Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Abstract

IntroductionGestational 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.MethodsA 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.ResultsA 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.ConclusionsNearly 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.

Results with Floxuridine, Actinomycin D, Etoposide, and Vincristine in Gestational Trophoblastic Neoplasias with International Federation of Gynecology and Obstetrics Scores ≥5

“…Another larger study of 320 subjects examining reproductive outcomes after floxuridine-based regimens at our center found that 97.8% successfully became pregnant [32]. A meta-analysis evaluating reproductive outcomes after chemotherapy for GTN revealed a pregnancy rate of 86.7% among those desiring children, with a malformation rate of 1.76% [33]. Therefore, our data demonstrated that the reproductive outcomes post-FAEV are comparable to other regimens.…”

Fertility and pregnancy outcome in gestational trophoblastic disease

“…A sub-group analysis among all treated women demonstrated a statistically significant lower pregnancy rate after multi-agent chemotherapy than after single-agent chemotherapy (OR=0.54, 95% CI 0.38 to 0.77, p=0.001). 40 Blagden et al found higher conception rates in women in the single-agent group who conceived within a year after completion of treatment, 36 while no difference in pregnancy rate between single-or multi-agent chemotherapy was found in a recent MITO-9 analysis. 31 Studies comparing pregnancies in women who conceived within 6 months after completion of chemotherapy with those who conceived later, noted a higher rate of spontaneous abortions in early conceptions.…”

Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations

“…Studies in the literature support a high pregnancy rate despite prior chemotherapy with no increased adverse outcomes. 1,9,12 Furthermore, as previously demonstrated, women of childbearing age were able to get pregnant after uterine arteries embolization, [13][14][15] this management was adopted when the patient was found having severe hemorrhage episodes over the chemotherapy.…”