Cervical intraepithelial neoplasia and the risk of spontaneous preterm birth: A Dutch population-based cohort study with 45,259 pregnancy outcomes

Autor: Leon F.A.G. Massuger, Diede L. Loopik, Albert G. Siebers, Ruud L.M. Bekkers, Folkert J. van Kemenade, Willem J. G. Melchers, Quirinus J. M. Voorham, Joris van Drongelen
Přispěvatelé: Pathology, Obstetrie & Gynaecologie, RS: GROW - R2 - Basic and Translational Cancer Biology
Rok vydání: 2021
Předmět:
Embryology
Databases
Factual
Epidemiology
PREDICTION
Maternal Health
Biopsy
Placenta
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Uterine Cervical Neoplasms
Labor and Delivery
0302 clinical medicine
Gynecologic Surgical Procedures
Pregnancy
Risk Factors
Medicine and Health Sciences
Childbirth
Medicine
030212 general & internal medicine
Registries
Netherlands
030219 obstetrics & reproductive medicine
Women's cancers Radboud Institute for Molecular Life Sciences [Radboudumc 17]
Obstetrics
Cancer Risk Factors
Pregnancy Outcome
Gestational age
Obstetrics and Gynecology
General Medicine
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
medicine.anatomical_structure
Oncology
Premature Birth
Female
Anatomy
Cohort study
Research Article
Adult
ELECTROSURGICAL EXCISION PROCEDURE
medicine.medical_specialty
PRECANCEROUS CHANGES
LARGE LOOP EXCISION
Surgical and Invasive Medical Procedures
Adenocarcinoma in Situ
Cervical intraepithelial neoplasia
Preterm Birth
Risk Assessment
CONIZATION
03 medical and health sciences
DELIVERY
All institutes and research themes of the Radboud University Medical Center
Mental Health and Psychiatry
MANAGEMENT
Humans
OBSTETRIC OUTCOMES
TRANSFORMATION ZONE
Cervix
Retrospective Studies
LESIONS
business.industry
Reproductive System
Biology and Life Sciences
Retrospective cohort study
Odds ratio
medicine.disease
Uterine Cervical Dysplasia
Pregnancy Complications
Medical Risk Factors
Birth
Women's Health
business
Mental Health Therapies
Developmental Biology
Zdroj: Plos Medicine, 18
PLoS Medicine, 18(6):e1003665. Public Library of Science
PLoS Medicine, Vol 18, Iss 6, p e1003665 (2021)
PLOS Medicine, 18(6):1003665. Public Library of Science
Plos Medicine, 18, 6
PLoS Medicine
ISSN: 1549-1277
Popis: Background Excisional procedures of cervical intraepithelial neoplasia (CIN) may increase the risk of preterm birth. It is unknown whether this increased risk is due to the excision procedure itself, to the underlying CIN, or to secondary risk factors that are associated with both preterm birth and CIN. The aim of this study is to assess the risk of spontaneous preterm birth in women with treated and untreated CIN and examine possible associations by making a distinction between the excised volume of cervical tissue and having cervical disease. Methods and findings This Dutch population-based observational cohort study identified women aged 29 to 41 years with CIN between 2005 and 2015 from the Dutch pathology registry (PALGA) and frequency matched them with a control group without any cervical abnormality based on age at and year of pathology outcome (i.e., CIN or normal cytology) and urbanization (
In a population-based study, Diede Loopik and colleagues investigate associations between cervical intraepithelial neoplasia and risk of preterm birth among Dutch women.
Author summary Why was this study done? Women who are treated for a precancerous cervical lesion may have an increased risk of preterm birth. It is unknown whether this increased risk is due to the treatment itself, to the cervical disease, or to secondary risk factors that are associated with both preterm birth and cervical disease. What did the researchers do and find? We identified women with untreated and treated cervical disease and matched them with a control group through the Dutch pathology registry and compared their pregnancy outcomes through the Dutch perinatal database. The control group (29,907 pregnancies) showed a 4.8% proportion of preterm birth, which increased to 6.9% in the untreated cervical disease group (5,940 pregnancies), 9.5% in the treated cervical disease group (9,412 pregnancies), and 15.6% in the group with multiple treatments (505 pregnancies). After adjustment for 19 potential confounders for preterm birth, women with untreated cervical disease had a 1.4 times and women with treated cervical disease had a more than 2 times increased odds of preterm birth compared to the control group. Independent from cervical disease, a volume excised from the cervix of 0.5 cc or more was associated with an approximately 2 times greater odds of preterm birth. What do these findings mean? We observed a strong association between women with a 0.5 cc or more excised cervical tissue volume (through biopsy and/or treatment) and the odds of preterm birth, regardless of severity of cervical disease or secondary risk factors associated with both preterm birth and cervical disease. Our findings suggest that caution should be taken when performing multiple biopsies or treatment for CIN in women of reproductive age and that women with such a history may benefit from close surveillance during pregnancy.
Databáze: OpenAIRE
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