Does hormonal contraception during molar pregnancy follow-up influence the risk and clinical aggressiveness of gestational trophoblastic neoplasia after controlling for risk factors?
| Autor: | Patrícia Rangel Sobral Dantas, Kevin M. Elias, Izildinha Maestá, Neil Howoritz, Antonio Braga, Joffre Amin Junior, Jorge Rezende Filho, Ross S. Berkowitz |
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| Přispěvatelé: | Universidade Estadual Paulista (Unesp), Brazilian Assoc Gestat Trophoblast Dis, Rio de Janeiro Fed Univ, Harvard Med Sch, Fluminense Fed Univ |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Dose Chorionic Gonadotropin Contraceptives Oral Hormonal Human chorionic gonadotropin Cohort Studies 03 medical and health sciences 0302 clinical medicine Molar pregnancy Pregnancy Risk Factors medicine Humans Gestational Trophoblastic Disease Retrospective Studies Gestational trophoblastic neoplasia Gynecology 030219 obstetrics & reproductive medicine Gestational trophoblastic disease business.industry Contraceptive Devices Female Obstetrics and Gynecology Retrospective cohort study Hydatidiform Mole medicine.disease Contraception Oncology Hormonal contraception 030220 oncology & carcinogenesis Female business Follow-Up Studies Cohort study |
| Zdroj: | Web of Science Repositório Institucional da UNESP Universidade Estadual Paulista (UNESP) instacron:UNESP |
| Popis: | Made available in DSpace on 2018-11-26T17:42:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-01 Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) Donald P. Goldstein MD Trophoblastic Tumor Registry Endowment Dyett Family Trophoblastic Disease Research and Registry Endowment Objective. To evaluate the influence of hormonal contraception (HC) on the development and clinical aggressiveness of gestational trophoblastic neoplasia (GTN) and the time for normalization of human chorionic gonadotropin (hCG) levels. Methods. A retrospective cohort study was conducted with women diagnosed with molar pregnancy, followed at the Rio de Janeiro Trophoblastic Disease Center, between January 2005 and January 2015. The occurrence of postmolar GTN and the time for hCG normalization between users of HC or barrier methods (BM) during the postmolar follow-up or GTN treatment were evaluated. Results. Among 2828 patients included in this study, 2680 (95%) used HC and 148 (5%) used BM. The use of HC did not significantly influence the occurrence of GTN (ORa: 0.66, 95% CI: 0.24-1.12, p = 0.060), despite different formulations: progesterone-only (ORa: 0.54, 95% CI: 0.29-1.01, p = 0.060) or combined oral contraception (COC) (ORa: 0.50, 95% CI: 0.27-1.01, p = 0.60) or with different dosages of ethinyl estradiol: 15 mcg (ORa, 1.33, 95% CI 0.79-2.24, p = 0.288), 20 mcg (ORa: 1.02, 95% CI: 0.64-1.65, p = 0.901), 30 mcg (ORa: 1.17, 95% Cl: 0.78-1.75, p = 0.437) or 35 mcg (ORa: 0.77, 95% CI: 0.42-1.39, p = 0.386). Time to hCG normalization weeks (ORa: 0.58, 95% CI: 0.43-1.08, p = 0.071) or time to remission with chemotherapy 14 weeks (ORa: 0.60, 95% CI: 0.43-1.09, p = 0.067) did not significantly differ among HC users when compared to patients using BM, when controlling for other risk factors using multivariate logistic regression. Conclusions. The use of HC during postmolar follow-up or GTN treatment does not seem to increase the risk of GTN or its severity and does not postpone the normalization of hCG levels. (C) 2017 Elsevier Inc. All rights reserved. Sao Paulo State Univ, Postgrad Program Gynecol Obstet & Mastol, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil Brazilian Assoc Gestat Trophoblast Dis, Rio de Janeiro Trophoblast Dis Ctr, 180 Laranjeiras St, Rio De Janeiro, RJ, Brazil Rio de Janeiro Fed Univ, Dept Gynecol & Obstet, Matern Sch, Postgrad Program Perinatal Hlth, 180 Laranjeiras St, Rio De Janeiro, RJ, Brazil Harvard Med Sch, Dept Obstet & Gynecol & Reprod Biol, Div Gynecol Oncol,Brigham & Womens Hosp,Dana Far, New England Trophoblast Dis Ctr,Donald P Goldstei, 75 Francis St, Boston, MA USA Fluminense Fed Univ, Postgrad Program Med Sci, Antonio Pedro Univ Hosp, Dept Maternal Child, 303 Marques do Parana St, Niteroi, RJ, Brazil Sao Paulo State Univ, Postgrad Program Gynecol Obstet & Mastol, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil FAPERJ: E-26/112.070/2012 |
| Databáze: | OpenAIRE |
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