Contraceptive use following gestational trophoblastic disease: A systematic review.

Autor: Hagey JM; Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States. Electronic address: jmhagey@gmail.com., Drury KE; Duke Women's Health Wake County North, Department of Obstetrics and Gynecology, Duke University, Wake Forest, NC, United States. Electronic address: kerry.drury@duke.edu., Kaplan S; Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, United States. Electronic address: samantha.kaplan@duke.edu., Davidson BA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States. Electronic address: brittany.davidson@duke.edu., Morse JE; Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States. Electronic address: jessica_morse@med.unc.edu.
Jazyk: angličtina
Zdroj: Contraception [Contraception] 2024 Sep; Vol. 137, pp. 110488. Date of Electronic Publication: 2024 May 17.
DOI: 10.1016/j.contraception.2024.110488
Abstrakt: Objective: To systematically review the effect of contraceptive methods following gestational trophoblastic disease (GTD) on timing of beta-human chorionic gonadotropin (hCG) remission, risk of post-molar gestational trophoblastic neoplasia (GTN), risk of unintended incident pregnancy, and interactions between contraceptive methods and disease treatment.
Study Design: We conducted a search of primary literature with search terms related to GTD and contraception through April 2023 in PubMed and extrapolated our search to other platforms. Randomized controlled trials, observational studies and case reports were eligible for inclusion if they reported on patients with known GTD who received a contraceptive method for pregnancy prevention. Data was abstracted on our main outcomes of interest: timing of beta-hCG remission, risk of post-molar GTN, risk of unintended incident pregnancy, and interactions between contraceptive methods and cancer-directed systemic disease treatment (e.g., chemotherapy). At least two authors reviewed manuscripts at each screening stage with consensus reached before data extraction. Quality assessment checklists were used to assess risk of bias for the different study types.
Results: Five thousand one hundred and five studies were identified in the database search, of which 42 were included for analysis. Eight thousand two hundred and ninety four participants were evaluated. Over half of the studies were case reports and only two were randomized controlled trials. While there was sparse data on all outcomes, no differences were noted in beta-hCG monitoring, risk of post-molar GTN or incident pregnancies between different contraceptive types. Interactions between contraceptive methods and cancer-directed systemic disease treatment (e.g., chemotherapy) or specific adverse events of contraceptive methods were not identified.
Conclusions: Data on contraceptive use following GTD is limited, but use of both hormonal and non-hormonal modern contraceptive methods appears safe. Counseling patients on the full range of contraceptive methods is important to help patients achieve their reproductive health goals and minimize the risk of disease progression through incomplete beta-hCG monitoring prior to future pregnancy.
Implications: Hormonal and non-hormonal contraceptive options may be used by patients following gestational trophoblastic disease without apparent changes in beta-hCG regression or risk of post-molar gestational trophoblastic neoplasia.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: