Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer
To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer. We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked t...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2021-10, Vol.138 (4), p.565-573 |
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| creator | Nitecki, Roni Floyd, Jessica Lamiman, Kelly Clapp, Mark A Fu, Shuangshuang Jorgensen, Kirsten Melamed, Alexander Brady, Paula C Kaimal, Anjali Del Carmen, Marcela G Woodard, Terri L Meyer, Larissa A Giordano, Sharon H Ramirez, Pedro T Rauh-Hain, J Alejandro |
| description | To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer.
We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.
Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.
In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups. |
| doi_str_mv | 10.1097/AOG.0000000000004532 |
| format | Article |
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We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.
Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.
In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.</description><identifier>ISSN: 0029-7844</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/AOG.0000000000004532</identifier><identifier>PMID: 34623068</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - surgery ; Cervix Uteri - pathology ; Cervix Uteri - surgery ; Cesarean Section - statistics & numerical data ; Cohort Studies ; Conization - methods ; Female ; Fertility Preservation - methods ; Fetal Growth Retardation - epidemiology ; Gravidity ; Humans ; Infant, Newborn ; Middle Aged ; Neoplasm Staging ; Pregnancy ; Pregnancy Complications, Neoplastic - surgery ; Pregnancy Outcome - epidemiology ; Premature Birth - epidemiology ; Propensity Score ; Stillbirth - epidemiology ; Trachelectomy - methods ; Uterine Cervical Neoplasms - surgery ; Young Adult</subject><ispartof>Obstetrics and gynecology (New York. 1953), 2021-10, Vol.138 (4), p.565-573</ispartof><rights>Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-ebaa52ecb9443e3cd10c3b12e682883c2d3987f3ed0c7b3daf72f2bda6bcb2d53</citedby><cites>FETCH-LOGICAL-c419t-ebaa52ecb9443e3cd10c3b12e682883c2d3987f3ed0c7b3daf72f2bda6bcb2d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34623068$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nitecki, Roni</creatorcontrib><creatorcontrib>Floyd, Jessica</creatorcontrib><creatorcontrib>Lamiman, Kelly</creatorcontrib><creatorcontrib>Clapp, Mark A</creatorcontrib><creatorcontrib>Fu, Shuangshuang</creatorcontrib><creatorcontrib>Jorgensen, Kirsten</creatorcontrib><creatorcontrib>Melamed, Alexander</creatorcontrib><creatorcontrib>Brady, Paula C</creatorcontrib><creatorcontrib>Kaimal, Anjali</creatorcontrib><creatorcontrib>Del Carmen, Marcela G</creatorcontrib><creatorcontrib>Woodard, Terri L</creatorcontrib><creatorcontrib>Meyer, Larissa A</creatorcontrib><creatorcontrib>Giordano, Sharon H</creatorcontrib><creatorcontrib>Ramirez, Pedro T</creatorcontrib><creatorcontrib>Rauh-Hain, J Alejandro</creatorcontrib><title>Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer.
We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.
Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.
In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Cervix Uteri - pathology</subject><subject>Cervix Uteri - surgery</subject><subject>Cesarean Section - statistics & numerical data</subject><subject>Cohort Studies</subject><subject>Conization - methods</subject><subject>Female</subject><subject>Fertility Preservation - methods</subject><subject>Fetal Growth Retardation - epidemiology</subject><subject>Gravidity</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Neoplastic - surgery</subject><subject>Pregnancy Outcome - epidemiology</subject><subject>Premature Birth - epidemiology</subject><subject>Propensity Score</subject><subject>Stillbirth - epidemiology</subject><subject>Trachelectomy - methods</subject><subject>Uterine Cervical Neoplasms - surgery</subject><subject>Young Adult</subject><issn>0029-7844</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1Lw0AQhhdRbK3-A5E9eonuV5LNsZS2CoUKVfC27G4mMZKPursR8u-NtIo4lznM-8wwD0LXlNxRkqX38-36jvwpEXN2gqZUpjxinL-eoikhLItSKcQEXXj_PoZokvFzNOEiYZwkcorUtg-2a8DjrsDhDfCqcj7gJwdlq1s74HkRwOEVuFDVVRii3V67qi3xrncluAEXncNL7epxEnQJeAHus7K6xosRB3eJzgpde7g69hl6WS2fFw_RZrt-XMw3kRU0CxEYrWMG1mRCcOA2p8RyQxkkkknJLct5JtOCQ05saniui5QVzOQ6MdawPOYzdHvYu3fdRw8-qKbyFupat9D1XrFYkvF3GadjVByi1nXeOyjU3lWNdoOiRH2rVaNa9V_tiN0cL_SmgfwX-nHJvwB-63VN</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Nitecki, Roni</creator><creator>Floyd, Jessica</creator><creator>Lamiman, Kelly</creator><creator>Clapp, Mark