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Hajri T, Massoud M, Vergne M, Descargues P, Allias F, You B, Lotz JP, Haesebaert J, Bolze PA, Golfier F, Massardier J. Multiple pregnancy with complete hydatidiform mole and coexisting normal fetus in a retrospective cohort of 141 patients. Am J Obstet Gynecol 2024; 230:362.e1-362.e8. [PMID: 37722570 DOI: 10.1016/j.ajog.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Multiple pregnancy with a complete hydatidiform mole and a normal fetus is prone to severe obstetrical complications and malignant transformation after birth. Prognostic information is limited for this rare form of gestational trophoblastic disease. OBJECTIVE This study aimed to determine obstetrical outcomes and the risk of gestational trophoblastic neoplasia in women with multiple pregnancy with complete hydatidiform mole and coexisting normal fetus, and to identify risk factors for poor obstetrical and oncological outcomes to improve patient information and management. STUDY DESIGN This was a retrospective national cohort study of 11,411 records from the French National Center for Trophoblastic Disease registered between January 2001 and January 2022. RESULTS Among 11,411 molar pregnancies, 141 involved histologically confirmed multiple pregnancy with complete hydatidiform mole and coexisting normal fetus. Roughly a quarter of women (23%; 33/141) decided to terminate pregnancy because of presumed poor prognosis or by choice. Among the 77% of women (108/141) who continued their pregnancy, 16% of pregnancies (17/108) were terminated because of maternal complications, and 37% (40/108) ended in spontaneous miscarriage before 24 weeks' gestation. The median gestational age at delivery in the remaining 47% of pregnancies (51/108) was 32 weeks. The overall neonatal survival rate at day 8 was 36% (39/108; 95% confidence interval, 27-46) after excluding elective pregnancy terminations. Patients with free beta human chorionic gonadotropin levels <10 multiples of the median were significantly more likely to reach 24 weeks' gestation compared with those with free beta human chorionic gonadotropin levels >10 multiples of the median (odds ratio, 7.0; 95% confidence interval, 1.3-36.5; P=.022). A lower free beta human chorionic gonadotropin level was also associated with better early neonatal survival (the median free beta human chorionic gonadotropin level was 9.4 multiples of the median in patients whose child was alive at day 8 vs 20.0 multiples of the median in those whose child was deceased; P=.02). The overall rate of gestational trophoblastic neoplasia after a multiple pregnancy with complete hydatidiform mole and a normal fetus was 26% (35/136; 95% confidence interval, 19-34). All 35 patients had low-risk International Federation of Gynecology and Obstetrics scores, and the cure rate was 100%. Termination of pregnancy on patient request was not associated with lower risk of gestational trophoblastic neoplasia. Maternal complications such as preeclampsia and postpartum hemorrhage were not associated with higher risk of gestational trophoblastic neoplasia, and neither were high human chorionic gonadotropin levels or newborn survival at day 8. CONCLUSION Multiple pregnancy with complete hydatidiform mole and coexisting fetus carries a high risk of obstetrical complications. In patients who continued their pregnancy, approximately one-third of neonates were alive at day 8, and roughly 1 in 4 patients developed gestational trophoblastic neoplasia. Therefore, the risk of malignant transformation appears to be higher compared with singleton complete moles. Low levels of free beta human chorionic gonadotropin may be indicative of better early neonatal survival, and this relationship warrants further study.
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Affiliation(s)
- Touria Hajri
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Mona Massoud
- Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Margot Vergne
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Pierre Descargues
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Fabienne Allias
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Pathology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Benoit You
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Investigation Center for Treatments in Oncology and Hematology of Lyon (CITOHL), Lyon, France
| | - Jean-Pierre Lotz
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology and Cellular Therapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, Alliance for Cancer Research (APREC), Paris, France
| | - Julie Haesebaert
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Research on Healthcare Performance (RESHAPE), Inserm U1290, Université Claude Bernard Lyon 1, France
| | - Pierre-Adrien Bolze
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - François Golfier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Jerome Massardier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Femme Mere Enfant University Hospital, Lyon, France.
