The effect of early pregnancy following chemotherapy on disease relapse and foetal outcome in women treated for gestational trophoblastic tumours

Abstract

Little literature exists on the safety of early pregnancy following chemotherapy. Here we assess the rate of relapse and foetal outcome in women who have completed single and multi-agent chemotherapy for gestational trophoblastic tumours. The records of 1532 patients treated for persistent gestational trophoblastic tumours at Charing Cross Hospital between 1969 and 1998 were reviewed. Patients were defined as receiving single agent or multi-agent treatment. Relapse rates and foetal outcome were reviewed in the 230 patients who became pregnant within 12 months of completing chemotherapy. In the single agent group 153 (22%) of 691 patients conceived early. Three subsequently relapsed. In the multi-agent group, 77 (10%) of 779 patients conceived early, two then relapsed. Relapse rates were 2% (3 out of 153) and 2.5% (2 out of 77) for each group compared to 5% and 5.6% in the comparative non-pregnant groups. Outcomes of 230 early pregnancies: 164 (71%) delivered at full term, 35 (15%) terminations, 26 (11%) spontaneous abortions, three (1.3%) new hydatidiform moles and two (1%) stillbirths. Early pregnancies were more common in the single agent group (P50.001), but spontaneous miscarriages and terminations were more likely to occur in the multi-agent group (P=0.04 and 0.03, respectively). Of the fullterm pregnancies, three (1.8%) babies were born with congenital abnormalities. Patients in either group who conceive within 12 months of completing chemotherapy are not at increased risk of relapse. Though, we still advise avoiding pregnancy within 12 months of completing chemotherapy, those that do conceive can be reassured of a likely favourable outcome.

Fertility and outcomes of pregnancy after chemotherapy in a sample of childbearing aged women

“…Except from Hodgkin's disease, where no clear conclusions can be drawn [2,[6][7][8][9][10], most of the studies on reproductive performance of women treated with anticancer drugs have described no increase in the incidence of infertility, prematurity, stillbirths or congenital malformations. The influence of the specific agents used on fertility and pregnancy outcomes is culled from studies including women treated for gestational trophoblastic tumour [11][12][13][14][15][16][17][18][19][20][21], ovarian carcinoma [22][23][24][25], and breast [26][27][28][29]. The results of our survey are in accordance with those studies.…”

Reproductive Outcomes After Gestational Trophoblastic Neoplasia. A Comparison Between Single-Agent and Multiagent Chemotherapy

“…The increased risk of miscarriage and stillbirth reported by some authors 18,20 is not confirmed by our data; all the patients in our study, however, conceived at least 12 months after the end of treatment. Pregnancy delay to at least 12 months after chemotherapy completion should be recommended to all patients to allow optimal surveillance and early tumor relapse detection.…”

“…Blagden et al 18 reported a higher miscarriage rate in patients conceiving within 12 months after combination chemotherapy. We cannot compare these results with ours because all patients in our study completed follow-up before conception.…”

Management of Gestational Trophoblastic Disease

“…The rate of congenital abnormality was low (1.8%), irrespective of the type of chemotherapy used. 63 The rate of stillbirth was elevated compared with the normal population (18.6 in 1000 births). 64 However, in another UK study of 241 treated patients who had a pregnancy within 12 months of chemotherapy, there was no significant increased risk of miscarriage, ectopic pregnancy, second molar pregnancy or stillbirth compared to the general UK population.…”