title: Complete molar pregnancy in adolescents from North and South America: Clinical presentation and risk of gestational trophoblastic neoplasia.
abstract: To compare complete hydatidiform mole (CHM) clinical presentation and risk factors associated with GTN development between North American and South American adolescents.
  
  
  
  This non-concurrent cohort study was undertaken including adolescents with CHM referred to centers in North America (New England Trophoblastic Disease Center, Harvard University, USA), and South America (Botucatu Trophoblastic Disease Center-São Paulo State University, Brazil; Trophoblastic Unit of Central University of Venezuela and Maternidad Concepcion Palacios of Caracas, Venezuela) between 1990 and 2012. Data were obtained from medical records and pathology reports. Study participants were allocated into 2 groups: North America (NA) and South America (SA).
  
  
  
  In NA and SA, 13.1% and 30.9% of patients with hydatidiform mole were adolescents, respectively. Of these, 77.6% in NA and 86.1% in SA had pathologic diagnosis of CHM (p=0.121). Vaginal bleeding (SA=69% vs NA=51%; p=0.020), anemia (SA=48% vs NA=18%; p<0.001), and elevated serum hCG (SA=232,860mIU/mL vs NA=136,412mIU/mL; p=0.039) were more frequent in SA than in NA. Median gestational age at diagnosis (SA=12weeks, NA=11weeks; p=0.030) differed whereas GTN development rate (SA=20%, NA=27%; p=0.282) showed no significant difference between groups. Compared to NA, medical complications and clinical factors associated with post-molar GTN were more frequent among SA adolescents.
  
  
  
  Medical complications and clinical factors associated with GTN development were more frequent in SA than in NA adolescents with CHM, suggesting that, in South America, awareness about the importance of diagnosing molar pregnancy early and considering CHM in the differential diagnosis in adolescents suspected to be pregnant should be raised.
authors.affiliation: Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil.
authors.forename: Renan Rocha
authors.initials: RR
authors.lastname: Soares
authors.affiliation: Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil; Trophoblastic Diseases Center of the Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil. Electronic address: imaesta@fmb.unesp.br.
authors.forename: Izildinha
authors.initials: I
authors.lastname: Maestá
authors.affiliation: Maternidad Concepción Palácios de Caracas, Venezuela.
authors.forename: José
authors.initials: J
authors.lastname: Colón
authors.affiliation: Trophoblastic Disease Center of Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil; Trophoblastic Disease Center of Antonio Pedro University Hospital of Fluminense Federal University, Rio de Janeiro, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braga
authors.affiliation: Department of Obstetrics and Gynecology, GTD Unit, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela.
authors.forename: Aleydah
authors.initials: A
authors.lastname: Salazar
authors.affiliation: Department of Obstetrics and Gynecology, GTD Unit, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela.
authors.forename: Rafael Cortés
authors.initials: RC
authors.lastname: Charry
authors.affiliation: Trophoblastic Disease Center of São Paulo Hospital, Department of Obstetrics, Paulista School of Medicine, UNIFESP-São Paulo Federal University, São Paulo, SP, Brazil.
authors.forename: Sue Yazaki
authors.initials: SY
authors.lastname: Sun
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein, MD Trophoblastic Tumor Registry, Brigham and Women's Hospital, Harvard Cancer Center/Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein, MD Trophoblastic Tumor Registry, Brigham and Women's Hospital, Harvard Cancer Center/Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, USA.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology*; D006801:Humans; D006828:Hydatidiform Mole / Q000453:epidemiology*; D009656:North America; D011247:Pregnancy; D012189:Retrospective Studies; D013020:South America; D055815:Young Adult
keywords: Adolescents; Gestational trophoblastic neoplasia; Molar pregnancy