Preterm birth risk elevated after early cervical cancer treatment

Women with early-stage cervical cancer who conceive ≥3 months following fertility-sparing surgery may be at an increased risk of preterm delivery, according to results of a retrospective study presented at SGO 2021.

This population-based cohort study involved women aged 18–45 years at time of stage IA1-IB1 cervical cancer diagnosis according to the California Cancer Registry in 2000–2012. Their data was linked with the database of the California Office of Statewide Health Planning and Development 2000–2015 to identify oncologic and obstetric outcomes. The women included had to have conceived ≥3 months following fertility-sparing surgery and delivered after 23 weeks gestation, and the outcome only pertained to the first pregnancy after cancer diagnosis (n=113; median age 32 years, 52.2 percent non-Hispanic White).

The cancer histology was primarily squamous cell carcinoma (62.8 percent). Most patients (88.5 percent) underwent loop electrosurgical excision procedure (LEEP) or conization, while 8.8 percent underwent trachelectomy. Obstetric risk factors such as parity, singleton or twin pregnancy, abnormal placentation, and pregnancy-related comorbidities such as gestational diabetes and pregnancy-associated hypertension were well balanced between groups.

Preterm birth was more common among cervical cancer cases than healthy controls (n=226) or women who had conceived ≥1 year pre-cervical cancer diagnosis (cervical cancer controls; n=213), be it before 32 weeks (5.3, 1.3, and 2.3 percent, respectively) or before 37 weeks (26.5, 8.4, and 13.1 percent, respectively).

The risk of preterm birth before 32 weeks was higher among cervical cancer cases compared with healthy controls (odds ratio [OR], 4.17, 95 percent confidence interval [CI], 1.02–16.99), but not when compared with cervical cancer controls. [SGO 2021, abstract 10654]

The risk of preterm birth before 37 weeks was increased among cervical cancer cases compared with both healthy controls (OR, 3.94, 95 percent CI, 2.10–7.38) and cervical cancer controls (OR, 2.39, 95 percent CI, 1.34–4.25).

Neonatal morbidity* in the first 30 days of life was more common among cervical cancer cases (15.9 percent) than healthy controls (7.5 percent; OR, 2.33, 95 percent CI, 1.15–4.72) or cervical cancer controls (6.6 percent; OR, 2.69, 95 percent CI, 1.29–5.64).

Incidence of foetal demise did not significantly differ between the cancer case, healthy control, and cervical cancer control groups (n=1, 1, and 0, respectively), nor did Caesarean delivery (43.4, 35.8, and 36.6 percent, respectively) or severe maternal morbidity (n=4, 2, and 5 patients). Growth restriction also did not differ between groups, be it <5^th percentile (3.5, 7.5, and 4.2 percent; respectively) or <10^th percentile (8.0, 11.5, and 8.9 percent, respectively).

Although the numbers were small, the risk for preterm birth was more common among patients who underwent trachelectomy than LEEP or conization, be it <32 weeks (30 percent vs 2 percent; n=3 vs 2) or <37 weeks (80 percent vs 20 percent). All 10 patients who underwent trachelectomy delivered via Caesarean section.  

“Forty percent of patients with cervical cancer will be diagnosed before age 45,” remarked study author Dr Roni Nitecki from the MD Anderson Cancer Center, Houston, Texas, US. Many of these patients will have not completed childbearing.

“Those with early-stage disease are eligible for fertility-sparing surgery … [however,] cancer therapy can impact not only fertility but also the course of a subsequent pregnancy,” she continued.

“[The results of this study showed that] patients who delivered after cervical cancer treatment had a high live birth rate, but higher odds of preterm delivery and neonatal morbidity,” noted Nitecki.

“These data are important for shared decision-making discussions regarding fertility-sparing surgery for patients with early-stage cervical cancer,” she added.