Authors' reply re: Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following a complete hydatidiform mole: a historical database review.

Abstract

OBJECTIVE: To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). DESIGN: Historical database review. SETTING: Charing Cross Hospital Gestational Trophoblastic Disease Centre London United Kingdom. POPULATION: Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated followed between 2003 and 2012. METHODS: We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. MAIN OUTCOME MEASURES: Time to hCG remission risk of developing postmolar GTN and proportion of women with high FIGO risk score. RESULTS: No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both P = 0.19) GTN development (HC users versus non-users: 20.1 and 16.7% P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8% P = 0.15). Moreover no association between HC and GTN development was found even when an age-adjusted model was used (OR = 1.37 95% CI 0.91-2.08 P = 0.13). CONCLUSIONS: The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore HC can be safely used to prevent a new conception following CHM regardless of hCG level. TWEETABLE ABSTRACT: Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM. (c) 2015 Royal College of Obstetricians and Gynaecologists.