{"product_id":"chemotherapy-during-pregnancy-using-adriamycin-to-treat-breast-cancer-while-protecting-the-heart","title":"Chemotherapy During Pregnancy: Using Adriamycin to Treat Breast Cancer While Protecting the Heart","description":"\u003cp\u003ePregnancy-associated breast cancer (PABC) is a rare but challenging condition that requires careful balancing of effective cancer treatment with the safety of the developing fetus. This case report details how a 39-year-old woman with twin pregnancy received chemotherapy with adriamycin (a powerful anthracycline drug) after her second trimester, alongside close cardiac monitoring by a multidisciplinary team. Despite an existing heart condition, she tolerated all four cycles of chemotherapy without changes in heart function, delivered healthy twins, and both infants showed no signs of heart damage from the drug. The report emphasizes that with careful surveillance and a collaborative heart-care team, chemotherapy can be a viable option for pregnant women with breast cancer.\u003c\/p\u003e\n\n\u003ch1\u003eChemotherapy During Pregnancy: Using Adriamycin to Treat Breast Cancer While Protecting the Heart\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eUnderstanding Pregnancy-Associated Breast Cancer\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#case\"\u003eThe Case: A Mother of Twins Faces Breast Cancer\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eHow This Case Was Managed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#findings\"\u003eKey Findings: What the Treatment Showed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#qa\"\u003eAnswers to Important Questions About PABC\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications: What This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of This Report\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients and Care Teams\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eChemotherapy with adriamycin was given safely in the second trimester of a twin pregnancy, with no change in maternal heart function during treatment.\u003c\/li\u003e\n\u003cli\u003eThe patient had pre-existing cardiomyopathy with an ejection fraction of 45-50%, which made pregnancy high-risk and required close cardiac monitoring.\u003c\/li\u003e\n\u003cli\u003eCardioprotective treatment with carvedilol was started before chemotherapy, and heart function remained stable throughout all four cycles.\u003c\/li\u003e\n\u003cli\u003eBoth twins delivered at 32 weeks had normal heart ultrasounds after birth, showing no immediate evidence of cardiotoxicity from the drug.\u003c\/li\u003e\n\u003cli\u003eAfter delivery, the mother's heart function decreased to 40-45%, requiring medication adjustments, highlighting the need for continued postpartum cardiac follow-up.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eUnderstanding Pregnancy-Associated Breast Cancer\u003c\/h2\u003e\n\u003cp\u003ePregnancy-associated breast cancer (PABC) is defined as breast cancer that is diagnosed during pregnancy or within one year after childbirth. It is a particularly difficult situation because doctors must consider both the mother's health and the safety of the unborn baby. Women with PABC often face more aggressive tumor features compared with nonpregnant women of the same age, according to a nationwide Dutch study (Suelmann et al., 2021). Despite this, the outlook for PABC patients is not necessarily worse — \u003cstrong\u003eif standard treatment is provided without delay\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eTreatment typically involves surgery, chemotherapy, and other therapies, but each step must be timed carefully to avoid harming the fetus. One major concern with certain chemotherapy drugs, particularly anthracyclines like adriamycin, is their potential to damage the heart (a condition called cardiotoxicity). This is why cardio-oncology — a specialty focused on heart health in cancer patients — plays such a vital role in managing PABC.\u003c\/p\u003e\n\u003cp\u003eThe learning objective that guided the authors of this case report was to decrease cardiovascular morbidity in pregnant patients undergoing cardiotoxic chemotherapy by using regular surveillance and a multidisciplinary team approach.\u003c\/p\u003e\n\n\u003ch2 id=\"case\"\u003eThe Case: A Mother of Twins Faces Breast Cancer\u003c\/h2\u003e\n\u003cp\u003eIn this case report, a 39-year-old woman (gravida 4, para 3, meaning she had been pregnant four times and had three prior live births) was pregnant with twins. At 8 weeks of gestation, she came to her doctors with a right breast mass and on-and-off bloody nipple discharge that had been present for about one year. She had significant medical history, including obesity with a body mass index (BMI) of 45.4 kg\/m² and medically controlled essential hypertension (high blood pressure). She had no family history of breast or ovarian cancer, no history of substance abuse, was a nonsmoker, and drank alcohol only occasionally.