed the data of 25 pregnant women with new-onset AML diagnosed during pregnancy. We showed that most cases of new-onset AML were diagnosed during the last two trimesters of pregnancy and that M2 was the main subtype. The clinical manifestations or diagnosis at an earlier gestational stage may be risk factors for poor pregnancy outcomes. In addition, the neonatal outcomes are good if pregnant women with new-onset AML diagnosed during pregnancy are treated properly.\u003c/p\u003e \u003cp\u003eAcute leukemia ranks third after breast and cervical cancer in association with pregnancy, and AML accounts for more than two-thirds of leukemia cases that are diagnosed during pregnancy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, there is no report about the main subtype of new-onset AML diagnosed during pregnancy. In our study we found that M2 was the main subtype. A previous report showed that most cases of acute leukemia are diagnosed during the second and third trimesters [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. We showed that 16% of cases of new-onset AML diagnosed during pregnancy were detected in the first trimester, 52% were detected in the second trimester, and 32% were detected in the third trimester. Most cases of new-onset AML were also diagnosed during the last two trimesters, which is similar to the diagnosis of acute leukemia during pregnancy.\u003c/p\u003e \u003cp\u003eThe early symptoms of AML such as fatigue and weakness, are nonspecific [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The physiological changes associated with pregnancy can also mask certain laboratory abnormalities that are typically present in AML patients, such as anemia, leukocytosis or thrombocytopenia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. For the above reasons, pregnancy often results in delayed diagnosis. The median time between initial clinical manifestation and diagnosis was 2 weeks in our study. Most of the pregnant women with new-onset AML in our study were diagnosed shortly after clinical manifestations appeared. Early diagnosis is key for good pregnancy and neonatal outcomes.\u003c/p\u003e \u003cp\u003eThere is no standard approach for the treatment of new-onset AML diagnosed during pregnancy. Decision-making according to gestational age, the choice of the therapeutic approach and the balance of maternal and fetal risk in this clinical dilemma is extremely complex, sometimes including ethical considerations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. If AML is diagnosed during the first trimester, the teratogenic risks due to chemotherapy are significant because this period correlates with the stage of active organogenesis. Therefore, it is advisable to consider termination of pregnancy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. When AML is diagnosed in the second and third trimesters, chemotherapy can be administered, because the risks of malformation are minimal and treatment delays may compromise maternal outcomes without improving fetal outcomes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. All the 4 pregnant women with new-onset AML diagnosed in the first trimester chose to undergo therapeutic abortion and all the 8 pregnant women diagnosed in the third trimester continued their pregnancies. Among the 13 pregnant women diagnosed in the second trimester, 8 chose to undergo therapeutic abortion, and 5 continued their pregnancies. More than half of the pregnant women with new-onset AML diagnosed in the second trimester opted for abortion, which may have been due to worry about the harmful effect of chemotherapy on the fetus.\u003c/p\u003e \u003cp\u003eExcept for term pregnancy, therapeutic abortion is often proposed after a careful evaluation of other parameters such as the urgency of treatment, the prognosis of the disease, the risks of therapy for the fetus and mother, and the psychosocial context [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our study showed that the gestational age at initial clinical manifestations and diagnosis was lower in the abortion group than in the delivery group. New-onset AML with clinical manifestations or diagnosis at an earlier gestational stage may lead to increased risk for poor pregnancy outcomes. In addition, gravidity and parity may have an impact on pregnancy outcomes. However, our results showed that there were no differences in gravidity and parity between the abortion and delivery groups.