Introduction

When your loved one is diagnosed with a molar pregnancy and loses a pregnancy, it not only affects them but you, their partners and families. 

It’s okay to not feel okay, even though you are not the one directly experiencing the molar pregnancy. 

Acknowledging that this situation affects you too is a crucial step towards healing and supporting your loved one through this difficult time together. 

Definition of molar pregnancy

Firstly, it is very important for you to completely understand what molar pregnancies are. Unfortunately, in molar pregnancies, no baby will develop because something went wrong during the initial stages of the pregnancy. Molar pregnancy, also known as a hydatidiform mole, is a type of gestational trophoblastic disease (GTD).¹ GTD is a group of rare disorders related to pregnancy, where the cells that should develop into the placenta after the sperm fertilises the egg, grow abnormally into tumours inside of the womb instead.^1-3 While GTD can be non-cancerous or cancerous, the tumours developed in molar pregnancies are usually non-cancerous.^1,2 However, there is still potential for molar pregnancies to become cancerous. Therefore, if an individual is diagnosed with it, they should seek clinical management as soon as possible.^3,4

Molar pregnancies are described as the most common type of GTD, of whichthere are 2 versions: complete molar pregnancy (or clinically known as complete hydatidiform mole) and partial molar pregnancy (or clinically known as partial hydatidiform mole), each with defining features.^1,2

Complete molar pregnancy

Complete molar pregnancies are when a sperm fertilises an egg that does not have maternal genes.^1-5 Unfortunately, no baby develops as no embryo can form.^2,4

Partial molar pregnancy 

Partial molar pregnancies are different to complete molar pregnancies as there is partial development of the baby. This usually occurs because a normal egg, containing maternal genes, is fertilised by two sperm.^1-5 This leads to an abnormal number of genes which prevents the baby from surviving and developing normally.^1-5

In extremely rare cases, it is possible for your loved one to have a twin pregnancy where one baby is normal and the other is a molar pregnancy, usually a complete molar pregnancy, together in the womb.³ Such events have their own complications.

Some symptoms

Molar pregnancies can be diagnosed early in the pregnancy using different advanced methods, the mainstay typically by ultrasound scan. It is worth noting your loved one may experience:^3-5

• Irregular vaginal bleeding that is brownish, can look like “prune juice” in the first trimester 
• Hyperemesis Gravidarum (excessive nausea and vomiting)
• High Human chorionic gonadotropin (hCG) levels for gestational age
• Pelvic pain

Risk factors 

Although molar pregnancies are rare, the likelihood of them occurring does vary globally and there are some identified factors that can increase the risk:^2,3

• Age: women less than 21 years old and women older than 35 years
• Ethnicity: higher rate in asian women
• Genes
• Spontaneous miscarriage or a history or spontaneous miscarriages
• Malnutrition
• Previous molar pregnancies

After a loved one has been diagnosed with a molar pregnancy, clinical management usually involves clinicians removing the growth in the womb followed by monitoring of the individual’s condition.³ The clinical management has a high success rate but in some cases chemotherapy or additional surgery such as a hysterectomy is required.³

To best support your loved one who experienced the molar pregnancy, it is important to understand how this experience can impact you. Recognising the different ways that it can affect you, or having potential answers to changes in behaviour, can help you to address them effectively. The emotional, psychological, social and medical impacts of molar pregnancies will be discussed as well as potential coping strategies too. This may help offer you support and solace as you navigate this challenging and emotional time together.

Emotional and Social Impact

Experiencing a molar pregnancy does mean experiencing a loss and it’s natural to be focused on your loved one’s feelings. However, your feelings also matter and you may be feeling a lot of emotions such as:^6,7

• Shock
• Anger and Pain
• Grief and Loss
• Loneliness
• Helpless
• Feeling of Numbness

This list is not comprehensive and you may experience a range of emotions. Factors such as anticipation of the pregnancy, feeling unable to ease your loved one’s pain, the unexpected nature of the situation and questioning why such a rare event happened to your family can all contribute towards your feelings. Additionally, you may notice your relationships with others becoming strained or changing in unexpected ways. 

