Maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia in Brazilian women

• Published in: Gynecologic oncology Vol. 112; no. 3; pp. 568 - 571
• Main Authors: Braga, Antônio, Maestá, Izildinha, Michelin, Odair Carlito, Delmanto, Lúcia Regina Gomes, Consonni, Marcos, Rudge, Marilza Vieira Cunha, Belfort, Paulo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2009
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brazil; Chemotherapy; Cisplatin - administration & dosage; Cohort Studies; Cyclophosphamide - administration & dosage; Dactinomycin - administration & dosage; Doxorubicin - administration & dosage; Etoposide - administration & dosage; Female; First subsequent pregnancy outcome; Gestational Trophoblastic Disease - complications; Gestational Trophoblastic Disease - drug therapy; Gestational Trophoblastic Disease - pathology; Gestational trophoblastic neoplasia; Hematology, Oncology and Palliative Medicine; Humans; Hydroxyurea - administration & dosage; Methotrexate - administration & dosage; Obstetrics and Gynecology; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Factors; Vincristine - administration & dosage; Brazil; First subsequent pregnancy outcome; Chemotherapy; Gestational trophoblastic neoplasia
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2008.10.027

Abstract Objective To evaluate maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia (GTN) in Brazilian patients. Methods This study included 252 subsequent pregnancies after chemotherapy for GTN treated between 1960–2005. Correlations of maternal and perinatal outcomes with chemotherapy regimen (single or multiagent) and the time interval between chemotherapy completion and first subsequent pregnancy were investigated. Results There was a significant increase in adverse maternal outcomes in women who conceived < 6 months than 6–12 months (76.2% and 19.6%; p < 0.0001; OR = 13.12; CI 95% = 3.87–44.40) and > 12 months (76.2% and 21.7%; p < 0.0001; OR = 11.56; CI 95% = 3.98–33.55) after chemotherapy. Spontaneous abortion frequency was higher < 6 months (71.4%) than 6–12 months (17.6%; p < 0.0001; OR = 11.66; CI 95% = 3.55–38.22) and > 12 months (9.4%; p < 0.0001; OR = 23.97; CI 95% = 8.21–69.91) after chemotherapy. There was no difference in adverse perinatal outcomes (stillbirth, fetal malformation, and preterm birth) related to the interval after chemotherapy and subsequent pregnancy. The overall occurrence of adverse maternal and perinatal outcomes did not significantly differ between patients on single or multiagent regimens. Conclusion Adverse maternal outcomes and spontaneous abortion were more frequent among patients who conceived within 6 months of chemotherapy completion. In these cases, careful prenatal monitoring and hCG level measurement 6 weeks after the completion of any new pregnancy are recommended.