\u003c\/p\u003e\n\u003cp\u003eA biopsy of the breast mass revealed a tumor that was “weakly estrogen receptor positive” (5%), “progesterone receptor positive” (13%), “human epidermal growth factor receptor-2 (HER2) negative,” and positive for lymph node involvement. The cancer was classified as stage IIb pregnancy-associated breast cancer. She was offered termination of pregnancy because of the high-risk nature of both the cancer and her twin pregnancy, but she declined. Instead, she chose to undergo a right radical mastectomy (complete removal of the breast tissue) with axillary lymph node dissection at 11 weeks of gestation.\u003c\/p\u003e\n\u003cp\u003eBecause of high-risk features in her cancer, her oncology team planned to give adjuvant chemotherapy (treatment after surgery to reduce the risk of cancer recurrence) starting at 15 weeks gestation. The plan was 4 cycles of adriamycin and cyclophosphamide (known as AC chemotherapy), administered every 3 weeks.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow This Case Was Managed\u003c\/h2\u003e\n\u003cp\u003eBefore starting chemotherapy, an echocardiogram (an ultrasound of the heart) was performed. This revealed an unexpected finding: the patient had a new diagnosis of cardiomyopathy — a disease of the heart muscle — with a left ventricular (LV) ejection fraction (EF) of 45%–50%. The ejection fraction measures the percentage of blood the heart pumps out with each beat; a normal value is usually 55% or higher. Her LV was also severely dilated (enlarged). She had only mild symptoms (NYHA functional class I–II), meaning she was comfortable at rest but had some limitation during ordinary physical activity.\u003c\/p\u003e\n\u003cp\u003eA thorough work-up was performed, including a complete blood count, complete metabolic panel, thyroid studies, iron studies, an electrocardiogram (ECG), and limited genetic testing. After excluding other causes, the only remaining diagnosis was \u003cstrong\u003eidiopathic cardiomyopathy\u003c\/strong\u003e — heart muscle disease of unknown cause. The team calculated her risk using established tools. Notably, the CARPREG II (Cardiac Disease in Pregnancy Study) and modified World Health Organization (mWHO) scores indicate that pregnancy is high-risk in patients with LVEF below 45%, and even contraindicated when LVEF is below 30%. Her LVEF of 45–50% placed her in a higher-risk category.\u003c\/p\u003e\n\u003cp\u003eAfter careful discussions between the patient, the oncology team, and the cardio-oncology team, carvedilol (a heart failure medication) 12.5 mg twice daily was started before beginning chemotherapy to offer cardioprotection. This medicine can help protect the heart from the damaging effects of anthracyclines.\u003c\/p\u003e\n\u003cp\u003eDuring each of the 4 AC chemotherapy cycles, the cardio-obstetrics and cardio-oncology teams performed regular surveillance, measuring maternal echocardiogram, brain natriuretic peptide (BNP, a marker of heart strain), and troponin (a marker of heart muscle injury). Her pregnancy care was managed by maternal-fetal medicine specialists, with serial fetal ultrasounds — all of which were normal.\u003c\/p\u003e\n\u003cp\u003eAfter weighing the risks of delaying further cancer treatment against the risks of early delivery, a shared decision was made to deliver the twins early, at 32 weeks of gestation. Because the patient requested a Cesarean section to avoid increasing the workload (afterload) on her heart during vaginal delivery, and because the cardio-obstetrics team supported this approach, a Cesarean section was chosen as the mode of delivery.\u003c\/p\u003e\n\n\u003ch2 id=\"findings\"\u003eKey Findings: What the Treatment Showed\u003c\/h2\u003e\n\u003cp\u003eThe patient tolerated all four cycles of AC chemotherapy without any change in her left ventricular ejection fraction from baseline. She experienced no symptoms of heart failure during the entire pregnancy. All serial fetal ultrasounds were normal throughout.\u003c\/p\u003e\n\u003cp\u003eThe twins — a boy and a girl — were delivered at 32 weeks with no complications. Their Apgar scores (a quick assessment of a newborn's health) were as follows:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eMale infant: Apgar scores of 5 at 1 minute and 7 at 5 minutes\u003c\/li\u003e\n  \u003cli\u003eFemale infant: Apgar scores of 8 at 1 minute and 7 at 5 minutes\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eBecause the babies had been exposed to adriamycin in utero, a pediatric echocardiogram was performed on both infants. \u003cstrong\u003eNeither infant showed any evidence of cardiotoxicity\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eAfter delivery, however, the mother’s LVEF decreased to 40%–45%. Her heart failure medications were adjusted accordingly:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eCarvedilol was increased to 25 mg twice daily\u003c\/li\u003e\n  \u003cli\u003eSacubitril\/valsartan 24\/26 mg twice daily was added\u003c\/li\u003e\n  \u003cli\u003eSpironolactone 25 mg daily was added\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eShe also complained of chest pain after delivery, which prompted a computed tomography (CT)–based coronary angiogram. This ruled out epicardial coronary artery disease (blockages in the large heart arteries) and spontaneous coronary artery dissection (a tear in the artery wall). Cardiac magnetic resonance imaging (MRI) showed no evidence of delayed enhancement (which would indicate fibrosis or a prior heart attack) and no LV hypertrophy (which would suggest hypertensive heart disease). The team then considered the possibility of microvascular disease — disease of the small heart blood vessels. Isosorbide mononitrate 30 mg daily and aspirin 81 mg daily were started, and the patient had a favorable response in her chest pain.