Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

<div><p>Objective</p><p>To examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss.</p><p>Design</p><p>Population-based observational study nested in retrospective matched cohort</p><p>Setting</p><p>Kaiser Permanente Northwest integrated health plan in Oregon/Washington, U.S.A.</p><p>Population</p><p>Female health plan members age 14–53 years with documented pregnancies from 1998–2009. Women with prior excisional and ablative cervical surgical procedures (N = 322) were compared to women unexposed to cervical procedures (N = 4,307) and, separately, to those having undergone only diagnostic/biopsy procedures (N = 847).</p><p>Methods</p><p>Using log-linear regression models, we examined risk of adverse pregnancy outcomes in relation to prior excisional or ablative cervical surgical procedures. We stratified excisional procedures by excision thickness. We evaluated for confounding by age, body mass index, race, smoking history, previous preterm birth, and parity.</p><p>Results</p><p>We found a positive association between excisional treatment > = 1.0 cm and the outcomes preterm birth and low birth weight (preterm birth unadjusted risk ratio [RR] = 2.15, 95% confidence interval [CI] 1.16–3.98 for excisions ≥1.0 cm compared to unexposed women), particularly in women who delivered within one year of surgery (RR = 3.26, 95% CI 1.41–7.53). There was no clear association between excisional treatment and cesarean delivery, and treated women did not have a substantially higher risk of dysfunctional labor. Ablative treatment was not associated with low birth weight, preterm birth, or cesarean delivery but was associated with pregnancy loss (RR = 1.43, 95% CI 1.05–1.93 vs. unexposed women). Analyses using the diagnostic procedures comparison group produced similar results.</p><p>Conclusion</p><p>Women with > = 1.0 cm excisional treatment had elevated risk of preterm birth and low birth weight when compared to unexposed women and women with cervical diagnostic procedures. This suggests that increased risk derives from the treatment itself, not from other characteristics. The observed association between pregnancy loss and ablative surgical treatment requires further investigation.</p></div

Time to Pregnancy among Women Exposed or Unexposed to Cervical Treatment Procedures over 12 Years of Follow-Up.

<p>Time to Pregnancy among Women Exposed or Unexposed to Cervical Treatment Procedures over 12 Years of Follow-Up.</p

Risk of pregnancy loss compared to live birth in 322 women with cervical surgical treatment compared to 4,307 women unexposed to cervical treatment or diagnostic procedures and 847 women exposed to diagnostic/biopsy procedures only, Kaiser Permanente Northwest, 1998–2009.

<p>Risk of pregnancy loss compared to live birth in 322 women with cervical surgical treatment compared to 4,307 women unexposed to cervical treatment or diagnostic procedures and 847 women exposed to diagnostic/biopsy procedures only, Kaiser Permanente Northwest, 1998–2009.</p

Demographic and behavioral characteristics of women who had undergone previous cervical surgical treatment compared with those who were either unexposed to cervical procedures or had only undergone diagnostic treatment, Kaiser Permanente Northwest, 1998–2009

<p>Demographic and behavioral characteristics of women who had undergone previous cervical surgical treatment compared with those who were either unexposed to cervical procedures or had only undergone diagnostic treatment, Kaiser Permanente Northwest, 1998–2009</p

Risk of preterm birth, low birth weight, and cesarean delivery in 322 women with cervical surgical treatment compared to 4,307 women unexposed to cervical treatment or diagnostic procedures, Kaiser Permanente Northwest, 1998–2009.

<p>Risk of preterm birth, low birth weight, and cesarean delivery in 322 women with cervical surgical treatment compared to 4,307 women unexposed to cervical treatment or diagnostic procedures, Kaiser Permanente Northwest, 1998–2009.</p

Risk of preterm birth, low birth weight, and cesarean delivery in 322 women with cervical surgical treatment compared to 847 women with cervical diagnostic/biopsy procedures only, Kaiser Permanente Northwest, 1998–2009.

<p>Risk of preterm birth, low birth weight, and cesarean delivery in 322 women with cervical surgical treatment compared to 847 women with cervical diagnostic/biopsy procedures only, Kaiser Permanente Northwest, 1998–2009.</p

Time to Pregnancy among Women Exposed to Cervical Treatment Procedures or Diagnostic Procedures over 12 Years of Follow-Up.

<p>Time to Pregnancy among Women Exposed to Cervical Treatment Procedures or Diagnostic Procedures over 12 Years of Follow-Up.</p

Pregnancy among Women Exposed or Unexposed to Cervical Treatment orDiagnostic Procedures.

<p>HR = hazard ratio;</p><p>CI = confidence interval</p><p>^a adjusted for all covariates listed</p><p>Pregnancy among Women Exposed or Unexposed to Cervical Treatment orDiagnostic Procedures.</p

Inclusion and Exclusion Criteria to Establish a Cohort of Women Exposed to Cervical Treatment or Diagnostic Procedures and a Matched Sample of Unexposed Women, Kaiser Permanente Northwest, 1998–2009.

<p>Inclusion and Exclusion Criteria to Establish a Cohort of Women Exposed to Cervical Treatment or Diagnostic Procedures and a Matched Sample of Unexposed Women, Kaiser Permanente Northwest, 1998–2009.</p

Characteristics of Women Exposed or Unexposed to Cervical Treatment or Diagnostic Procedures.

<p>^a women with an infertility diagnosis, fertility testing, or fertility treatment</p><p>^b obstetric history defined as at least one pregnancy documented in the electronic medical record prior to the index date</p><p>Characteristics of Women Exposed or Unexposed to Cervical Treatment or Diagnostic Procedures.</p