Additional cervical cancer screenings increase preterm delivery risk for young women

Key takeaways:

• Each additional cervical screening was linked to a 0.073 percentage point increase in preterm birth.
• Hypertension or diabetes presence increased preterm birth risk by 0.26 percentage points.

Undergoing more cervical cancer screenings was associated with an increased risk for preterm birth among women aged 18 to 24 years, especially among those with hypertension or diabetes, researchers reported.

“Our study reinforces that even when the risks of a procedure are small for an individual, this can affect a large number of people at the population level,” Rebecca Aliastra Bromley-Dulfano, MS, an MD/PhD student at Stanford University and Harvard University, told Healio. “Our findings are likely most relevant as an input for people who examine the trade-offs when deciding how to best screen for cervical cancer across an entire population. However, our findings also underscore the importance of recognizing that cervical procedures can increase the risk for adverse birth outcomes such as preterm delivery.”

Bromley-Dulfano and colleagues conducted a cross-sectional study, published in JAMA Health Forum, with data from 11,333,151 women aged 18 to 24 years (mean age, 20.9 years; 53.5% white) who had a singleton, nulliparous birth from 1996 to 2018 in the U.S. Researchers utilized data from the CDC’s National Center for Health Statistics to evaluate associations between the cumulative recommended number of cervical cancer screenings and birth outcomes, specifically preterm birth.

The primary outcomes were binary indicators for preterm birth and very preterm birth defined as delivery before 37 and 34 weeks gestation, respectively.

The mean number of guideline-recommended cervical screenings by the time of childbirth for the study population was 2.4. Overall, 10.1% of the study population experienced preterm births and 2.9% experienced very preterm births. Each additional recommended cervical screening was associated with a 0.073 percentage point increase in risk for preterm birth but was not statistically significant for risk for very preterm birth.

The 6.8% of women included in this study who had hypertension or diabetes had an increased risk for preterm birth by 0.26 percentage points compared with women without these comorbidities (P < .001).

“We think our findings would likely best be used as an input to a decision analysis model to help weigh the oncological benefits of cervical cancer screening against adverse birth outcomes to help determine the optimal strategy for when and how often to screen people,” Bromley-Dulfano said. “Future research will also need to consider what role and impact the HPV vaccine will have at the population level. Finally, this work highlights the need for more research on less-invasive techniques to biopsy and treat suspicious lesions, the use of cerclage and other interventions to reduce preterm delivery risk, and potential opportunities for cervical cancer treatment guidelines to also incorporate childbearing plans into procedural timing consideration.”

For more information:

Rebecca Aliastra Bromley-Dulfano, MS, can be reached at rabd@stanford.edu.