\u003c\/p\u003e\n\u003cp\u003ePostpartum staging scans — including a bone scan and CT of the abdomen and chest — revealed no metastasis (spread of cancer). She then started weekly paclitaxel chemotherapy, completing 11 additional cycles to reach a total of 12 cycles, before moving on to endocrine treatment (hormone therapy) planned for 5 to 10 years. She was closely followed postpartum by both the cardio-obstetrics and cardio-oncology teams.\u003c\/p\u003e\n\n\u003ch2 id=\"qa\"\u003eAnswers to Important Questions About PABC\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eQuestion 1: Is a diagnosis of PABC associated with poor outcomes?\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnswer: No,\u003c\/strong\u003e a diagnosis of PABC does not by itself worsen prognosis if standard treatment is provided. However, PABC frequently presents with a more aggressive histopathologic profile (that is, more aggressive features under the microscope) than breast cancer in age-matched nonpregnant women. It is crucial not to delay treatment until after delivery, because such delays have been associated with poor outcomes. The focus of managing PABC is balancing effective treatment of the mother without delay while ensuring the safety and well-being of the developing fetus.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestion 2: What are the treatment options in PABC?\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnswer:\u003c\/strong\u003e Surgery is considered the safest treatment option at any stage of pregnancy. Chemotherapeutic agents like adriamycin are safe during the second and third trimesters of pregnancy. Although drugs like adriamycin are associated with an increased risk of cardiomyopathy, they are essential components of breast cancer chemotherapy regimens. Patients with PABC who receive adriamycin require regular monitoring and evaluation by a collaborative team of cardio-obstetrics and cardio-oncology specialists.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestion 3: Is adriamycin safe for treatment in PABC?\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnswer:\u003c\/strong\u003e There is a scarcity of data about survival outcomes in PABC patients, which limits our understanding. A meta-analysis by Hartman et al. that included 13 studies and 900 cases of PABC found a \u003cstrong\u003e47% increased risk of all-cause death\u003c\/strong\u003e and a \u003cstrong\u003e13% increased risk of cancer relapse or disease progression\u003c\/strong\u003e compared with nonpregnant patients. Pregnancy is considered high-risk in patients with LVEF below 45% and is contraindicated if LVEF is below 30%, as indicated by the CARPREG II and modified WHO scoring systems. In this case, the patient's low LVEF (around 40–45% after measurement) increased her risk of cardiac decompensation, thus necessitating appropriate aggressive interventions. The report highlights that a thorough evaluation can mitigate potential risks and potentially improve maternal-fetal outcomes.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestion 4: How can we improve maternal and fetal outcomes in PABC?\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnswer:\u003c\/strong\u003e Over the past two decades, there has been a concerning and consistent increase in maternal mortality rates in the United States. Cardiovascular disease is the leading cause of these maternal deaths, predominantly from cardiomyopathy. PABC is a challenging diagnosis for both patients and physicians. A comprehensive and collaborative approach involving obstetricians, maternal-fetal medicine, cardio-obstetrics, oncology, cardio-oncology, and pediatrics is needed to address the unique needs and challenges of PABC treatment. The decision to continue a pregnancy should be based on carefully discussing cancer prognosis, treatment, and future fertility with the patient, her partner, and the multidisciplinary team.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications: What This Means for Patients\u003c\/h2\u003e\n\u003cp\u003eThis case report demonstrates that a woman with pre-existing cardiomyopathy (LVEF around 45–50%) can safely undergo anthracycline-based chemotherapy during the second trimester of a twin pregnancy, provided she receives intensive cardiac monitoring and preventive heart-failure treatment.\u003c\/p\u003e\n\u003cp\u003eKey clinical takeaways include:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEarly delivery is not always required:\u003c\/strong\u003e In this case, delivery was planned at 32 weeks, but the decision was individualized to balance cancer treatment needs and fetal maturity. Every patient requires a personalized plan.