Ethnic disparities in complete and partial molar pregnancy incidence: a retrospective analysis of arab and jewish women in single medical center.

BACKGROUND: Molar pregnancies, encompassing complete and partial moles, represent a rare and enigmatic gestational disorder with potential ethnic variations in incidence. This study aimed to investigate relations of ethnicity with risks of complete and partial molar pregnancies within an Israeli population while accounting for age differences. METHODS: A retrospective study was conducted of data recorded during 2007-2021 in an academic medical center in Israel. The study population comprised 167 women diagnosed with complete or partial moles, for whom data were obtained through histological examination and P57 immunostaining. Maternal age and ethnicity were extracted from electronic medical records. Incidence rates were calculated per 10,000 live births, and a nested case-control study compared demographic characteristics and molar pregnancy incidences between Arab and Jewish women. Statistical analyses included age-adjusted comparisons, relative risk calculations and multivariate logistic regression. RESULTS: The overall risk of molar pregnancy was 22 per 10,000 live births (95% confidence interval [CI] 18-25). Among Arab women, the overall risk was 21 (95% CI 17-25), and for PM and CM: 14 (95% CI 11-17) and 7 (95% CI 5-10), respectively. Among Jewish women, the overall risk was 23 (95% CI 18-29), and for PM and CM: 12 (95% CI 8-17) and 11 (95% CI 7-16), respectively. Among Arab women compared to Jewish women, the proportion of all the partial moles was higher: (65.3% vs. 51.6%, p = 0.05). The incidence of partial mole was higher among Arab than Jewish women, aged 35-39 years (26 vs. 8 per 10,000, p = 0.041), and did not differ in other age groups. After adjusting for age, the relative risk of partial moles was lower among Jews than Arabs (0.7, 95% CI 0.4-1.0, p = 0.053). For Arab compared to Jewish women, the mean age at molar pregnancies was younger: 31.0 vs. 35.1 years. However, other factors did not differ significantly between Arab and Jewish women with molar pregnancies. In multivariate analysis, Jewish ethnicity was significantly associated with a higher risk of complete molar pregnancies (OR = 2.19, 95% CI 1.09-4.41, p = 0.028). CONCLUSION: This study highlights ethnic differences in molar pregnancy risk within the Israeli population. Jewish ethnicity was associated with a higher risk of complete molar pregnancies, while Arab women had a significantly higher risk of partial moles. These findings underscore the need to consider ethnicity when studying gestational disorders. Further research should seek to elucidate the underlying factors contributing to these differences.

Effect of race/ethnicity on risk of complete and partial molar pregnancy after adjustment for age.

OBJECTIVE: To quantify the effect of race/ethnicity on risk of complete and partial molar pregnancy. METHODS: We conducted a cross-sectional study including women who were followed for complete or partial mole and those who had a live singleton birth in a teaching hospital in the northeastern United States between 2000 and 2013. We calculated race/ethnicity-specific risk of complete and partial mole per 10,000 live births, and used logistic regression to estimate crude and age-adjusted relative risks (RR) of complete and partial mole. RESULTS: We identified 140 cases of complete mole, 115 cases of partial mole, and 105,942 live births. The risk of complete mole was 13 cases per 10,000 live births (95% confidence interval [CI] 11-16) and that of partial mole was 11 cases per 10,000 live births (95% CI 9-13). After age-adjustment, Asians were more likely to develop complete mole (RR 2.3 95% CI 1.4-3.8, p<0.001) but less likely to develop partial mole (RR 0.2; 95% CI 0.04-0.7, p=0.02) than whites. Blacks were significantly less likely than whites to develop partial mole (RR 0.4; 95% CI 0.2-0.8, p=0.01) but only marginally less likely to develop complete mole (RR 0.6; 95% CI 0.3-1.0, p=0.07). Hispanics were less likely than whites to develop complete mole (RR 0.4; 95% CI 0.2-0.7, p=0.002) and partial mole (RR 0.4; 95% CI 0.2-0.9, p=0.02). CONCLUSION: Race/ethnicity is a significant risk factor for both complete and partial molar pregnancy in the northeastern United States.

Effect of race/ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial molar pregnancy at a tertiary care referral center.

