The risk of preterm birth of treated versus untreated cervical intraepithelial neoplasia (CIN): A systematic review and meta-analysis

Nora A. Danhof, Esme I. Kamphuis, Jacqueline Limpens, Luc R.C.W. Van Lonkhuijzen, Eva Pajkrt, Ben W.J. Mol

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Abstract Cervical surgery is associated with preterm birth (PTB) and neonatal morbidity. However, it is unknown whether this increased risk is due to the surgery itself or to the cervical intraepithelial neoplasia (CIN) underlying the surgery. Our objective was to assess the risk for PTB in women with treated and untreated CIN. We performed an electronic literature search in MEDLINE, Embase and CENTRAL for studies that reported on pregnancy outcome after treated and untreated CIN. The methodological quality was scored using the STROBE combined checklist for observational studies. We extracted data on PTB < 37 weeks, very PTB < 32 weeks, spontaneous PTB < 37 weeks, (preterm) premature rupture of membranes ((P)PROM), perinatal mortality and section caesarean each before and after treatment for CIN. We used the Mantel-Haenszel method to estimate summarizing odds ratios. Our search identified 620 studies, of which 20 were reporting on pregnancy outcome for a total of 12,159,293 women. There were 20,832 women who gave birth after treatment for CIN before pregnancy, 52 women who gave birth after treatment for CIN during pregnancy, 64,237 women with CIN who gave birth before treatment, and 8,902,865 women who gave birth without CIN. Compared to women with untreated CIN, women treated for CIN before or during pregnancy, had a significantly higher risk of PTB < 37 weeks (OR 1.7, 95% CI 1.0-2.7). When comparing women treated for CIN before pregnancy (n = 20,832) to women with untreated CIN (n = 64,162), we found an OR of 1.4 with a 95% confidence interval of 0.85-2.3. Women treated during pregnancy had a clearly increased risk for PTB (OR 6.5, 95% CI 1.1-37), and (P)PROM (OR 1.8, 95% CI 1.4-2.2). In women with cervical surgery, the risks for spontaneous PTB < 37 weeks (OR 0.87, 95% CI 0.54-1.4), caesarean section (OR 1.0, 95% CI 0.71-1.5) and perinatal mortality (OR 1.0, 95% CI 0.38-2.8) were not increased. The increased risk of PTB in women who underwent cervical surgery for CIN is especially increased when performed during pregnancy. When performed before pregnancy the risk of PTB is increased, although insignificant.

LanguageEnglish
Article number8929
Pages24-33
Number of pages10
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume188
DOIs
Publication statusPublished - 1 May 2015

Keywords

  • Cervical intraepithelial neoplasia
  • Cervical surgery
  • Pregnancy outcomes
  • Preterm birth

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Danhof, Nora A. ; Kamphuis, Esme I. ; Limpens, Jacqueline ; Van Lonkhuijzen, Luc R.C.W. ; Pajkrt, Eva ; Mol, Ben W.J. / The risk of preterm birth of treated versus untreated cervical intraepithelial neoplasia (CIN) : A systematic review and meta-analysis. In: European Journal of Obstetrics and Gynecology and Reproductive Biology. 2015 ; Vol. 188. pp. 24-33.
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abstract = "Abstract Cervical surgery is associated with preterm birth (PTB) and neonatal morbidity. However, it is unknown whether this increased risk is due to the surgery itself or to the cervical intraepithelial neoplasia (CIN) underlying the surgery. Our objective was to assess the risk for PTB in women with treated and untreated CIN. We performed an electronic literature search in MEDLINE, Embase and CENTRAL for studies that reported on pregnancy outcome after treated and untreated CIN. The methodological quality was scored using the STROBE combined checklist for observational studies. We extracted data on PTB < 37 weeks, very PTB < 32 weeks, spontaneous PTB < 37 weeks, (preterm) premature rupture of membranes ((P)PROM), perinatal mortality and section caesarean each before and after treatment for CIN. We used the Mantel-Haenszel method to estimate summarizing odds ratios. Our search identified 620 studies, of which 20 were reporting on pregnancy outcome for a total of 12,159,293 women. There were 20,832 women who gave birth after treatment for CIN before pregnancy, 52 women who gave birth after treatment for CIN during pregnancy, 64,237 women with CIN who gave birth before treatment, and 8,902,865 women who gave birth without CIN. Compared to women with untreated CIN, women treated for CIN before or during pregnancy, had a significantly higher risk of PTB < 37 weeks (OR 1.7, 95{\%} CI 1.0-2.7). When comparing women treated for CIN before pregnancy (n = 20,832) to women with untreated CIN (n = 64,162), we found an OR of 1.4 with a 95{\%} confidence interval of 0.85-2.3. Women treated during pregnancy had a clearly increased risk for PTB (OR 6.5, 95{\%} CI 1.1-37), and (P)PROM (OR 1.8, 95{\%} CI 1.4-2.2). In women with cervical surgery, the risks for spontaneous PTB < 37 weeks (OR 0.87, 95{\%} CI 0.54-1.4), caesarean section (OR 1.0, 95{\%} CI 0.71-1.5) and perinatal mortality (OR 1.0, 95{\%} CI 0.38-2.8) were not increased. The increased risk of PTB in women who underwent cervical surgery for CIN is especially increased when performed during pregnancy. When performed before pregnancy the risk of PTB is increased, although insignificant.",
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The risk of preterm birth of treated versus untreated cervical intraepithelial neoplasia (CIN) : A systematic review and meta-analysis. / Danhof, Nora A.; Kamphuis, Esme I.; Limpens, Jacqueline; Van Lonkhuijzen, Luc R.C.W.; Pajkrt, Eva; Mol, Ben W.J.

