What Is a Molar Pregnancy?
Molar pregnancies result from abnormal fertilization, and they can cause serious health issues if not treated properly. Here's what to know about the rare pregnancy complication.
Medically reviewed by Lulu Zhao, M.D.
Most pregnancies are healthy and progress normally. However, approximately 1 in 1000 pregnancies are complicated by a condition called a molar pregnancy or hydatidiform mole. Molar pregnancies are caused when the genetic material within the egg and sperm combine in an imbalanced way. These conceptions are almost always nonviable and need to be removed from the uterus.
Fortunately, molar pregnancies rarely impact future pregnancies. However, while they are generally benign (not cancerous) for the pregnant person, in rare cases, they can become malignant if left untreated. Here's what to know about molar pregnancy causes, risk factors, symptoms, and how they're typically treated.
What Is a Molar Pregnancy?
The phenomenon that results in a molar pregnancy happens at the very beginning of gestation, says Sasha Andrews, MD, a maternal-fetal medicine specialist at Obstetrix of Colorado, part of Pediatrix Medical Group. Molar pregnancies occur when genetic material from the egg and sperm combine abnormally. This causes the cells that usually form the placenta to develop abnormally.
There are two main types of molar pregnancies: complete and partial:
In a complete molar pregnancy, an abnormal placenta forms without an embryo
In a partial molar pregnancy, an abnormal placenta forms, along with an embryo that's unable to survive (in extremely rare cases, the embryo can develop, but typically with significant genetic abnormalities)
As a molar pregnancy progresses, the placenta forms a mass, which takes over the pregnancy. This mass, or tumor, is called a hydatidiform mole, which is how molar pregnancy gets its name.
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Most of the time, molar pregnancies resolve completely after treatment, but sometimes they become invasive or cancerous, which is why it's important that molar pregnancies be thoroughly removed from the body. Follow-up testing of blood hCG levels is conducted to ensure no tissue remains.
During this follow-up period, it's important to not get pregnant, as a new gestation could make it difficult to tell if a cancer is forming. After several months it should be safe to conceive again.
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Causes of Molar Pregnancy
Molar pregnancies occur because of problems that happen when the sperm and egg meet. "Both partial and complete molar pregnancies are caused by abnormal fertilization, leading to an imbalance of genetic material from the egg and sperm," describes Dr. Andrews.
In complete molar pregnancies, one or two sperm fertilize an empty egg, resulting in genetic material solely from the paternal side. In a partial molar pregnancy, maternal genetic material is present, but two sperm fertilize the egg, resulting in an abnormally high number of paternal chromosomes (69 total chromosomes, instead of the typical 46).
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Risk Factors for a Molar Pregnancy
Anyone can have a molar pregnancy, though they're very uncommon in the first place. Still, certain people may be more prone to experiencing a molar pregnancy, says Dr. Andrews. Younger pregnant people (less than 20 years) and those over the age of 35 have a higher risk of molar pregnancy.
Additionally, experiencing a previous molar pregnancy increases your chances of having another one, notes Dr. Andrews. The risk of having a repeat molar pregnancy is about 1-2%, according to March of Dimes.
Symptoms of a Molar Pregnancy
Early signs of a molar pregnancy may resemble symptoms of any pregnancy, such as a missed period or sore breasts, says Adi Katz, MD, the director of gynecology at Lenox Hill Hospital. As time progresses, you may notice other, more concerning symptoms.
These include intense nausea and vomiting, vaginal bleeding, and lower abdominal pain or pressure from your uterus, says Dr. Katz. "The uterus can also be bigger than expected," she says. Some of these molar pregnancy symptoms, such as intense nausea and vomiting or hyperemesis gravidarum, result from higher than normal amounts of the pregnancy hormone hCG.
Occasionally, people with molar pregnancies will develop hypertension or signs of preeclampsia, such as swelling of the extremities. Thyroid issues (like hyperthyroidism) can develop, and grape-like cysts (called molar pregnancy discharge) may also pass out of your vagina.
There are certain symptoms of molar pregnancy that require emergency care, warns Dr. Katz. Anemia from excess vaginal bleeding is one of them. "Another emergency can be severe nausea and vomiting with inability to eat or drink, therefore becoming severely dehydrated," explains Dr. Katz.
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Diagnosing a Molar Pregnancy
Although your pregnancy may at first appear normal in many ways, your healthcare provider may suspect that you have a molar pregnancy if you're experiencing abnormal bleeding or other concerning symptoms, your hCG levels are higher than expected, or you have an abnormal first trimester ultrasound result.
Occasionally, partial molar pregnancies are diagnosed with pathology after submitting tissue from what seems to be a normal first trimester miscarriage.
Molar Pregnancy Treatment
Some people will miscarry their molar pregnancy spontaneously. When this happens, you may notice bleeding, along with the molar pregnancy discharge of small, grape-like cysts. Miscarriage of a partial molar pregnancy may be indistinguishable from a normal first trimester miscarriage. However, often, molar pregnancies need to be removed surgically, usually via a dilation and curettage (D&C) procedure, which uses a suctioning device to remove tissue from your uterus.
Taking a "wait and see" approach with molar pregnancies is not advisable, says Dr. Katz. "It is unsafe to leave it untreated," she explains. In addition to D&C treatment, your hCG levels will need to be monitored for several weeks or months, until you no longer have any pregnancy hormone left in your body, says Dr. Katz. This signals that no remnants of the molar pregnancy remain.
Most health care providers recommend waiting at least 6 to 12 months before getting pregnant again after a molar pregnancy. This ensures that no abnormal tissue remains, and decreases your chance of having another molar pregnancy.
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Possible Complications from a Molar Pregnancy
If not properly treated and promptly addressed, molar pregnancies can result in both immediate and longer-term complications. "Immediate complications of molar pregnancies can include anemia from vaginal bleeding and hyperemesis gravidarum" (a form of severe morning sickness), says Dr. Andrews. "The high hCG levels can also cause abnormal thyroid function and ovarian theca lutein cysts." In rare cases, preeclampsia may occur, says Dr. Andrews.
In some people, the tissue from the molar pregnancy remains in the uterus, even after treatment. When this happens, the abnormal tissue develops into a condition called gestational trophoblastic neoplasia (GTN). This occurs in about 15-20% of complete molar pregnancies and 1-5% of partial molar pregnancies.
With GTN, the residual molar tissue can grow and invade into surrounding tissue, and can even become cancerous. GTN is typically treated with chemotherapy drugs and/or surgery. Even more rarely, the molar tissue develops into choriocarcinoma, a type of cancer that may require chemotherapy and other cancer-fighting drugs.
Key Takeaways
Hearing about molar pregnancies and their complications can be scary. But it's important to understand that the majority of people who experience molar pregnancies—especially if they are properly treated—do not end up with long-term issues and go on to have healthy pregnancies in the future. If you have questions about molar pregnancies or think you may be experiencing one, contact your OB-GYN or midwife.
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