Premature delivery risk increases following fertility-sparing surgery for cervical cancer

Women who became pregnant after fertility-sparing surgery for cervical cancer were more likely to have a preterm delivery compared with controls, according to results from a population-based cohort study.

“Systematic reviews have found that if a patient wants to conceive after fertility-sparing surgery for cervical cancer, she is often able to. However, there are many more nuanced pregnancy outcomes that have not been very well delineated,” Roni Nitecki, MD, MPH, of the University of Texas MD Anderson Cancer Center, told Healio.

“Because cervical cancer is rare in the United States and not every woman will be a candidate for fertility-sparing surgery and then a fraction of those women decide that they want to conceive, most observational studies that examine what happens after fertility-sparing surgery end up with very few pregnancy cases that preclude making robust conclusions about pregnancy outcomes,” Nitecki said.

Nitecki and colleagues used data from the California Cancer Registry and the California Office of Statewide Health Planning and Development (OSHPD) available from 2000 to 2012 and identified 107 women aged 18 to 45 years who underwent either cervical conization or a loop electrosurgical excision procedure for stage I cervical cancer and conceived at least 3 months afterward.

Two control groups were created: a population-based control group of 214 patients who did not have a record in the California Cancer Registry, and a cervical cancer control group of 173 patients who conceived more than 1 year before their diagnosis. Each control group was matched 2:1 to the case group when possible, according to the study.

Most patients in the case group were non-Hispanic white women aged 26 to 35 years who had no additional comorbidities. The most prevalent histologies were squamous cell carcinoma in 74 patients and adenocarcinoma in 36 patients. In the case group, the median time from surgery to conception was 14.1 months.

The case group had the highest odds of premature delivery at 21.5%, compared with 9.3% of the population control group (OR = 2.7; 95% CI, 1.4-5.1) and 12.7% of the cervical cancer control group (OR = 1.9; 95% CI, 1-3.6). There were also higher odds of neonatal morbidity in the case group compared with the cervical cancer control group (15.9% vs. 6.9%; OR = 2.5; 95% CI, 1.2-5.5), but not the population control group (15.9% vs. 9.8%; OR = 1.7; 95% CI, 0.9-3.4), according to the researchers.

There were no other statistically significant differences between the controls and the case group.

“Importantly, pregnancies after fertility-sparing surgery for cervical cancer did not have an increased risk of cesarean section, small for gestational age weight at birth or severe maternal morbidity,” Nitecki said.

The researchers said the study had several limitations, including the fact that they were unable to control for covariates that could possibly contribute to the differences they saw in the preterm birth rate and neonatal morbidity, such as history of preterm birth, maternal BMI and smoking.

“Despite these limitations, we used a novel linkage between population-level databases to rigorously identify cervical cancer patients and compare their obstetric outcomes with those of participants in control groups,” Nitecki and colleagues wrote in the study, published in Obstetrics & Gynecology.

“This study provides evidence to foster shared decision-making discussions regarding obstetric outcomes after fertility-sparing treatment for early cervical cancer,” they added. “With greater knowledge of these risks and close antenatal surveillance, there may be room for intervention to prolong gestation and achieve more favorable neonatal outcomes.”