\u003c/p\u003e \u003cp\u003eVaginal delivery is associated with a reduced risk of bleeding, and it is preferred (if no contraindication exists) to cesarean section. However, 53.8% of the pregnant women with new-onset AML underwent cesarean section in our study. This may be because most of the pregnant women with new-onset AML delivered prematurely. Obstetricians often choose cesarean section instead of vaginal delivery for the preterm delivery. AML may increase the risk of complications and mortality in pregnant women. The incidences of postpartum hemorrhage and DIC in the pregnant women with new-onset AML were 28% and 8%, respectively, which are higher than those of healthy pregnant women. Among the 4 pregnant women who died, 2 had the M2 subtype and the other 2 had the M5 subtype. All pregnant women with new-onset APL survived with early treatment and had a good prognosis.\u003c/p\u003e \u003cp\u003eWhen pregnancy is sufficiently advanced to allow a reasonable chance of successful delivery, elective induction should be considered prior to the commencement of treatment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, none of the pregnant women with new-onset AML who died received chemotherapy before delivery in our study. In addition, we noticed that the mortality rate was increased in the delivery group compared to the abortion group. This may be because chemotherapy was delayed to wait for the fetus to develop. Modifications of therapy to ensure the birth of a healthy infant may adversely affect maternal prognosis. Therefore, it is challenging to balance the benefits of the mother and fetus.\u003c/p\u003e \u003cp\u003eThe usual treatment of AML consists of a combination of cytarabine with anthracycline for the induction course to achieve complete remission [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Congenital anomalies, including limb deformities, ventral septal defects, and cardiomyopathy, have been reported [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. All pregnant women with the M2 and M5 subtypes chose to receive chemotherapy after abortion or delivery in our study. The pregnant women who received chemotherapy during pregnancy all had the APL subtype. ATRA is indicated for the treatment of APL [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. When combined with chemotherapy, ATRA results in an excellent long-term outcomes in patients with APL. However, ATRA is associated with substantial toxic effects when used during the first trimester of gestation, including neurological and cardiovascular malformations [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. ATRA administration during the second or third trimester of pregnancy seems to have no adverse effect on outcomes, although preterm deliveries and reversible cardiac symptoms have been reported [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In our study, 3 pregnant women with new-onset APL received ATRA and DNR to achieve complete remission during pregnancy. The other patient received ATRA and ATO in the second trimester. ATO, given its high potential embryotoxicity, cannot be recommended at any stage of pregnancy [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The reason that the pregnant women received ATO during pregnancy was that they had decided to terminate the pregnancy before treatment. All cases of APL diagnosed during pregnancy treated with ATRA in combination with DNR or ATO resulted in favorable maternal outcomes.\u003c/p\u003e \u003cp\u003eThirteen newborns were delivered and 3 of them had been exposed to chemotherapy in the second and third trimesters. No congenital malformations or neonatal deaths were reported. The incidence of prematurity was 69.2% for the pregnant women with new-onset AML. One of the 13 newborns was small for gestational age. This baby was exposed to ATRA and DNR in the second trimester. The reasons for the intrauterine growth restriction may be maternal anemia and nutritional deficiencies caused by AML [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Two of the 13 newborns suffered asphyxia, but they both recovered quickly without complications. A total of 61.5% of the newborns were admitted to the NICU, with prematurity and neonatal respiratory distress syndrome being the main reasons for the admission. Premature infants are a high-risk group for neonatal respiratory distress syndrome. Therefore, premature birth is the primary cause of admission to the NICU.