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCardioprotective medications can help:\u003c\/strong\u003e Carvedilol, a beta-blocker, was started before chemotherapy to protect the heart. Other heart-failure medications were added postpartum as needed.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFetal monitoring is essential:\u003c\/strong\u003e Serial ultrasounds and pediatric echocardiography after birth can confirm that the baby’s heart was not affected by chemotherapy exposure.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePostpartum follow-up is critical:\u003c\/strong\u003e The patient's heart function decreased after delivery, requiring medication adjustments. Even if heart function remains stable during pregnancy, it can change afterward, so ongoing cardio-oncology care is necessary.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eThe report also stresses the importance of diagnosing and managing cardiac risk early. Because pregnancy itself puts stress on the heart, women with pre-existing low ejection fractions need to be identified before chemotherapy so that protective strategies can be put in place.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of This Report\u003c\/h2\u003e\n\u003cp\u003eThis is a single case report, not a large clinical trial. The authors acknowledge that there is a paucity of data about survival outcomes in patients with PABC, which limits general understanding. The meta-analysis cited (by Hartman et al.) found that PABC patients have a 47% increased risk of all-cause death and a 13% increased risk of cancer relapse compared with nonpregnant patients — but these numbers come from pooled observational data, not randomized controlled trials.\u003c\/p\u003e\n\u003cp\u003eAdditionally, the patient's cardiomyopathy was diagnosed after it was discovered on a baseline echocardiogram, and no cause could be identified despite extensive work-up. The long-term effects of in-utero adriamycin exposure on children are not yet fully known; in this case, the infant echocardiograms were normal, but longer follow-up is not reported. Because of the uniqueness of this patient's situation (twin pregnancy, cardiomyopathy, breast cancer), findings may not apply to all women with PABC.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients and Care Teams\u003c\/h2\u003e\n\u003cp\u003eBased on this case and the literature cited, the authors suggest the following approach for pregnant patients with breast cancer who need anthracycline chemotherapy:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEstablish a multidisciplinary team early\u003c\/strong\u003e — involving obstetricians, maternal-fetal medicine specialists, cardio-oncologists, cardio-obstetricians, oncologists, and pediatricians.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePerform a baseline echocardiogram\u003c\/strong\u003e before starting chemotherapy to assess left ventricular function. If LVEF is below 45%, pregnancy itself is high risk, and if below 30%, it is contraindicated.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eConsider cardioprotective medications\u003c\/strong\u003e such as carvedilol, especially if the baseline EF is borderline or low.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMonitor the mother's heart frequently\u003c\/strong\u003e with echocardiograms, BNP, and troponin measurements before and after each chemotherapy cycle.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMonitor the fetus with serial ultrasounds\u003c\/strong\u003e to ensure normal growth and well-being.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePlan the timing and mode of delivery\u003c\/strong\u003e in a shared decision-making process that balances cancer treatment urgency with fetal maturity. In this case, a Cesarean section was chosen to avoid increased cardiac workload during vaginal delivery.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEvaluate the newborn's heart\u003c\/strong\u003e with a pediatric echocardiogram after exposure to anthracyclines in utero.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eContinue cardiac and oncological follow-up after delivery\u003c\/strong\u003e, because heart function can change postpartum, and further cancer therapy may be needed.\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003eThe authors also call for expanding research evidence to develop policies and programs that cater to the specific needs of pregnant patients with breast cancer undergoing chemotherapy. Because maternal mortality is rising in the U.S., with cardiovascular disease as the leading cause, improving cardio-obstetric care in this high-risk population is essential.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is pregnancy-associated breast cancer?\u003c\/h3\u003e\n\u003cp\u003ePregnancy-associated breast cancer is breast cancer diagnosed during pregnancy or within one year after childbirth. It often has more aggressive features than breast cancer in nonpregnant women of the same age, but the outlook is not necessarily worse if standard treatment is given without delay. Treatment must balance the mother's health and the safety of the unborn baby.