Association between antioxidant vitamins and oxidative stress among patients with a complete hydatidiform mole

Association of gestational trophoblastic disease with subsequent development of non-trophoblastic cancer

OBJECTIVE

To evaluate the association between gestational trophoblastic disease and the subsequent risk of developing non-trophoblastic cancer.

METHODS

We conducted a retrospective cohort study of 3084 women with gestational trophoblastic disease and 1 415 812 women with obstetric deliveries in Quebec, Canada, between 1989 and 2021. The main exposure was gestational trophoblastic disease, including hydatidiform moles, invasive moles, and gestational choriocarcinoma. The outcome was development of non-trophoblastic cancer during 33 years of follow-up. We measured the association of gestational trophoblastic disease with non-trophoblastic cancer using adjusted hazard ratios (HR) and 95% confidence intervals (CI), and tested whether associations were stronger for certain types of cancer or cancers with later onset.

RESULTS

The incidence of non-trophoblastic cancer was greater for women with invasive moles (47.1/10 000 person-years) and gestational choriocarcinoma (59.3/10 000 person-years) than hydatidiform moles (18.4/10 000 person-years) and no gestational trophoblastic disease (22.4/10 000 person-years). Gestational choriocarcinoma (HR 2.33, 95% CI: 1.35-4.01; P = 0.002) and invasive moles (HR 1.97, 95% CI: 1.06-3.65; P = 0.033) were associated with an elevated risk of non-trophoblastic cancer compared with no gestational trophoblastic disease, while hydatidiform moles were not. Gestational choriocarcinoma and invasive moles were mainly associated with gynecologic cancer. However, risk of cancer was limited to the short-term period after pregnancy and became similar to no gestational trophoblastic disease by the end of follow-up.

CONCLUSION

While invasive moles and gestational choriocarcinoma appear to be associated with the subsequent development of non-trophoblastic cancer, the absolute risk is small and limited to the short-term.

The causal relationship between hydatidiform mole and nutrients: A two-sample Mendelian randomization study

BACKGROUND

Hydatidiform mole (HM), a subset of gestational trophoblastic disease, is considered precancerous and exhibits geographical variation. The incidence of HM is linked to nutritional factors. This study aimed to investigate the causal relationship between nutrients and HM using a bidirectional two-sample Mendelian randomization (MR) approach.

METHODS

We utilized publicly available genome-wide association study data to assess the causal associations between levels of specific vitamins (retinol, vitamins B12, B6, C, D, E, folate, and carotene) and minerals (iron, calcium, and magnesium) with HM. The MR analysis was conducted and reported following the STROBE-MR guidelines, employing MR Egger and inverse variance weighted (IVW) methods to estimate associations, with MR-PRESSO for pleiotropy testing.

RESULTS

The study revealed vitamin B6 as a significant protective factor against HM (MR-Egger OR: 0.094, 95 % CI: 0.011-0.0778, P < 0.05; IVW OR: 0.365, 95 % CI: 0.142-0.936, P < 0.05). Folate and magnesium showed suggestive associations with HM, whereas most other nutrients did not exhibit a causal relationship. MR-PRESSO analysis supported the absence of horizontal pleiotropy of vitamin B6. Besides, reverse MR analysis did not reveal a significant causal association between HM and serum nutrient levels, suggesting that differences of nutrients in HM patients may not be directly attributed to the mole.

CONCLUSION

This MR study provides evidence that vitamin B6 may protect against HM, and suggests potential roles for folate and magnesium in HM development, while highlighting the need for further research to confirm these findings.

Epidemiology of Gestational Trophoblastic Disease

Worldwide incidence rates of gestational trophoblastic disease (GTD) are difficult to estimate and compare due to large methodological differences within and between countries. Asia has generally reported higher incidence rates than Europe and North America, but modern reports have demonstrated a temporal decrease of GTD incidence rates in Asia and an increase in some European countries and North America. The main risk factors for hydatidiform mole are maternal age and previous molar events. Future studies on the epidemiology of GTD should include gestational trophoblastic neoplasia and international collaborative studies on this rare disease should be encouraged.

Influence of COVID-19 pandemic on molar pregnancy and postmolar gestational trophoblastic neoplasia: An observational study

OBJECTIVE

To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID-19 pandemic.

DESIGN

Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross-sectional analysis, with application of a questionnaire.

SETTING

Six Brazilian Reference Centres on gestational trophoblastic disease.

POPULATION

2662 patients with MP/postmolar GTN treated from March-December/2015-2020 were retrospectively evaluated and 528 of these patients answered a questionnaire.

METHODS

Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross-sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID-19 pandemic compared with previous years.

MAIN OUTCOME MEASURES

The incidence of MP/postmolar GTN.

RESULTS

Compared with the last 5 pre-pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID-19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90-3.29, P < 0.001), have a pre-evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38-2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01-3.43, P = 0.047) when compared with 2015-2019.

CONCLUSIONS

Although the incidence of MP/postmolar GTN remained stable during the COVID-19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN.

Dietary Factors and Incidence of Hydatidiform Mole: An Ecological Study

The current ecological study aims to explore the association between dietary factors and hydatidiform mole (HM) incidence in Japan and China. HM incidence in Japan gradually declined from 1970s to 1990s, while the dietary structure also changed during the same period, mainly characterized by a decrease in the consumption of cereals and an increase in the consumption of meat, eggs, and dairy products. In China, HM incidence varied by regions, and it positively correlated with the per capita intake of rice, fish and shrimp, and animal fat, as well as the proportion of GDP of primary industry; and negatively correlated with the per capita intake of wheat flour, starch and sugar, protein, and iron, and the proportion of protein in the caloric nutrients and the proportion of nonagricultural population. In partial analysis, the correlations of HM incidence with rice, fish and shrimp, iron, and the proportion of protein in caloric nutrients remained significant. Meanwhile, alcoholic beverage consumption and the proportion of empty calories in caloric food were also found to be positively correlated with HM incidence, while phosphorus consumption was negatively correlated. Our results suggested that HM incidence could be influenced by dietary factors.

Cyantraniliprole impairs reproductive parameters by inducing oxidative stress in adult female wistar rats

Cyantraniliprole is a synthetic insecticide used to control pests of up to 23 different types of crops. It is able to modulate ryanodine-like calcium channels, which are widely found in the organism of insects and mammals. The objective of this research was to verify the possible reproductive effects of adult female Wistar rats exposure to cyantraniliprole. Animals (67 days old) were exposed to the chemical at doses of 10 or 150 mg/kg/day, orally, for 28 consecutive days (control animals received only the vehicle). Vaginal secretions were collected during the exposure period to assess the regularity of the estrous cycle; the liver, kidneys, pituitary gland, adrenal gland, uterus, and ovaries were collected and weighed; reproductive organs were assessed for histopathological evaluation and for biochemical markers of oxidative stress and progesterone plasma level was measured. Both doses caused negative changes in the morphology and redox system of the uterus and ovaries. Animals exposed to 10 mg/kg also exhibited higher level of plasma progesterone, elevated levels of lipid peroxidation in reproductive organs, increased superoxide dismutase activity in the uterus and glutathione peroxidase activity on the ovary, while the 150 mg/kg group exhibited an increment in estrous cycle length and diminished uterine glandular epithelium. Based on these results, we conclude that cyantraniliprole may have acted as an endocrine disruptor, and its effects are mediated by oxidative stress.