\u003c/p\u003e \u003cp\u003eTransient neonatal myelosuppression (TNM) is a rare but potentially life-threatening adverse effect of fetal exposure to maternal chemotherapy during pregnancy [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. It gives rise to infections and/or hemorrhage. However, no newborns, who were admitted to the NICU suffered from TNM in our study. Transient dilated cardiomyopathy was reported in a newborn exposed to idarubicin and ATRA early in the second trimester of pregnancy [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, no newborns born to mothers with new-onset AML who were admitted to the NICU showed creatine kinase (CK) elevation or dilated cardiomyopathy. Their renal and liver function tests were normal. All the newborns survived without obvious complications.\u003c/p\u003e \u003cp\u003eAdditionally, this study has certain limitations. The relatively small sample size of the study may have influenced the accuracy of our results. Moreover, the long-term neonatal outcomes were not included in our study. This is because we could not obtain the detailed growth development of each newborn due to the retrospective nature of the study. We will establish a prospective cohort study of newborns of mothers with new-onset AML in the future.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, we provide a comprehensive description of the pregnancy and neonatal outcomes of new-onset AML diagnosed during pregnancy. Most pregnant patients with new-onset AML are diagnosed in the last two trimesters. Pregnant women with new-onset AML diagnosed earlier in pregnancy had worse pregnancy outcomes. However, the neonates of pregnant women with new-onset AML had good outcomes with appropriate treatment. Future work should expand this study to the long-term outcomes of the newborns born to mothers with new-onset AML diagnosed during pregnancy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003eDr. Ding: protocol/project development, data collection, data analysis, manuscript writing. Drs. Xiao, Fu, Liu and Huang: data collection, data analysis. Dr. Mo: project development, manuscript editing. All authors contributed to the study conception and design. The first draft of the manuscript was written by Jing Ding and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This study was supported by the Foundation of 2018 Beijing Key Clinical Specialty Construction Project-Pediatrics (2199000726)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u0026nbsp; \u0026nbsp;The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthical approval\u003c/strong\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethic Committee (EC) from the Peking University People\u0026rsquo;s Hospital.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eInformed consent\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSalama M, Isachenko E, Ludwig S et al (2019) A successful multidisciplinary approach for treatment and for preserving the reproductive potential in a rare case of acute lymphocytic leukemia during pregnancy. Gynecol Endocrinol 35: 115-118. https:// doi. org/10. 1080/ 09513590. 2018. 1498833.\u003c/li\u003e\n\u003cli\u003eWang P, Yang Z, Shan M, et al (2021). Maternal and fetal outcomes of acute leukemia in pregnancy: a retrospective study of 52 patients. Front Oncol 11: 5803994. https://doi.org/10.3389/fonc.2021. 803994.eCollection 2021.\u003c/li\u003e\n\u003cli\u003ePatel SJ, Ajebo G, Kota V, et al (2020). Analysis of outcomes in hospitalized pregnant patients with acute myeloid leukemia. Am J Blood Res 10: 68-75. https://doi.org/eCollection 2020.\u003c/li\u003e\n\u003cli\u003eNolan S, Czuzoj-Shulman N, Abenhaim HA (2020). Obstetrical and newborn outcomes among women with acute leukemias in pregnancy: a population-based study. J Matern Fetal Neonatal Med 33: 3514-3520. https://doi.org/10.1080/14767058.2019.1579188.\u003c/li\u003e\n\u003cli\u003eChang A, Patel S (2015). Treatment of acute myeloid leukemia during pregnancy. Ann Pharmacother, 49(1):48-68. https://doi.org/10.1177/1060028014552516.