BACKGROUND: The reported incidence of molar pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. OBJECTIVE: We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. STUDY DESIGN: All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. RESULTS: A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians (median 31.0 years, P = .03). Blacks had higher gravidity than whites (P < .001) and Hispanics (P = .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1-39.2%; P = .02). A total of 144 patients with partial mole were analyzed. There were 108 white and 36 non-white patients. Median age was 31 years for white and 29 years for non-white patients (P = .006). Median gravidity was 2 for white and 3 for non-white patients (P < .001), and median parity was 0 for white patients and 1 for non-white patients (P = .003). There were no significant differences with respect to presenting signs and symptoms, gestational age, preevacuation human chorionic gonadotropin level, or risk of progression to gestational trophoblastic neoplasia. CONCLUSION: Hispanic patients with complete molar pregnancy had a significantly lower risk of developing gestational trophoblastic neoplasia than white patients. There were no significant differences among groups in terms of presenting symptoms, gestational age at diagnosis, or preevacuation human chorionic gonadotropin levels for either complete mole or partial mole patients.

The p.L750V mutation in the NLRP7 gene is frequent in Mexican patients with recurrent molar pregnancies and is not associated with recurrent pregnancy loss.

OBJECTIVE: The aim of this study is to analyze NLRP7 mutation frequency in 20 Mexican patients with recurrent hydatidiform moles (RHMs). PATIENTS: Twenty patients with RHMs, 50 couples with recurrent pregnancy loss (RPL), and 100 controls were included in the study. Molecular analysis of the NLRP7 coding region was performed in patients with RHMs. Restriction enzyme digestion analysis and direct sequencing of the identified mutations were performed in controls and patients with RPL. RESULTS: Patients displayed between two and six moles, and 10 of them presented other forms of pregnancy loss. Twelve (60%) patients were homozygous for the missense mutation c.2248C > G (p.L750V), five (25%) patients were heterozygous for the p.L750V mutation and the c.1018 G > A (p.E340K) variant, and three (15%) patients were heterozygous for the c.1018 G > A (p.E340K) variant. Five (5%) control women and four women and one man (5%) with RPL were heterozygous for the p.L750V mutation and two (2%) patients with RPL were heterozygous for the p.E340K variant. CONCLUSIONS: A total of 60% of our RHM patients presented homozygous p.L750V mutations, 25% were compound heterozygotes for p.L750V mutation and the p.E340K variant, and 15% were heterozygous for p.E340K variant. Heterozygous p.L750V mutations were frequently observed in our population. Homozygous mutations were also present in patients with RHMs. Additional studies are needed to understand the role of the p.E340K variant in RHMs and RPL.

Temporal trends in the frequency of hydatidiform mole in lombardy, northern Italy, 1996-2008.

OBJECTIVE: To analyze temporal trends of hospital admissions due to molar pregnancies in Italian and non-Italian women in Lombardy during the 1996-2008 period. METHODS: A standard form is used to register all discharges from public or private hospitals in Lombardy. Hydatidiform mole (HM) cases were identified when searching the database for code 630 of the International Classification of Diseases, Ninth Revision (ICD-9). Ratios of HM per 100,000 pregnancies in strata of age and nationality were computed. RESULTS: The estimated frequency of HM in Lombardy over the period 1996-2008 was 104.4 per 100,000 pregnancies (SE, 2.8) or 1 case in 935 pregnancies. The frequency of HM tended to decrease in the late 1990s, the crude ratio per 100,000 pregnancies being 127.3 in 1996, 89.3 in 2000, and 113.1 in 2008. The temporal trend analysis, adjusted for age class and geographical origin, showed a significant decrease (P = 0.025). The frequency of HM was 99.8/100,000 pregnancies among Italian women, 112.1/100,000 pregnancies among women from other European countries, 85.1/100,000 pregnancies among women from Africa, 176.9/100,000 pregnancies from South America, and 163.0/100,000 pregnancies among Asian women. Considering the periods 1996-2001 and 2002-2008 separately, the frequency of HMs was largely similar for all groups, except in Asian women: in this group, the frequency of HMs was 242.7/100,000 pregnancies and 120.1/100,000 pregnancies in 1996-2001 and 2002-2008, respectively. CONCLUSION: Between 1996 and 2008, the HM incidence in Lombardy showed a slight but significant decrease, mostly owing to the decrease of HM incidence among Asian women.

Increase in the incidence of gestational trophoblastic disease in The Netherlands.

