Abstract
To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team. Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a team of psychologists and reported by the 389 support groups conducted from 2014 to 2018. The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n = 137; 73.6%) reached spontaneous remission of molar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression, more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p = 0.067), less educated (p = 0.054), and whose disease progressed to GTN (p = 0.018), as well as in those who had to undergo multi-agent chemotherapy (p = 0.028) or hysterectomy (p = 0.001) adjuvant to clinical treatment. This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.
Highlights
The emotional aspects associated with normal pregnancies have been widely studied and described, when associated with high-risk gestations that may pose special risks to maternal and fetal health.[1,2] Of all pregnancy complications in Brazil, about 1:200-400 are cases of gestational trophoblastic disease (GTD)
It highlights the importance of specialized care only found in a reference center (RC), essential to support the recovery of the mental health of these women
Clinical staging of women that progressed to gestational trophoblastic neoplasia (GTN) used the 2002 Federation of Gynecology and Obstetrics (FIGO)-World Health Organization (WHO) criteria
Summary
The emotional aspects associated with normal pregnancies have been widely studied and described, when associated with high-risk gestations that may pose special risks to maternal and fetal health.[1,2] Of all pregnancy complications in Brazil, about 1:200-400 are cases of gestational trophoblastic disease (GTD). GTD is a fertilization error of cytogenetic origin that potentially leads to an obstetric near miss and may progress to gestational trophoblastic neoplasia, which may be a cause of maternal death if not treated adequately.[3,4,5]. These women face a great emotional impact when diagnosed with GTD. The emotional repercussions of this disease have been studied because of its particular circumstances and characteristics of GTD.[6,7] Their psychosocial impact should be understood to define directions for the improvement of the approaches adopted by multidisciplinary teams.[5,9]
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