\u003c\/p\u003e\n\u003ch3\u003eCan chemotherapy be given while pregnant?\u003c\/h3\u003e\n\u003cp\u003eYes, certain chemotherapy drugs like adriamycin are considered safe during the second and third trimesters. Surgery is the safest option at any stage of pregnancy. In this case, the patient received four cycles of adriamycin plus cyclophosphamide, starting at 15 weeks of gestation, with careful monitoring of both mother and fetus.\u003c\/p\u003e\n\u003ch3\u003eIs adriamycin chemotherapy safe for the baby's heart?\u003c\/h3\u003e\n\u003cp\u003eIn this case, the twins exposed to adriamycin in the womb had normal heart ultrasounds after birth, with no signs of heart damage. However, long-term effects of in-utero exposure are not fully known, and longer follow-up was not reported in this case report.\u003c\/p\u003e\n\u003ch3\u003eWhat heart monitoring is needed during chemotherapy in pregnancy?\u003c\/h3\u003e\n\u003cp\u003eBefore chemotherapy, a baseline echocardiogram is essential to assess heart function. During treatment, regular monitoring may include echocardiograms, BNP and troponin blood tests after each cycle. In this case, close surveillance by cardio-oncology and cardio-obstetrics teams was used because the patient was found to have borderline low heart function.\u003c\/p\u003e\n\u003ch3\u003eWhat happened to the mother and twins in this case?\u003c\/h3\u003e\n\u003cp\u003eThe mother tolerated all four chemotherapy cycles with no change in her heart function during pregnancy and no heart failure symptoms. Twins were delivered by Cesarean at 32 weeks with normal newborn heart checks. After delivery, however, the mother's heart function dropped to 40-45%, requiring medication adjustments and further monitoring.\u003c\/p\u003e\n\u003ch3\u003eWhat does ejection fraction (LVEF) mean and why is it important?\u003c\/h3\u003e\n\u003cp\u003eEjection fraction measures the percentage of blood the heart pumps out with each beat; a normal value is usually 55% or higher. Pregnancy is considered high-risk when LVEF is below 45% and contraindicated when below 30%, according to CARPREG II and modified WHO scoring systems. This patient's baseline of 45-50% raised her risk.\u003c\/p\u003e\n\u003ch3\u003eWhat follow-up is recommended after pregnancy for PABC patients?\u003c\/h3\u003e\n\u003cp\u003ePostpartum follow-up is critical because heart function can change after delivery, as seen in this case where the mother needed medication adjustments. Newborns exposed to anthracyclines should have a pediatric echocardiogram. Ongoing cardio-oncology care and cancer treatment, such as further chemotherapy or hormone therapy, may also be needed after delivery.\u003c\/p\u003e\n\u003ch3\u003eI'm pregnant and have breast cancer with a heart condition. Should I get a second opinion before starting Adriamycin chemotherapy?\u003c\/h3\u003e\n\u003cp\u003eA pregnant patient with breast cancer and a known heart condition, especially a low ejection fraction, should seek a second opinion before starting Adriamycin-based chemotherapy. Pregnancy with an ejection fraction below 45% is considered high risk, and below 30% it is contraindicated. This case shows that with careful cardiac monitoring and preventive heart-failure medication, chemotherapy was tolerated, but such a plan should be reviewed by experts in cardio-oncology. A second opinion can confirm that appropriate heart surveillance and protective strategies are in place before treatment begins. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Chemotherapy in Pregnancy\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Priyanshu Nain, MBBS; Lakshya Seth, BS; Ashley Shawn Bell, RN; Priyanka Raval, MD; Gyanendra Sharma, MD; Monique Bethel, MD; Garima Sharma, MD; Avirup Guha, MD, MPH\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e JACC: Case Reports, Vol. 28, 2023 (Article 102141)\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication date:\u003c\/strong\u003e December 20, 2023\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublisher:\u003c\/strong\u003e Elsevier on behalf of the American College of Cardiology Foundation (open access under CC BY-NC-ND license)\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c\/strong\u003e Dr. Guha was supported by the American Heart Association–Strategically Focused Research Network Grant in Disparities in Cardio-Oncology (#847740 and #863620) and the Department of Defense Prostate Cancer Research Program Physician Research Award (#HT9425-23-1-0158); he has consulted for Myovant, Pfizer, and Novartis. All other authors reported no relevant relationships to disclose.\u003c\/p\u003e\n\u003cp\u003eThis patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace individualized medical advice from a qualified healthcare provider.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47545199460508,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/zh\/products\/chemotherapy-during-pregnancy-using-adriamycin-to-treat-breast-cancer-while-protecting-the-heart","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}