If you have sadly experienced pregnancy loss before, it is okay if your emotions are not as intense.⁸ Some individuals have also reported feeling negatively towards those experiencing normal pregnancies.⁷ Regardless of what your feelings are, it is still important to seek support and not underestimate the importance of addressing your emotions.

Given how rare molar pregnancies are, you may find it difficult to explain to others or feel frustrated when people do understand, which can lead to feelings of loneliness. However, you are not alone. There are organisations such as Miscarriage Association, created by those who have had similar experiences, and can offer support not just for your loved one but for you too. Additionally, you can access various online and in-person support groups that meet your specific needs and can offer additional support. You may find a list of available groups on your local NHS Foundation Trust’s website.

Psychological Consequences

Following molar pregnancies and undergoing clinical management, your loved one is likely to experience psychological effects such as anxiety, depression, mood swings and other psychological challenges.^3,8-10 Witnessing this happening to your loved one can be very difficult for families with a study reporting that from its research, male partners of those who experience molar pregnancies also present with high levels of anxiety.⁹

To effectively manage these emotional, social and psychological effects, seeking support from healthcare professionals is crucial, especially since recognising these effects may be challenging in itself. Healthcare professionals not only provide medical care to you but can also provide: 

• Coping strategies
• Counselling
• Educational resources 

If you have encountered a situation where you did not receive the support you needed, remember that not all healthcare professionals are alike. They have a duty of care and seeking help from another healthcare professional can offer new opportunities for support and understanding.

Long-term Effects

It’s also okay if you and your loved one are not at the same point in the healing journey as everyone responds to events differently. Therefore, it is important to avoid comparing your or your loved one’s emotional journey with others, as it is not beneficial to anyone involved. However, the support network surrounding you and your loved one can have a positive impact even if they may not fully grasp your experience directly. This is particularly important as you move forward after the molar pregnancy, gradually rebuilding and adjusting to everyday life.⁸

As mentioned previously, once your partner or family member has experienced a molar pregnancy, there is the possibility they may experience another,^2,3 which can cause anxiety about future pregnancies.^6,7 As a result, for partners, your sexual relationship with your loved one may be affected.⁷ Once your loved one has been cleared through follow ups to start trying for a baby again, there are options and support available to help you through this process. If your loved one is unable to conceive naturally again, for reasons such as undergoing a hysterectomy, there are alternative options available for family planning. Therefore, it is important to take your time and not to rush yourselves. Discussions of these with your healthcare professional can also help guide you to the most appropriate planning options for your family.  

FAQs

Will our relationship return to normal?

Everyone processes loss differently, which can lead to changes in your relationship. While it is uncertain if things will return to how they were before, seeking support from your support network or through counselling, either individually or together, can help navigate this challenging time and find stability.⁶

What is the difference between partial molar pregnancy and twin pregnancy?

There are two types of twin pregnancies. One type results in non-identical twins and it happens when two eggs are fertilised by two sperm and develop separately in the womb. The second type which leads to identical twins is similar to partial molar pregnancy as two sperm fertilise one egg. However, in identical-twin pregnancies, the fertilised egg splits into two so each egg has the right number of genes for the babies to develop normally. Whereas, in partial molar pregnancy there are too many genes in one egg for the baby to develop normally. 

Summary

Having a loved one experience a molar pregnancy can be very difficult, especially accepting that no baby came from the pregnancy. 

However, to heal, it is important to acknowledge that the molar pregnancy can impact you in various ways emotionally, socially and psychologically. It is also necessary to understand the long-term effects after the diagnosis to best support your loved one experiencing the molar pregnancy. Please remember that you can and should seek help if you are suffering in any way. The coping strategies and resources described in this article can be a step in the right direction, but it is also important that you seek additional advice and support from your healthcare professionals.

Keywords:

• Molar pregnancy
• Partners
• Families
• Loss