In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 188, 8929, 01.05.2015, p. 24-33.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The risk of preterm birth of treated versus untreated cervical intraepithelial neoplasia (CIN)

T2 - European Journal of Obstetrics Gynecology and Reproductive Biology

AU - Danhof, Nora A.

AU - Kamphuis, Esme I.

AU - Limpens, Jacqueline

AU - Van Lonkhuijzen, Luc R.C.W.

AU - Pajkrt, Eva

AU - Mol, Ben W.J.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Abstract Cervical surgery is associated with preterm birth (PTB) and neonatal morbidity. However, it is unknown whether this increased risk is due to the surgery itself or to the cervical intraepithelial neoplasia (CIN) underlying the surgery. Our objective was to assess the risk for PTB in women with treated and untreated CIN. We performed an electronic literature search in MEDLINE, Embase and CENTRAL for studies that reported on pregnancy outcome after treated and untreated CIN. The methodological quality was scored using the STROBE combined checklist for observational studies. We extracted data on PTB < 37 weeks, very PTB < 32 weeks, spontaneous PTB < 37 weeks, (preterm) premature rupture of membranes ((P)PROM), perinatal mortality and section caesarean each before and after treatment for CIN. We used the Mantel-Haenszel method to estimate summarizing odds ratios. Our search identified 620 studies, of which 20 were reporting on pregnancy outcome for a total of 12,159,293 women. There were 20,832 women who gave birth after treatment for CIN before pregnancy, 52 women who gave birth after treatment for CIN during pregnancy, 64,237 women with CIN who gave birth before treatment, and 8,902,865 women who gave birth without CIN. Compared to women with untreated CIN, women treated for CIN before or during pregnancy, had a significantly higher risk of PTB < 37 weeks (OR 1.7, 95% CI 1.0-2.7). When comparing women treated for CIN before pregnancy (n = 20,832) to women with untreated CIN (n = 64,162), we found an OR of 1.4 with a 95% confidence interval of 0.85-2.3. Women treated during pregnancy had a clearly increased risk for PTB (OR 6.5, 95% CI 1.1-37), and (P)PROM (OR 1.8, 95% CI 1.4-2.2). In women with cervical surgery, the risks for spontaneous PTB < 37 weeks (OR 0.87, 95% CI 0.54-1.4), caesarean section (OR 1.0, 95% CI 0.71-1.5) and perinatal mortality (OR 1.0, 95% CI 0.38-2.8) were not increased. The increased risk of PTB in women who underwent cervical surgery for CIN is especially increased when performed during pregnancy. When performed before pregnancy the risk of PTB is increased, although insignificant.

AB - Abstract Cervical surgery is associated with preterm birth (PTB) and neonatal morbidity. However, it is unknown whether this increased risk is due to the surgery itself or to the cervical intraepithelial neoplasia (CIN) underlying the surgery. Our objective was to assess the risk for PTB in women with treated and untreated CIN. We performed an electronic literature search in MEDLINE, Embase and CENTRAL for studies that reported on pregnancy outcome after treated and untreated CIN. The methodological quality was scored using the STROBE combined checklist for observational studies. We extracted data on PTB < 37 weeks, very PTB < 32 weeks, spontaneous PTB < 37 weeks, (preterm) premature rupture of membranes ((P)PROM), perinatal mortality and section caesarean each before and after treatment for CIN. We used the Mantel-Haenszel method to estimate summarizing odds ratios. Our search identified 620 studies, of which 20 were reporting on pregnancy outcome for a total of 12,159,293 women. There were 20,832 women who gave birth after treatment for CIN before pregnancy, 52 women who gave birth after treatment for CIN during pregnancy, 64,237 women with CIN who gave birth before treatment, and 8,902,865 women who gave birth without CIN. Compared to women with untreated CIN, women treated for CIN before or during pregnancy, had a significantly higher risk of PTB < 37 weeks (OR 1.7, 95% CI 1.0-2.7). When comparing women treated for CIN before pregnancy (n = 20,832) to women with untreated CIN (n = 64,162), we found an OR of 1.4 with a 95% confidence interval of 0.85-2.3. Women treated during pregnancy had a clearly increased risk for PTB (OR 6.5, 95% CI 1.1-37), and (P)PROM (OR 1.8, 95% CI 1.4-2.2). In women with cervical surgery, the risks for spontaneous PTB < 37 weeks (OR 0.87, 95% CI 0.54-1.4), caesarean section (OR 1.0, 95% CI 0.71-1.5) and perinatal mortality (OR 1.0, 95% CI 0.38-2.8) were not increased. The increased risk of PTB in women who underwent cervical surgery for CIN is especially increased when performed during pregnancy. When performed before pregnancy the risk of PTB is increased, although insignificant.

KW - Cervical intraepithelial neoplasia

KW - Cervical surgery

KW - Pregnancy outcomes

KW - Preterm birth

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