title: Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review.
abstract: OBJECTIVE
  To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM).
  
  
  METHODS
  Historical database review.
  
  
  METHODS
  Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom.
  
  
  METHODS
  Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012.
  
  
  METHODS
  We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined.
  
  
  METHODS
  Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score.
  
  
  RESULTS
  No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13).
  
  
  CONCLUSIONS
  The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level.
  
  
  CONCLUSIONS
  Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.
authors.affiliation: Trophoblastic Disease Center, Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital at Fluminense Federal University, Rio de Janeiro, Brazil.|Postdoctoral Program of Science without Borders (Brazilian Government) - Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK.|Postdoctoral Program of Gynecology, Obstetrics and Mastology Postgraduate of Botucatu Medical School, UNESP- São Paulo State University, Botucatu, São Paulo, Brazil.|Trophoblastic Disease Center, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Braga
authors.affiliation: Trophoblastic Disease Center, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil.
authors.forename: I
authors.initials: I
authors.lastname: Maestá
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Savage
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Harvey
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology*; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000097:blood / Q000601:surgery*; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D003278:Contraceptives, Oral, Hormonal
keywords: Gestational trophoblastic neoplasia; hormonal contraceptives; human chorionic gonadotropin; hydatidiform mole; oestrogen; progestogen