AML may be discovered and diagnosed incidentally during a routine physical examination or if the patient is pregnant at the time of diagnosis. Chemotherapy administered early in pregnancy is teratogenic and prone to miscarriage and should be avoided whenever possible. The pros and cons of continuing a pregnancy should be carefully communicated to the patient, and the pregnancy should be terminated before starting treatment. If the pregnancy cannot be terminated for religious or ethical reasons, it will cause confusion in the management. Patients must be informed of the adverse consequences of delaying treatment for the mother. Chemotherapy can be administered, but there is an increased risk of early fetal death, congenital malformations and low birth weight babies. Patients in the middle or late stages of pregnancy can receive chemotherapy with greater confidence because they are not at risk for congenital malformations. In a Canadian report, 49 of 58 combined pregnancies with acute leukemia resulted in 50 live births. Half of these babies were born prematurely, and 4 were low birth weight. One of the 50 infants had a congenital malformation, and the infant later developed adrenal and thyroid tumors. Long-term follow-up studies of eight of the children showed normal growth and development. Chemotherapy near the time of delivery may result in a significant reduction in fetal whole blood cells and require intensive hematologic support. Treatment with retinoic acid (ATRA) alone is safest and highly effective in PML/RARA-positive acute promyelocytic leukemia (APL) patients in mid- and late pregnancy. A TRA is a teratogenic agent and should be avoided in early pregnancy. Arsenic trioxide is also a teratogenic agent and its use in the treatment of A PL combined pregnancy has not been reported. The management of pregnant women with leukemia should involve the collaboration of an obstetrician and a joint decision with the pregnant woman about the best time to deliver the baby. In stable patients, chemotherapy can be delayed, supported by growth factors and blood products, and live births may be safely induced at 30 weeks of gestation. The most important thing is to keep the patient fully informed about the disease and treatment options. Recommendations 1. Pregnant women with AML should be managed jointly by hematologists and obstetricians and gynecologists with the full knowledge and participation of the mother. Chemotherapy early in pregnancy is likely to result in fetal malformations and should be avoided. The timing of termination of pregnancy should be discussed with the mother. If continuing the pregnancy will pose a risk to the mother’s life, chemotherapy should be administered. 3. Chemotherapy in the middle and late stages of pregnancy is likely to lead to miscarriage, preterm birth and low birth weight babies. Early induction of labor between chemotherapy sessions should be considered. 4. A TRA can be used in the middle and late stages of pregnancy.