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Morgan JC, Ernst LM, Grable I. Elevation of Maternal Serum α-Fetoprotein: Implications for the Neonate. Neoreviews 2024; 25:e117-e121. [PMID: 38296791 DOI: 10.1542/neo.25-2-e117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Jessica Celine Morgan
- Department of Obstetrics and Gynecology, University of Chicago/NorthShore University Health System, Evanston, IL
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, IL
| | - Ian Grable
- Department of Obstetrics and Gynecology, University of Chicago/NorthShore University Health System, Evanston, IL
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Skogler J, Moberg T, Tancredi L, Styrmisdóttir L, Hedayati E, Alarcon-Ruiz CA, Khamis A, Persad E, Iskandarani G, Hansson SR, Bruschettini M. Association between human chorionic gonadotropin (hCG) levels and adverse pregnancy outcomes: A systematic review and meta-analysis. Pregnancy Hypertens 2023; 34:124-137. [PMID: 37951184 DOI: 10.1016/j.preghy.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/01/2023] [Indexed: 11/13/2023]
Abstract
Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and adverse pregnancy outcomes. We conducted a systematic review including studies measuring hCG blood levels in the first or second trimester, reporting on any of the 12 predefined adverse pregnancy outcomes with logistic regression-adjusted association estimates. The primary outcomes were placenta-associated complications, such as miscarriage, preeclampsia, intrauterine growth restriction, and preterm delivery. We searched PubMed, Embase and CINAHL Complete. The hCG levels were analysed as multiple of the median (MoM). Odds ratio (OR) and 95% confidence interval (CI) were used. Risk of bias and the certainty of evidence were assessed using ROBINS-I and GRADE, respectively. Meta-analysis also showed that hCG levels, reported as MoM ≥2/2.31/2.5, might be associated with an increased risk of preeclampsia (OR 2.08, 95% CI 1.26 to 3.44) and preterm delivery (OR 1.29, 95% CI 1.12 to 1.47), but the evidence is very uncertain. High second trimester hCG levels may be associated with preeclampsia and preterm delivery but confidence in evidence is low.
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Affiliation(s)
| | - Tilda Moberg
- Lund University, Lund, Sweden; Helsingborg Hospital, Helsingborg, Sweden.
| | - Luca Tancredi
- Regiomed Medical School, University of Split School of Medicine, Split, Croatia
| | | | - Ehsan Hedayati
- Nezam Mafi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Assem Khamis
- Wolfson Palliative Care Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Emma Persad
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Evidence-based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria
| | | | - Stefan R Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
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Araganji R, Somannavar MS, Vernekar SS, Kavi A, Hoffman MK, Goudar SS. The impact of low-dose aspirin on markers of inflammation and placental function: an ancillary study of the ASPIRIN trial. J Matern Fetal Neonatal Med 2022; 35:6901-6905. [PMID: 34016022 DOI: 10.1080/14767058.2021.1929160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the impact of low-dose aspirin (81 mg) on markers of maternal inflammation and placental function. SETTING Rural Southern India. POPULATION Nulliparous women with a singleton pregnancy dated by ultrasound who were enrolled in the ASPIRIN (Aspirin Supplementation for Pregnancy Indicated risk Reduction In Nulliparas) Trial. METHODS We performed a case-control study to elucidate the impact of low dose aspirin (LDA) on markers of placental function and maternal inflammation among women who delivered prematurely compared to term controls in women enrolled in the ASPIRIN trial. Women were prospectively enrolled in an ancillary observational trial wherein maternal serum was collected and measured between 10 to 13 weeks and 17 to 21 weeks of gestation after initiation of aspirin or an identical placebo. RESULTS From 2016-18 with a total of 666 n women enrolled in this ancillary trial of whom 269 were selected for analyte analysis. Women who received LDA had lower levels of Alpha Feto-Protein (AFP) at 10 to 13 weeks than women who received placebo (Placebo) (LDA 18.3 ng/mL vs 21.4 ng/mL -P 0.001). AFP was similar between the two groups at 17 to 21 weeks. No other differences were seen in C-Reactive protein or Anti-Mullerian Hormone. CONCLUSION Low-dose aspirin administration lowers AFP early in pregnancy.
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Affiliation(s)
- Ramesh Araganji
- Department of Physiology, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Manjunath S Somannavar
- Department of Biochemistry, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Sunil S Vernekar
- Department of Physiology, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Avinash Kavi
- Department of Community Medicine, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | | | - Shivaprasad S Goudar
- Department of Physiology, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, India
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