OBJECTIVE: The objective of this study is to determine the incidence and time trends of gestational trophoblastic disease (GTD) in The Netherlands using population-based data. METHODS: Data on patients with a pathologically confirmed diagnosis of GTD from 1995 to 2008 were obtained from PALGA, a national archive containing all histopathology reports in The Netherlands. Data on number of deliveries were obtained from the Database of Statistics Netherlands. RESULTS: During the study period, 4249 GTD patients were registered. Overall incidence rates of hydatidiform mole (HM), choriocarcinoma and placental site trophoblastic tumor (PSTT) were 1.34 per 1000 deliveries, 3.1 per 100,000 deliveries, and 1.0 per 100,000 deliveries, respectively. Incidence rates of HM increased from 1.02 per 1000 deliveries in 1995 to 1.56 per 1000 in 2001, an increase of 0.091 per year (95% CI 0.081-0.101). After 2001 incidence rates remained constant (increase per year -0.010, 95% CI -0.045-0.024). Maternal age and ethnicity are known to influence the risk of HM. Highest incidences were observed in women under 20 and over 40years of age. The proportion of deliveries accounted for by women over 40years of age increased from 1.5% to 2.9%, whereas women under 20 accounted for 1.5% of deliveries. The proportion of live births of Asian descent increased from 2.6% to 3.7%. CONCLUSION: The incidence of GTD in The Netherlands increased significantly from 1995 to 2008. This can partially be explained by increased maternal age and increased proportion of live births of Asian descent. Part of the increase might result from improved diagnostic techniques. However, these factors do not seem to account for the total observed increase and part of the increase therefore remains unexplained.

Dermatoglyphic patterns on fingers and gynecological cancers.

OBJECTIVES: Fingerprints have so far been used for determining the basis of certain malignant diseases, with positive outcomes. Considering the high rates of cancer-related mortality in Iran, this study was conducted for the purpose of examining the dermatoglyphic pattern of fingers in patients with gynecological cancers as compared to healthy people. STUDY DESIGN: The present study was conducted on 151 women with gynecological cancers as the case group and 152 healthy women with no history of such cancers as control group. The dematographic details of participants from both control and case groups were collected using a checklist, and the pattern of their fingerprints was prepared and examined. The data were analyzed for their significance using chi-square test and t- test. Odds ratio with 95% confidence intervals were calculated. RESULTS: Dermatoglyphic analysis showed that arch and loop patterns significantly changed in cases group as compared to control. However, the odds ratio suggested that loop pattern in 6 or more fingers might be a risk factor for developing gynecological cancers. CONCLUSION: Our results showed that there is an association between fingerprint patterns and gynecological cancers and so, dermatoglyphic analysis may aid in the early diagnosis of these cancers.

Epidemiological study of complete and partial hydatidiform mole in Abu Dhabi: influence age and ethnic group.

An unmatched case control study of molar pregnancy was carried out at this hospital between 1978 and 1987 to investigate the influence of maternal age and ethnic group on the incidence of complete and partial hydatidiform mole. The age specific incidence of complete mole was minimal between the ages of 30 and 34 years (relative risk 1), showed a minor peak in teenagers (relative risk 3.1, 95% confidence interval 6.5-1.4), and a major peak in those of 35 years and over. Between 35 and 39 years the relative risk was 2.5 (95% CI 6.2-1.0) and at 40 years or more the relative risk was 9.8 (95% CI 28.9-3.3). No age group showed a significantly increased risk of partial mole. The women of Abu Dhabi had increased risks of both forms of molar pregnancy relative to women in Nottingham, England (relative risk 1): the risk of complete mole was increased threefold (95% CI 4.2-2.2) and that of partial mole twofold (95% CI 4.0-1.2). The increased risk of complete mole was greatest in Gulf Arabs (mainly Omanis and Yemenis) who had a sixfold increase in crude relative risk (95% CI 10.7-3.5). The increased risks of complete mole associated with maternal ethnic group remained after adjustment for maternal age distribution.

The intrauterine contraceptive device and hydatidiform mole: a negative association.

None of the 135 hydatidiform moles studied (40 complete and 95 partial) occurred in women currently wearing the IUCD. In the control series of 1,244 non-molar spontaneous abortions, conception took place with the IUCD in situ in 48 women (3.87%). The difference between the observed number of molar pregnancies with the IUCD in situ, i.e., 0, and the "expected" number, i.e., 4.64 (3.87%) was statistically different (p less than 0.05). This difference could not be explained by such uncontrolled confounding variables as maternal age, menstrual age of the abortions, prior pregnancy loss, gravidity, ethnicity or contraceptive practices. It is suggested that the IUCD selectively suppresses the development of molar pregnancies. The theoretical and practical implications of this observation are discussed.

