Subsequent Pregnancy Experience in Patients With Molar Pregnancy and Gestational Trophoblastic Tumor

Abstract

The records of the New England Trophoblastic Disease Center (NETDC) since its inception in 1965 were reviewed with the aim of investigating subsequent pregnancies in patients who had been treated for molar pregnancy and persistent gestational trophoblastic tumors. Information on both partial and complete mole was included. There have been 1278 total pregnancies recorded after treatment for complete mole at NETDC and 251 subsequent pregnancies after partial mole. The rates of live full-term and preterm birth were 69% and 7.4%, respectively, in women with a complete mole and 75% and 1.6%, respectively, for women with a partial mole. There were seven stillborn infants (0.5%) and 40 (4%) congenital anomalies reported in the women who had complete mole and one stillbirth and three (0.4%) congenital anomalies in the women with partial mole. The rates of spontaneous abortion were 18% and 16%, respectively. Among women who were treated for persistent trophoblastic disease, there were 581 subsequent pregnancies. In these women the rate of full-term live birth was 68%, preterm live birth 6%, stillbirth 1.5%, congenital anomalies 2.3%, and spontaneous abortion 17%. These data are similar to the pregnancy experience of the population at large. A review of the data from four other centers showed similar results. There were no cases of premature ovarian failure recorded among the patients in the NETDC registry. Secondary infertility was reported by 4.4% of the women. Thirty-four patients experienced a second molar pregnancy. At least 6 months of normal serum human chorionic gonadotropin levels were recorded in all cases. Fourteen were repeat complete mole and 10 were repeat partial mole. Four patients who had initially had a partial mole had a complete mole, and six who had a complete mole with the first pregnancy had a subsequent partial mole. There were 35 subsequent pregnancies among 22 women who had two previous molar pregnancies, seven of which were third molar pregnancies. There were also 20 (57%) live full-term births, three spontaneous abortions, and one stillbirth. The rate of congenital anomalies was 5%. Patients who became pregnant before completion of recommended follow-up after molar pregnancy or persistent gestational trophoblastic tumors had pregnancy experiences that were comparable with the others in this study group.