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Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy
  1. Anastasios Tranoulis1,
  2. Dimitra Georgiou2,
  3. Ahmad Sayasneh1,3 and
  4. John Tidy4
  1. 1 Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, King's College, London, UK
  2. 2 Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust, Imperial College, London, UK
  3. 3 School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College, London, UK
  4. 4 Sheffield Trophoblastic Centre, Weston Park Hospital, Sheffield, UK
  1. Correspondence to Dr Anastasios Tranoulis, Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, King's College, London SE1 7EH, UK; tasostranoulis{at}yahoo.com

Abstract

Introduction Gestational trophoblastic neoplasia represents a rare placental malignancy spectrum that is treated with single- or multi-agent chemotherapy. This disease often impacts women of childbearing age, making post-chemotherapy fertility and obstetrical outcomes an important consideration. We aimed to ascertain the pregnancy rates and obstetric outcomes in women with gestational trophoblastic neoplasia after undergoing treatment with chemotherapy.

Methods A systematic literature review was conducted to identify studies that reported post-chemotherapy fertility and obstetric outcomes among women with gestational trophoblastic neoplasia. We performed a single-proportion meta-analysis for the outcomes of conception/pregnancy rate, term live birth rate, first and second trimester spontaneous abortions rate, stillbirth rate, premature delivery rate, and fetal/neonatal malformation rate.

Results A total of 27 studies were included in the analysis. The median age ranged between 25.5 and 33.1 years. The pregnancy rate among women with a desire to conceive, comprising a total of 1329 women and 1192 pregnancies, was 86.7% (95% CI 80.8% to 91.6%). The term live birth rate in 6752 pregnancies was 75.84% (95% CI 73.4% to 78.2%). The adverse pregnancy outcomes were seemingly comparable to those of the general population apart from a minor increase in the stillbirth rate. The pooled proportion for the outcome of malformation rate was 1.76% (95% CI 1.3% to 2.2%). The repeat mole rate in 6384 pregnancies was 1.28% (95% CI 0.95% to 1.66%). Subsequent sub-group analysis indicated that neither multi-agent chemotherapy nor conception within 12 months post-chemotherapy increased the adverse obstetric events risk or fetal malformations.

Conclusions Nearly 90% of patients desiring future fertility after chemotherapy for gestational trophoblastic disease were able to conceive. In addition, adverse pregnancy outcomes were similar to that in the general population. Multi-agent chemotherapy does not seemingly increase the malformation rate.

  • gestational trophoblastic neoplasia
  • fertility
  • obstetric outcomes

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Footnotes

  • Contributors Study conception and design belongs to AT. AT, DG carried out acquisition, analysis and interpretation of data as well as manuscript editing. AS carried out manuscript editing. JT critically revised and appraised the manuscript. The authors certify that there is no actual or potential conflict of interest in relation to this article. We also certify that no party has a direct interest in the results of the research and that no benefit will be conferred on us or any organization with which we are associated. This manuscript is not currently under consideration for publication in another journal.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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