\u003c/li\u003e\n\u003cli\u003eLi YW, Xu YF, Hu W, et al (2020). Acute myeloid leukemia during pregnancy: a single institutional experience with 17 patients and literature review. Int J Hematol 112: 487-495. https://doi. org/10.1007/s12185-020-02938-2.\u003c/li\u003e\n\u003cli\u003eLi H, Han C, Li K, et al (2019). New onset acute promyelocytic leukemia during pregnancy: report of 2 cases. Cancer Biol Ther 20: 397-401. https://doi.org/10.1080/15384047.2018.1529122.\u003c/li\u003e\n\u003cli\u003eKriouile M, Ameqrane F, Soradi H, et al (2022). Acute myeloid leukemia and pregnancy about a case and review of the literature. Sch Int J Obstet Gynec 5: 285-287. https://doi. org/10.36348/sijog.2022.v05i06.001.\u003c/li\u003e\n\u003cli\u003eChelghoum Y, Vey N, Raffoux E, et al (2005). Acute leukemia during pregnancy: a report on 37 patients and a review of the literature. Cancer 104:110-117. https://doi.org/10.1002/cncr.21137.\u003c/li\u003e\n\u003cli\u003eZhu D, Tang D, Chai X, et al (2021). Acute leukemia in pregnancy: a single institutional experience with 21 cases at 10 years and a review of the literature. Ann Med 53: 567-575. https://doi.org/10. 1080/07853890.2021.1908586.\u003c/li\u003e\n\u003cli\u003eThomas X(2015). Acute myeloid leukemia in the pregnant patient. Eur J Haematol 95:124-136. https://doi.org/10.1111/ejh.12479.\u003c/li\u003e\n\u003cli\u003eAli R, Ozkalemkaş F, Oz\u0026ccedil;elik T, et al (2003). Maternal and fetal outcomes in pregnancy complicated with acute leukemia: a single institutional experience with 10 pregnancies at 16 years. Leuk Res 27:381-385. https://doi.org/10.1016/s0145-2126(02)00182-0.\u003c/li\u003e\n\u003cli\u003eAvivi I, Brenner B (2014). Management of acute myeloid leukemia during pregnancy. Future Oncol 10:1407-1415. https://doi.org/10.2217/fon.14.64.\u003c/li\u003e\n\u003cli\u003eShapira T, Pereg D, Lishner M (2008). How I treat acute and chronic leukemia in pregnancy. Blood Rev 22: 247-259. https:// doi. org/10.1016/j.blre.2008.03.006.\u003c/li\u003e\n\u003cli\u003eGreenlund LJ, Letendre L, Tefferi A (2001). Acute leukemia during pregnancy: a single institutional experience with 17 cases. Leuk Lymphoma 41: 571-577. https://doi.org/10.3109/10428190109060347.\u003c/li\u003e\n\u003cli\u003eAli S, Jones GL, Culligan DJ, et al (2015). Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy. Br J Haematol 170: 487-495. https://doi.org/10.1111/bjh.13554.\u003c/li\u003e\n\u003cli\u003eMilojkovic D, Apperley JF (2014). How I treat leukemia during pregnancy. Blood 123(7): 974-984. https://doi.org/10.1182/blood-2013-08-283580.\u003c/li\u003e\n\u003cli\u003eFann RJ, D\u0026rsquo;Silv EC, Tanusha K, et al (2023). Acute leukemia and lymphoma in pregnancy, a retrospective study from a tertiary center in Malaysia. Med J Malaysia 78: 429-436. https://doi.org/\u003c/li\u003e\n\u003cli\u003eIsrael Henig, Liat Vidal, Oryan Henig, et al (2013). Acute myeloid leukemia diagnosed during pregnancy: facing challenges. Systematic review and analysis of 174 reported cases. Blood 122:1421. https://doi.org/10.1182/blood.V122.21.1421.1421.\u003c/li\u003e\n\u003cli\u003eFracchiolla NS, Scium\u0026egrave; M, Dambrosi F, et al (2017). Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature. BMC Cancer 17: 442. https://doi. org/10.1186/s12885-017-3436-9.\u003c/li\u003e\n\u003cli\u003eAmit O, Barzilai M, Avivi I (2015). Management of hematologic malignancies: special considerations in pregnant women. Drugs 75: 1725-1738. https://doi.org/10.1007/s40265-015-0464-0.\u003c/li\u003e\n\u003cli\u003eKayser S, Schlenk RF, Platzbecker U (2018). Management of patients with acute promyelocytic leukemia. Leukemia 32:1277-1294. https://doi.org/10.1038/s41375-018-0139-4.\u003c/li\u003e\n\u003cli\u003eValappil S, Kurkar M, Howell R (2007). Outcome of pregnancy in women treated with all-trans retinoic acid; a case report and review of literature. Hematology 12: 415-418. https://doi.org/10.1080/ 10245330701448594.\u003c/li\u003e\n\u003cli\u003eMiguel A Sanz, Pierre Fenaux, Martin S Tallman, et al (2019). Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet. Blood 133: 1630-1643. https://doi.org/10.1182/blood-2019-01-894980.