Absence of KHDC3L mutations in Chinese patients with recurrent and sporadic hydatidiform moles.

To date, two maternal-effect genes have been shown to play causal roles in recurrent hydatidiform moles (RHMs). NLRP7, a major gene for this condition, codes for a nucleotide-binding oligomerization domain-like receptor and is mutated in 48 to 60% of patients with RHMs. KHDC3L is a recently identified gene that is mutated in 14% of NLRP7-negative patients. We screened KHDC3L for mutations in a total of 101 Chinese patients, 15 with at least two hydatidiform moles, 16 with at least two reproductive losses including one hydatidiform mole, and 70 with one hydatidiform mole and no other form of reproductive loss, but did not find any mutation. Our data favor the causal role of KHDC3L in a minority of RHM cases, demonstrate its noninvolvement in other forms of reproductive loss, and indicate the presence of other unidentified genes that cause or increase patients' susceptibility to RHMs in the Chinese population.

The spectrum of NLRP7 mutations in French patients with recurrent hydatidiform mole.

OBJECTIVES: The NLRP7 gene (19q13.42) is associated with recurrent and/or familial hydatidiform moles. Several mutations, histopathological types and reproductive outcomes have been described. We studied our recurrent hydatidiform mole cases recorded since 1999 in order to identify links between clinic, histology and genetics. STUDY: We present here the gestational history and the spectrum of NLRP7 mutations in our French series. DESIGN: We performed a retrospective study from clinical forms received for genetic diagnosis. Cases declaration was based on a voluntary initiative coming from French practitioners, subjected to patients' agreement. RESULTS: Among 12 recurrent hydatidiform moles investigated, we identified 3 cases of confirmed homozygous NLRP7 mutation and 3 cases of heterozygous NLRP7 mutation. One patient bore a novel mutation p.Leu880Ser in a homozygous state. CONCLUSIONS: We here identified a new homozygous NLRP7 mutation. Unfortunately, no modern therapeutic option has proven effective to obtain evolutive pregnancies. Then, fundamental and clinical researches seem to be necessary. Moreover, collecting RHM cases is essential.

Gestational trophoblastic disease among Hispanic women: a 21-year hospital-based study.

OBJECTIVE: Hispanics are the fastest growing minority group in the United States. Few reports have described gestational trophoblastic disease (GTD) in this population. The purpose of this study was to determine the incidence of GTD at our public hospital which primarily serves the Hispanic population. METHODS: All women diagnosed with GTD (partial and complete hydatidiform mole, choriocarcinoma) between 1983 and 2004 were identified from the institutional tumor registry, surgical pathology reports and hospital ICD-9 codes. Clinical data were retrospectively extracted from medical records. The live birth denominator was tabulated over the same interval of time by retrieving labor and delivery statistics and sorting by race. RESULTS: GTD was diagnosed in 596 patients over a 21-year study interval encompassing 289,897 live births. The overall incidence of GTD was 2.06/1000 live births. Hispanic women had a higher incidence compared to Blacks (2.38 vs. 1.34; P < 0.001), but not Whites (2.00; P = 0.17). The 416 Hispanic women were diagnosed with GTD at an earlier gestational age in the latter part of this study (12.3 vs. 16.2 weeks; P < 0.001). Hispanics were more likely to have a partial hydatidiform mole compared to Blacks (29% vs. 13%; P < 0.001) and Whites (18%; P = 0.04). Choriocarcinomas occurred least commonly in Hispanic patients (1 per 35,000 live births). Teenage Hispanic women were the only ethnic age group with a higher risk of developing GTD (odds ratio = 1.6, 95% confidence interval: 1.1, 2.2). CONCLUSION: Hispanic women had the highest incidence of GTD in this hospital-based study, were diagnosed at an earlier gestational age in the last decade and more frequently were diagnosed with partial moles.

Gestational trophoblastic disease in the Asian population of Northern England and North Wales.

