Cancer during pregnancy represents a potential conflict between optimal maternal treatment and fetal development. Traditionally, clinicians operated under the assumption that cancer treatment during pregnancy is incompatible with normal fetal development. However, recent evidence suggests that many diagnostic and treatment modalities cause little or no harm to the developing fetus. As such, both maternal and neonatal interests should be considered when developing management strategies for pregnant cancer patients. In this review, we will discuss issues related to fetal and neonatal health associated with conventional diagnostic and treatment approaches in the care of pregnant women with cancer. In addition, we offer recommendations on strategies to maximize fetal outcomes in pregnancies complicated by cancer.