Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: an observational study

Abstract

A remarkable nonlinear growth of small fibroids during initial pregnancy was observed, with a faster rate in the first trimester and a slowdown by midpregnancy. Those changes seem to be related to the similar increase of hCG levels until 12 weeks.

Myoma and myomectomy: Poor evidence concern in pregnancy

“…There are poor data in the literature on the recommendation for elective preconception myomectomy in asymptomatic women with fibroids . Preconception myomectomy seems to reduce uterine contractility, restore normal anatomy and stop local inflammation . In contrast, it may provoke endometrial damage and pelvic adhesions, responsible for unfavorable obstetric outcomes.…”

Human Chorionic Gonadotrophin as a Possible Mediator of Leiomyoma Growth during Pregnancy: Molecular Mechanisms

“…As alluded above, several reports have been published with the aim to clarify the influence of pregnancy on uterine leiomyomas but conclusions are not fully consistent [ 13 , 16 , 17 , 19 , 20 , 21 , 22 , 23 ]. The controversies among studies investigating the effects of pregnancy on fibroid growth can be explained by differences in the study design, the population studied and timing of ultrasound evaluations [ 13 , 16 , 17 , 19 , 20 , 21 , 22 , 23 ]. Noteworthy, some contributions have assessed leiomyoma increase during pregnancy starting after the 10th week of pregnancy and thus quite late to monitor correctly the growth pattern.…”

“…The logistic regression analysis revealed that the volumetric change occurred mainly in the first half of pregnancy and was influenced negatively by parity and positively by pre-pregnancy BMI, while maternal age correlated negatively with leiomyoma growth over the entire course of pregnancy [ 13 ]. Ciavattini et al examined 109 pregnant women who underwent an ultrasound scan before pregnancy, a second one at 7–8 weeks of gestation, a third examination at 10–13 week of gestation and a fourth scan at 20–22 weeks of gestation [ 19 ]. A significant increase for most leiomyomas during the first half of pregnancy (a median growth rate of 122% during the interval between the first and the second scan; median growth rate of 108% between the second and third ultrasound; median growth rate of 25% between the third and fourth ultrasound) without a linear correlation between the growth trend and the gestational age (small leiomyomas seemed to grow at a faster rate in the first trimester and to undergo a slow down by mid-pregnancy) was reported.…”

“…In contrast with findings by De Vivo et al, at multivariate analysis, these authors could not confirm an association with maternal age, BMI, parity and gravidity. Moreover, these Authors demonstrated a significant positive correlation between hCG serum levels and the diameter of myomas during early pregnancy [ 19 ]. In a prospective cohort study of 25 women with fibroids undergoing In vitro fertilization (IVF) conducted by Benaglia et al, pregnant patients were systematically scanned after 4–5 weeks from embryo transfer.…”

“…Even if available evidence on this issue is not fully consistent [ 13 , 16 , 17 , 19 , 20 , 21 , 22 , 23 ], it is noteworthy that more recent and better-designed studies generally report a nonlinear increase in dimensions, with more growth in the first half of pregnancy, particularly during the first trimester [ 14 ]. Considering the increasing incidence of uterine fibroids during pregnancy and the possible correlation between fibroid size and adverse obstetric events [ 19 ], it might be important to obtain further information about the regulation of growth of these tumors during pregnancy. Of potential high relevance here is the role of hCG, as this hormone has an exponential raise at the beginning of pregnancy, i.e., during the period of potential maximal fibroid growth.…”