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Example:10.1021/acsami.1c06204 or Chem. Rev., 2007, 107, 2411-2502
Perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia: a systematic review of observational studies and meta-analysis
American Journal of Obstetrics and Gynecology  (IF8.661),  Pub Date : 2021-10-09, DOI: 10.1016/j.ajog.2021.10.004
Jose Mauro Madi, Machline Paim Paganella, Isnard Elman Litvin, Maurício Viggiano, Eliana Marcia Wendland, Kevin M. Elias, Neil S. Horowitz, Antonio Braga, Ross S. Berkowitz

Objective

To assess perinatal outcomes of first pregnancies following remission from gestational trophoblastic neoplasia (GTN), as well as the impact of the time between the end of chemotherapy and the subsequent pregnancy.

Data sources

The Medical Subject Headings related to perinatal outcomes, chemotherapy and GTN were used alone or in combination to retrieve relevant articles. We searched in EMBASE, LILACS, MEDLINE, Cochrane CENTRAL and Web of Science up to April/2019.

Study eligibility criteria

We included any observational or interventional studies, which evaluate perinatal outcomes of first pregnancy after chemotherapy for GTN. Animal studies, narrative reviews, expert opinions and previous treatments with potential risks for future perinatal outcomes which may represent confounding bias were excluded.

Study appraisal and synthesis methods

Two reviewers independently screened all identified references for eligibility and data extraction. Methodological quality and bias of included studies were assessed using the Study Quality Assessment Tool for Observational and Cross-Sectional Studies from the National Institutes of Health. For the meta-analysis, the measures of association were calculated using bivariate random-effects models. Statistical heterogeneity was evaluated with I2 statistics and explored through sensitivity analysis. Publication bias was assessed by visual inspection of the funnel plot or Egger’s test, according with the number of articles included. For all analyses, a p-value <0.05 indicated statistical significance. This study was registered on PROSPERO (CRD42018116513).

Results

A total of 763 studies were identified after literature search and 23 original studies were included in the systematic review and in the meta-analysis. The combined data from the subgroup meta-analysis (outcome versus time after chemotherapy) showed an incidence of 15.28% of spontaneous abortion (95%CI:12.37-18.74,I2=73%), 3.30% of malformation (95%CI:2.27-4.79,I2=31%), 6.19% of prematurity (95%CI:5.03-7.59,I2=0) and 1.73% of stillbirth (95%CI:1.17-2.55,I2=0%,). These results were not influenced by the time between the end of chemotherapy and the subsequent pregnancy, in the different outcomes studied: malformation (p=0.14,I2=31%), prematurity (p=0.46,I2=0) and stillbirth (p=0.66,I2=0), except for spontaneous abortion (p<0.01,I2=73%), with a higher occurrence if pregnancy occurred ≤6 months after chemotherapy.

Conclusions

Chemotherapy for GTN does not appear to increase the chance of unfavorable perinatal outcome, except for the higher occurrence of spontaneous abortion, when pregnancy occurs ≤6 months after chemotherapy.