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Risk of abnormal pregnancy completing chemotherapy for gestational trophoblastic tumor
Hideo Matsui1, Yoshinori Iitsuka, Kiyomi Suzuka
1Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba University Hospital, Japan. hmatsui@med.m.chiba-u.ac.jp
Objective:
This study analyzed the outcome of the first pregnancy following chemotherapy for gestational trophoblastic tumor (GTT).
Methods:
A total of 387 patients with GTT (85 patients with high-risk GTT and 302 patients with low-risk GTT) underwent chemotherapy at Chiba University Hospital between 1974 and 2000. Of these patients, 130 women (18 with high-risk GTT and 112 with low-risk GTT), who achieved remission and had at least one conception following chemotherapy, were included in the study.
Results:
The outcomes of all the first subsequent pregnancies in women treated with methotrexate, actinomycin-D, or etoposide (including those switched to other regimens), or combination therapy, were comparable to those in the Japanese general population. However, the incidence of abnormal pregnancies (spontaneous abortion, still birth, repeat mole) was significantly higher in women who conceived within 6 months of completing chemotherapy (4/15; 40%) than in those who conceived after the recommended waiting period of more than 12 months (10/95; 10.5%) (P = 0.028).
Conclusion:
Patients with GTT who achieved remission after chemotherapy with methotrexate, actinomycin-D, or etoposide, or combination therapy, may anticipate a normal future reproductive outcome. As pregnancies occurring within 6 months following remission are at risk of abnormalities, a waiting period of at least 6 months after chemotherapy for GTT is suggested.