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 Researchers focused on women with a common condition known as
cervical dysplasia, abnormal tissue growth that is typically caused
by the human papillomavirus (HPV). Milder cases of dysplasia may go
away on their own, but doctors often surgically remove abnormal
tissue in more severe cases to help prevent the condition from
progressing to full-blown cervical cancer.
“Women who have already had the surgery to remove pre-cancerous
lesions may want to wait a while to get pregnant, as we found the
risk of pre-term birth increased even more if women gave birth
within a year of their surgery,” said study co-author Allison
Naleway, of the Kaiser Permanente Center for Health Research in
Portland, Oregon.
In the study, researchers examined data on pregnancy outcomes for
4,307 women who didn’t have cervical procedures and compared them to
322 women who had surgery to remove precancerous tissue and another
847 women who had cervical biopsies to investigate abnormalities.
Women who had surgeries that cut out at least one centimeter of
tissue were more than twice as likely to have preterm births or
underweight babies as women who didn’t have any cervical procedures,
the study found.
And when women gave birth within one year of cervical surgery, their
odds of these complications more than tripled.
Compared to women who didn’t have surgery, those who did were more
likely to be smokers, overweight or obese and first-time mothers.
Researchers looked at several common surgical methods for removing
or destroying precancerous tissue, including excising cells with a
scalpel or destroying tissue with a laser, using a thin wire loop to
burn tissue with an electrical current or using a device that
freezes tissue.
About 5 percent of women who had ablation procedures, typically
using the wire loop, had preemies, compared with about 10 percent of
women who had less than 1.6 centimeters of tissue excised with
scalpels. When women had 1.6 centimeters of tissue or more cut out,
28 percent of them had preterm babies.
By way of comparison, 7 percent of women in the study who didn’t
have cervical procedures had preterm babies, as did 8 percent of
women who had cervical biopsies.
Women who had excision procedures cutting out at least 1 centimeter
of tissue were 2.2 times more likely to have low-birthweight babies
as women who had no cervical surgery or only biopsies, researchers
report in PLoS ONE.
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Miscarriages and stillbirths were more likely among women who had
ablations, however. About 25 percent of women who had ablations
experienced pregnancy loss, compared with 19 percent of women who
had excision procedures and 18 percent of women who didn’t have
cervical surgery or biopsy.
Cesarean deliveries were also more likely among women who had
cervical surgeries, but the increased risk wasn’t big enough to rule
out the possibility that it was due to chance.
One limitation of the study is that researchers lacked data on
excision thickness for some women and also didn’t have information
on a variety of factors that can influence pregnancy outcomes like
women’s income and education levels, marital status and type of
insurance.
GlaxoSmithKline, which makes one of two HPV vaccines approved in the
U.S., paid for the research and three of the authors were employees
of the company at the time. A fourth author disclosed having
received consulting fees from both GSK and Merck, which manufactures
the other U.S.-approved HPV vaccine.
The results suggest that the actual treatment of cervical dysplasia,
rather than the condition itself, is a relevant factor in increasing
the risk of pregnancy complications, said Dr. Christina Chu, a
gynecologic oncology researcher at Fox Chase Cancer Center in
Philadelphia who wasn’t involved in the study.
“The best thing that women can do is to protect themselves against
HPV infection, which is the greatest risk factor for developing
cervical dysplasia,” Chu added by email. “Girls and young women
should get the HPV vaccine.”
When women are treated for this condition, waiting to have a baby
may make sense.
“It does appear that the risks may be less for women who deliver
more than one year after excision, so if excision is necessary,
women may consider delaying pregnancy to allow the cervix to heal
fully,” Chu said.
SOURCE: http://bit.ly/2ko4xM0 PLoS ONE, online January 4, 2017.
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