A</creator><creator>Fu, Shuangshuang</creator><creator>Jorgensen, Kirsten</creator><creator>Melamed, Alexander</creator><creator>Brady, Paula C</creator><creator>Kaimal, Anjali</creator><creator>Del Carmen, Marcela G</creator><creator>Woodard, Terri L</creator><creator>Meyer, Larissa A</creator><creator>Giordano, Sharon H</creator><creator>Ramirez, Pedro T</creator><creator>Rauh-Hain, J Alejandro</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20211001</creationdate><title>Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer</title><author>Nitecki, Roni ; Floyd, Jessica ; Lamiman, Kelly ; Clapp, Mark A ; Fu, Shuangshuang ; Jorgensen, Kirsten ; Melamed, Alexander ; Brady, Paula C ; Kaimal, Anjali ; Del Carmen, Marcela G ; Woodard, Terri L ; Meyer, Larissa A ; Giordano, Sharon H ; Ramirez, Pedro T ; Rauh-Hain, J Alejandro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-ebaa52ecb9443e3cd10c3b12e682883c2d3987f3ed0c7b3daf72f2bda6bcb2d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Cervix Uteri - pathology</topic><topic>Cervix Uteri - surgery</topic><topic>Cesarean Section - statistics & numerical data</topic><topic>Cohort Studies</topic><topic>Conization - methods</topic><topic>Female</topic><topic>Fertility Preservation - methods</topic><topic>Fetal Growth Retardation - epidemiology</topic><topic>Gravidity</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Neoplastic - surgery</topic><topic>Pregnancy Outcome - epidemiology</topic><topic>Premature Birth - epidemiology</topic><topic>Propensity Score</topic><topic>Stillbirth - epidemiology</topic><topic>Trachelectomy - methods</topic><topic>Uterine Cervical Neoplasms - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nitecki, Roni</creatorcontrib><creatorcontrib>Floyd, Jessica</creatorcontrib><creatorcontrib>Lamiman, Kelly</creatorcontrib><creatorcontrib>Clapp, Mark A</creatorcontrib><creatorcontrib>Fu, Shuangshuang</creatorcontrib><creatorcontrib>Jorgensen, Kirsten</creatorcontrib><creatorcontrib>Melamed, Alexander</creatorcontrib><creatorcontrib>Brady, Paula C</creatorcontrib><creatorcontrib>Kaimal, Anjali</creatorcontrib><creatorcontrib>Del Carmen, Marcela G</creatorcontrib><creatorcontrib>Woodard, Terri L</creatorcontrib><creatorcontrib>Meyer, Larissa A</creatorcontrib><creatorcontrib>Giordano, Sharon H</creatorcontrib><creatorcontrib>Ramirez, Pedro T</creatorcontrib><creatorcontrib>Rauh-Hain, J Alejandro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nitecki, Roni</au><au>Floyd, Jessica</au><au>Lamiman, Kelly</au><au>Clapp, Mark A</au><au>Fu, Shuangshuang</au><au>Jorgensen, Kirsten</au><au>Melamed, Alexander</au><au>Brady, Paula C</au><au>Kaimal, Anjali</au><au>Del Carmen, Marcela G</au><au>Woodard, Terri L</au><au>Meyer, Larissa A</au><au>Giordano, Sharon H</au><au>Ramirez, Pedro T</au><au>Rauh-Hain, J Alejandro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2021-10-01</date><risdate>2021</risdate><volume>138</volume><issue>4</issue><spage>565</spage><epage>573</epage><pages>565-573</pages><issn>0029-7844</issn><eissn>1873-233X</eissn><abstract>To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer.
We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.
Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.
In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.</abstract><cop>United States</cop><pmid>34623068</pmid><doi>10.1097/AOG.0000000000004532</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Adult Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - surgery Cervix Uteri - pathology Cervix Uteri - surgery Cesarean Section - statistics & numerical data Cohort Studies Conization - methods Female Fertility Preservation - methods Fetal Growth Retardation - epidemiology Gravidity Humans Infant, Newborn Middle Aged Neoplasm Staging Pregnancy Pregnancy Complications, Neoplastic - surgery Pregnancy Outcome - epidemiology Premature Birth - epidemiology Propensity Score Stillbirth - epidemiology Trachelectomy - methods Uterine Cervical Neoplasms - surgery Young Adult |
| title | Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer |
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