OBJECTIVE: To determine the incidence and trends of gestational trophoblastic disease in the Asian population of Northern England and North Wales.A prospective observational study. SETTING: Trophoblastic Screening and Treatment Centre, Weston Park Hospital. POPULATION: A total of 3660 women registered with gestational trophoblastic disease between 1991 and 1999. MAIN OUTCOME MEASURES: 1. The incidence of gestational trophoblastic disease in Asian and non-Asian population. 2. Trend in incidence over study period. RESULTS: Three hundred and twenty-two Asian patients were registered. The incidence of gestational trophoblastic disease in the northern part of England and Wales averaged 1 per 714 live births. The incidence of gestational trophoblastic disease in the Asian population was 1.95 times higher than in the non-Asian population (1 per 387 live births vs 1 per 752 live births). There was an excess of molar pregnancies in the extreme maternal age groups; the incidence in these women was twice as high as in the whole reproductive cohort. The ratio of partial to complete hydatidiform mole increased from 0.9 in the lower age to 2.6 in the older age group. There appeared to be a slowly rising trend in the incidence of gestational trophoblastic disease; the increase was higher in the Asian than in the non-Asian population. The ratio of partial to complete moles increased with age in both populations. CONCLUSION: Asian women are at increased risk of having molar pregnancies. Molar pregnancies are more common at the extremes of reproductive age. The setting up of regional or national registration centres has helped to provide more accurate estimates of the true incidence of the disease.

Epidemiologic study of gestational trophoblastic diseases in Saudi Arabia.

The role of cultural and socioeconomic diversities (that is, marriage, conceptions at the extremes of reproductive life, consanguinity, economic affluence and such) were analyzed for significance in the epidemiologic study of gestational trophoblastic disease (GTD) in Saudi Arabia. For the study period, the incidence of hydatidiform mole remained unchanged at a mean of one in 448 pregnancies and one in 6,130 for its malignant counterpart. In the instance of molar pregnancies, the youngest (less than 20 years of age) and the oldest (more than 40 years of age) had significantly higher than expected incidence; in contrast, in malignant GTD, the trend was for a higher than expected frequency for the older age group only (more than 40 years of age). Consanguinity showed no significant epidemiologic role.

Ethnic differences at risk for gestational trophoblastic disease in New Mexico: A 25-year population-based study.

OBJECTIVE: The purpose of this study was to compare gestational trophoblastic disease incidence rates with the use of population-based data. STUDY DESIGN: All incident cases between 1973 and 1997 and live birth, pregnancy, and women at risk were tabulated with the use of data that were derived from the New Mexico Tumor Registry and Vital Records and Health Statistics Annual Reports. Statistical methods included trends analyses, odds ratios, and Poisson regression. RESULTS: Of 939 total cases, 312 non-Hispanic white women, 399 Hispanic white women, 201 American Indian women, and 27 other women were affected. Age-adjusted incidence rates were significantly higher for American Indian women (11.16%) compared with non-Hispanic (3.57%) or Hispanic white women (5.32%); the probability value was <.001. When live birth (1:438 women) and pregnancy (1:486 women) denominators were considered, American Indian women alone were at increased risk, and the ratio increased by 56% over 25 years. American Indian women were also at increased risk for partial mole (relative risk, 4.03; 95% CI, 2.57-6.31), invasive mole (relative risk, 26.7; 95% CI, 7.81-93.14), and choriocarcinoma (relative risk, 6.29; 95% CI, 1.81-22.66) variants. CONCLUSION: American Indians are at increased risk relative to the other predominant ethnic groups in New Mexico. Age-adjusted standardization provided a reproducible measurement that may be applicable across other registries.

Postmolar surveillance at a trophoblastic disease center that serves indigent women.

OBJECTIVE: The purpose of this study was to determine compliance with postmolar pregnancy surveillance in our indigent population. STUDY DESIGN: Data for all women who were diagnosed with molar pregnancy from January 1996 through December 2000 were entered prospectively into a database. After remission, postmolar pregnancy surveillance was continued for 6 months. Patients whose condition required chemotherapy for gestational trophoblastic tumor had 12 months of follow-up. Medical records were reviewed. RESULTS: Molar pregnancies occurred in 121 women: 103 Hispanic women (85%), 12 African American women (10%), and 6 white women (5%). Eighty-two women (68%) achieved remission without chemotherapy; 23 women (19%) were lost to follow-up without achieving remission, and 16 women (13%) had gestational trophoblastic tumor. Fifty-six Hispanic women (54%) completed postmolar pregnancy surveillance, compared with two African American women (11%, P <.01). Hispanic patients who were fluent in Spanish only were more likely to complete follow-up than bilingual Hispanic patients (62% vs 41%, P <.01). CONCLUSION: Hispanic women who were fluent in Spanish only were most likely to complete the recommended postmolar human chorionic gonadotropin surveillance.