PREDICTORS OF SUBSEQUENT PREGNANCY FOLLOWING MEDICAL TREATMENT IN OBESE WOMEN WITH COMPLEX ATYPICAL HYPERPLASIA

Abstract

To describe characteristics and outcomes of women with complex atypical hyperplasia (CAH) who underwent medical treatment and achieved subsequent pregnancy. This is a retrospective observational study at a single large safety net hospital from 2011-2018. Consecutive women diagnosed with CAH who received hormonal therapy and desired future fertility were examined. The main outcome measures were (i) subsequent pregnancy rate assessed with a cumulative function model and (ii) independent factors associated with subsequent pregnancy assessed with a competing risk analysis with the Fine-Gray model accounting for competing events for pregnancy (hysterectomy and cancer progression) in a multivariable model. A total of 66 women were examined. The median age was 33 (IQR 28-36) years. The median body mass index (BMI) was 37.1 (31.8-42.0) kg/m2, and 56 (84.8%) women were obese, including 24 (36.4%) women with class III obesity. The median follow-up of censored cases was 19.8 (IQR 11.7-31.9) months, and 21 measured events occurred during follow-up (8 subsequent pregnancies and 13 competing events). The cumulative rates of subsequent pregnancy at 1- and 2-year follow-up points were 8.8% and 11.0%, respectively. In a multivariable analysis, 1 kg/m2 incremental increase in baseline BMI was associated with a 7% decrease in the likelihood of subsequent pregnancy (adjusted-odds ratio 0.93, 95% confidence interval 0.88-0.98). Multiparous women were nearly 5 times more likely to achieve a subsequent pregnancy compared to nulliparous women (adjusted-odds ratio 5.56, 95% confidence interval 1.45-21.3). When stratified, multiparous women and those with a BMI below the median had a 2-year cumulative pregnancy rate of 37.0%, whereas there were no nulliparous women with a BMI above the median who achieved a subsequent pregnancy (absolute difference 37.0%, P=0.005). Twenty (30.3%) women received infertility treatment. When factored in the multivariable model, women who received infertility treatment had a significantly favorable pregnancy rate compared to those who did not (2-year cumulative pregnancy rate: 41.1% versus 0%, sub-division hazard ratio 19.3, 95% confidence interval 4.2-89.1) The chance of subsequent pregnancy in this predominantly obese population with CAH was overall low to modest, and both larger body habitus and nulliparity predicted a lower chance of subsequent pregnancy.