Natural history of molar pregnancy in adolescents: a study in north and South America

Abstract

Natural history of molar pregnancy in adolescents - A study in North and South America Introduction. Hydatidiform mole (HM) is a pregnancy complication characterized by varying degrees of trophoblastic proliferation and potential for malignancy. Therefore, close follow-up after the HM uterine evacuation is essential to detecting postmolar gestational trophoblastic neoplasia (GTN). Advanced maternal age (over 40 years) has been demonstrated to be a major risk factor for developing postmolar GTN. However, whether such risk is increased in adolescents with a molar pregnancy remains unknown. Objectives. To describe the clinical presentation of HM pregnancy in adolescents from North America and South America; to check whether there are differences in the risk of developing GTN between adult and adolescent populations; and to identify clinical factors that may predict the risk of developing postmolar GTN. Methods. This international collaborative nonconcurrent cohort study will include patients with HM who attended reference centers in North America (New England Trophoblastic Disease Center, Brigham and Women´s Hospital, Harvard Medical School) and South America (Centro de Doenças Trofoblásticas de Botucatu/Universidade Estadual Paulista, Centro de Enfermedad Trofoblástica de la Universidad Central de Venezuela, and Centro de Enfermedad Trofoblástica de la Maternidad Concepción Palácios de Caracas/Venezuela), between January/1990 and December/2010. Data will be collected from medical records. Patient life stage classified as adolescence (10-19 years) or adulthood (e 20 years) will be used as the predictive variable. Gestational age (in weeks), uterus size, vaginal bleeding, anemia, presence of theca-lutein cysts, hypermesis, preeclampsia, pre-evacuation serum hCG level, and HM histological type (partial or complete) will be considered as potential moderator/modifier variables. HM development into GTN will be the outcome variable. The analysis of moderator/modifier variables will include HM characteristics upon diagnosis. The odds ratio (OR) and 95% confidence intervals for the risk of postmolar GTN will be determined in both adolescents and non-adolescents (< 20 years; e 20 years). Logistic regression will be used to identify the clinical factors associated with postmolar GTN development. Differences will be considered significant when p <0.05. (AU)