Treatment of Precancerous Changes to the Cervix May Influence Later Pregnancy
According to a study published in Lancet, women who undergo certain treatments for cervical intraepithelial neoplasia or very early cervical cancer may have an increased risk of preterm delivery or low birthweight infants during subsequent pregnancies.
The cervix is a female reproductive organ that forms the lower portion of the uterus. Cervical cancer occurs when cervical cells grow out of control. When cells grow out of control, they spread and grow throughout the cervix and may invade and destroy neighboring organs or break away and spread through the bloodstream and lymphatic system to other parts of the body.
Effective screening programs for cervical cancer have decreased the frequency of this disease. Screening can detect precancerous changes to the cervix, known as cervical intraepithelial neoplasia (CIN). Because the more severe types of CIN may progress to cervical cancer, removal of these lesions reduces the risk of cancer.
CIN is often identified in women of reproductive age; this raises the issue of the effect of CIN treatment on subsequent fertility and pregnancy outcomes. CIN is often treated with surgical procedures that remove abnormal parts of the cervix but leave the rest of the uterus intact. These procedures include loop electrosurgical excision procedure (LEEP), cold-knife conization, or laser conization. CIN may also be treated by cryosurgery (freezing of abnormal cells on the surface of the cervix) or laser ablation (use of a laser to destroy abnormal cells on the surface of the cervix).
To evaluate the effects of these treatments on subsequent pregnancy outcomes, an international group of researchers conducted a combined analysis of 27 previously published studies. They included studies of CIN as well as studies of very early stage cervical cancer.
- None of the treatments influenced subsequent ability to get pregnant.
- Treatment with LEEP or cold-knife conization increased the risk of preterm delivery and low birthweight. The link between laser conization and preterm delivery was of borderline significance.
- Use of laser ablation did not influence pregnancy outcomes.
- None of the treatments were linked with an increased risk of death for the infant.
The researchers conclude that women who undergo surgical excision of abnormal parts of the cervix have an increased risk of problems during subsequent pregnancies. They note that this study “lends support to the philosophy of doctors not treating young women with mild abnormalities.”
Reference: Kyrgiou M, Koliopoulos G, Martin-Hirsch P et al. Obstetric Outcomes After Conservative Treatment for Intraepithelial or Early Invasive Cervical Lesions: Systematic Review and Meta-Analysis. Lancet. 2006;367:489-98.