Data for this review came from published studies selected from more than 7000 citations generated from searches of MEDLINE and ISI Current Contents databases with the search terms “gestational trophoblastic disease”, “hydatidiform mole”, “choriocarcinoma”, and “risk factors”. We also selected references from some papers published in English between 1966 and 2003. For GTD we limited the review to studies published after 1977, which included at least 65 cases. For choriocarcinoma we included all
ReviewEpidemiology and aetiology of gestational trophoblastic diseases
Section snippets
Hydatidiform mole
Trophoblasts are specialised epithelial cells, derived from the outermost layer of the blastocyst that originates in early embryonic differentiation. On the basis of morphological, immunophenotypical, and functional studies, trophoblasts can be classified into three distinct populations: cytotrophoblasts, syncytiotrophoblasts, and intermediate trophoblasts. The cytotrophoblasts are the germinative cells situated on the surface of the chorionic villi. In early gestation, cytotrophoblasts
Hospital-based studies and surveys
Table 3 shows the ratios of GTD per 100 000 pregnancies, deliveries, or live births from selected studies. Data from Europe, North America, and Oceania showed intermediate ratios of GTD ranging from 66 per 100 000 pregnancies in Italy8 to 121 in the United States.14, 15 In contrast with the generally low or intermediate ratios found in these regions, a remarkably high ratio was found in Alaska (389 per 100 000 deliveries)11 and Hawaii (460 per 100 000 live births).12 The largest study of these
Parental age
The best established risk factor associated with HM is maternal age.2, 7, 30, 43, 44, 45 Overall, the pattern of risk was similar across all studies and for the different types of GTD, with a higher risk for women under 20 years old (relative risk 1·1–10·0) and for women older than 40 years (3–11) compared with women aged 20–35. Risk estimates were extremely high for women older than 45 years (relative risk 107–841), although estimates were based on a smaller number of cases. Differences in the
Conclusion
CHM and PHM are two different entities. CHM has exclusively a paternal karyotype, generally a homozygous one, whereas PHM is triploid with both maternal and paternal chromosomes. A women with CHM has a substantially increased risk of developing persistent GTD. Whether heterozygous CHMs, arising from dispermy, have a higher risk of progression to choriocarcinoma than their homozygous counterparts is controversial.
In North America and Europe, ratios of HM are about 100 per 100 000 pregnancies.
Search strategy and selection criteria
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