\u003c/li\u003e\n\u003cli\u003eGuo M, Lv J, Chen X, et al (2022). Arsenic trioxide therapy during pregnancy: ATO and its metabolites in maternal blood and amniotic fluid of acute promyelocytic leukemia patients. Front Oncol 12: 887026. https://doi.org/10.3389 /fonc.2022.887026.eCollection 2022.\u003c/li\u003e\n\u003cli\u003eNowik CM, Gerrie AS, Wong J (2021). Conservative management of presumed fetal anemia secondary to maternal chemotherapy for acute myeloid leukemia. AJP Rep 11: e137-e141. https://doi. org/10.1055/S-0041-1740561. eCollection 2021 Oct.\u003c/li\u003e\n\u003cli\u003eSiu BL, Alonzo MR, Vargo TA, et al (2002). Transient dilated cardiomyopathy in a newborn exposed to idarubicin and all-trans-retinoic acid (ATRA) early in the second trimester of pregnancy. Int J Gynecol Cancer 12: 399-402. https://doi.org/10.1046/j.1525-1438.2002.01128.x.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acute myeloid leukemia, pregnancy, newborn, outcomes","lastPublishedDoi":"10.21203/rs.3.rs-3348961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3348961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe aim was to analyze the pregnancy and neonatal outcomes of pregnant women with new- onset acute myeloid leukemia (AML) diagnosed during pregnancy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this retrospective study 25 pregnant women who were diagnosed with new-onset AML during pregnancy from January 2010 to January 2021 were enrolled.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 4, 13 and 8 pregnant women with new-onset AML were diagnosed during the first, second, and third trimesters, respectively. Twelve of the 25 pregnant women underwent therapeutic abortion and 13 gave birth (9 preterm and 4 full-term newborns). The gestational age at initial clinical manifestations (13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 vs. 27.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6 weeks, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and diagnosis (16.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 vs. 29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 weeks, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) was lower in the pregnant women who underwent therapeutic abortion than in those who gave birth. Eighty-four percent (21/25) of the pregnant women with new-onset AML during pregnancy survived and were in remission and all the newborns were born alive. Three of the 13 newborns were exposed to chemotherapy, but no congenital malformations were observed. Eight newborns were admitted to the neonatal intensive care unit (NICU), and then all recovered. The complete blood counts and biochemical examinations of the 8 newborns were normal.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNew-onset AML during an earlier stage of pregnancy may increase the risk of poor pregnancy outcomes. The neonatal outcomes of pregnant women with new-onset AML during pregnancy are good with proper treatment.\u003c/p\u003e","manuscriptTitle":"Pregnancy and neonatal outcomes in 25 pregnant women diagnosed with new-onset acute myeloid leukemia during pregnancy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-07 02:31:54","doi":"10.21203/rs.3.rs-3348961/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2023-10-03T12:40:30+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-10-01T15:22:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Archives of Gynecology and Obstetrics","date":"2023-09-15T07:53:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-13T14:03:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2023-09-12T10:29:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a3009857-c820-4646-be82-0c03baf4100c","owner":[],"postedDate":"October 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-18T15:01:49+00:00","versionOfRecord":{"articleIdentity":"rs-3348961","link":"https://doi.org/10.1007/s00404-024-07402-8","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2024-03-11 15:00:28","publishedOnDateReadable":"March 11th, 2024"},"versionCreatedAt":"2023-10-07 02:31:54","video":"","vorDoi":"10.1007/s00404-024-07402-8","vorDoiUrl":"https://doi.org/10.1007/s00404-024-07402-8","workflowStages":[]},"version":"v1","identity":"rs-3348961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3348961","identity":"rs-3348961","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}