Tracking the Cesarean Delivery–Postmolar Gestational Trophoblastic Neoplasia Link
OBJECTIVE:
To evaluate whether the history of cesarean delivery influences the risk or clinical aggressiveness of postmolar gestational trophoblastic neoplasia.
METHODS:
This retrospective cohort study involved two gestational trophoblastic disease reference centers in Brazil and the United States. Medical records from patients with histopathologically confirmed hydatidiform mole between January 2002 and December 2022 were reviewed. Patients were grouped according to the presence or absence of prior cesarean delivery. The primary outcome was the development of postmolar gestational trophoblastic neoplasia; the secondary outcome was resistance to single-agent chemotherapy. Multivariable logistic regression models adjusted for relevant confounders were used to identify independent predictors.
RESULTS:
Among 2,904 patients with hydatidiform mole, prior cesarean delivery was associated in a multivariable logistic regression with an increased risk of postmolar gestational trophoblastic neoplasia (adjusted odds ratio [aOR] 1.45, 95% CI, 1.13–1.85) that was independent of age, complete hydatidiform mole histology, city of uterine evacuation, pre-evacuation human chorionic gonadotropin level, and year of hydatidiform mole diagnosis. Furthermore, neither the number of previous cesarean deliveries (aOR 1.43, 95% CI, 0.91–2.24) nor an elective indication (aOR 1.12, 95% CI, 0.60–2.08) appeared to modify this risk. Cesarean delivery history (aOR 1.27, 95% CI, 0.59–2.73) and number of (aOR 0.22, 95% CI, 0.02–1.89) or indication for (aOR 0.36, 95% CI, 0.06–2.03) prior cesarean delivery were not significantly associated with chemoresistance among 621 patients with low-risk gestational trophoblastic neoplasia.
CONCLUSION:
A history of cesarean delivery is associated with a 45.0% increased risk of postmolar gestational trophoblastic neoplasia without evidence of greater chemoresistance. These findings support current management protocols while indicating that patients with prior cesarean delivery may benefit from heightened clinical vigilance during standard postmolar surveillance.