title: Maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia in Brazilian women.
abstract: OBJECTIVE
  To evaluate maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia (GTN) in Brazilian patients.
  
  
  METHODS
  This study included 252 subsequent pregnancies after chemotherapy for GTN treated between 1960-2005. Correlations of maternal and perinatal outcomes with chemotherapy regimen (single or multiagent) and the time interval between chemotherapy completion and first subsequent pregnancy were investigated.
  
  
  RESULTS
  There was a significant increase in adverse maternal outcomes in women who conceived <6 months than 6-12 months (76.2% and 19.6%; p<0.0001; OR=13.12; CI 95%=3.87-44.40) and >12 months (76.2% and 21.7%; p<0.0001; OR=11.56; CI 95%=3.98-33.55) after chemotherapy. Spontaneous abortion frequency was higher <6 months (71.4%) than 6-12 months (17.6%; p<0.0001; OR=11.66; CI 95%=3.55-38.22) and >12 months (9.4%; p<0.0001; OR=23.97; CI 95%=8.21-69.91) after chemotherapy. There was no difference in adverse perinatal outcomes (stillbirth, fetal malformation, and preterm birth) related to the interval after chemotherapy and subsequent pregnancy. The overall occurrence of adverse maternal and perinatal outcomes did not significantly differ between patients on single or multiagent regimens.
  
  
  CONCLUSIONS
  Adverse maternal outcomes and spontaneous abortion were more frequent among patients who conceived within 6 months of chemotherapy completion. In these cases, careful prenatal monitoring and hCG level measurement 6 weeks after the completion of any new pregnancy are recommended.
authors.affiliation: Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP - Sao Paulo State University, Botucatu/SP, Brazil.
authors.forename: Antônio
authors.initials: A
authors.lastname: Braga
authors.forename: Izildinha
authors.initials: I
authors.lastname: Maestá
authors.forename: Odair Carlito
authors.initials: OC
authors.lastname: Michelin
authors.forename: Lúcia Regina Gomes
authors.initials: LR
authors.lastname: Delmanto
authors.forename: Marcos
authors.initials: M
authors.lastname: Consonni
authors.forename: Marilza Vieira Cunha
authors.initials: MV
authors.lastname: Rudge
authors.forename: Paulo
authors.initials: P
authors.lastname: Belfort
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001938:Brazil; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D006918:Hydroxyurea; D008727:Methotrexate