Psychologic impact of follow-up after low-risk gestational trophoblastic disease

To investigate the psychological consequences of hCG measurements during follow-up in patients with low-risk gestational trophoblastic disease. The length of follow-up of patients with molar pregnancy and spontaneous normalization of the hCG level is currently discussed, in consideration of the low incidence of recurrent disease.

Patients registered in the Dutch Central Registry of Hydatidiform Mole between January 2006 and December 2007 were eligible for this study. Patients received a questionnaire containing questions about follow-up and anxiety and stress during this period.

Seventy-six patients were eligible for the study. An inverted correlation (r = -0.35, p = 0.003) was found between the age of patients and the level of anxiety. Anxious patients scored higher for fear of recurrence (r = 0.49, p < 0.0001), of infertility (r = 0.40, p = 0.001) and of conceiving again (r = 0.30, p = 0.01). They experienced the measurements as a burden (r = 0.35, p = 0.003). Fewer patients (24%) were insecure before the monthly hCG measurement, compared to 51% during weekly measurements. The majority of women (80%) completed the follow-up and confirmed that they would come for weekly and monthly hCG measurements if it were optional.

Follow-up after low-risk GTD has psychologic consequences but provides reassurance as well. Therefore, women tend to accept the offered surveillance and refrain from pregnancy. Women with GTD should be counseled about the minor risk of recurrence and the consequences of follow-up.