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Effect of Cervical Carcinoma In Situ and Its Management on Pregnancy Outcome

From the Fred Hutchinson Cancer Research Center, Swedish Medical Center, Seattle, Washington, and Oregon Health Sciences University, Portland, Oregon.

Address reprint requests to: Janet Daling, PhD Fred Hutchinson Cancer Research Center 1100 Fairview Avenue North MP381, PO Box 19024 Seattle, WA 98109-1024 E-mail: jdaling{at}fhcrc.org

Objective: To assess the effect of cervical carcinoma in situ (CIS) and its management on subsequent pregnancy outcome.

Methods: We used a population-based retrospective cohort design that included record linkage between cancer data and birth records. The Cancer Surveillance System records of women with CIS (n = 1851, 312 diagnosed during pregnancy) diagnosed between 1984 and 1992, were linked to birth certificates of their first subsequent deliveries after CIS diagnosis. The comparison group (n = 9201) was a random sample of women without CIS who gave birth during the same years. The outcome measures were preterm and low birth weight infants subsequent to CIS diagnosis and treatment. Treatments included no therapy, dilation and curettage or endocervical curettage, cryosurgery or laser vaporization, and conization.

Results: Women with CIS who were not treated with conization had a small increased risk of preterm delivery (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.0, 2.0) and no increased risk of low birth weight infant (OR 1.0, 95% CI 0.7, 1.6), compared with women without CIS, after adjusting for maternal smoking, race, parity, marital status, and history of induced pregnancy termination. Women with CIS who had conization were more likely to deliver premature infants (OR 1.6, 95% CI 1.2, 2.0) than women without CIS, after adjusting for the same confounding factors. The apparently increased risk of low birth weight (OR 1.8, 95% CI 1.4, 2.4) seemed to be a reflection of premature delivery.

Conclusion: The risk of prematurity increased after conization for CIS and did not increase when women with CIS had other procedures.

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