Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer

Abstract

OBJECTIVE: To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer. METHODS: 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. RESULTS: 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. CONCLUSION: In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.

Adverse pregnancy outcomes of cancer survivors and infectious disease in their infants: The Japan Environment and Children's Study

“…Cervical cancer was the most frequent and women with a prior cervical cancer had a higher risk of preterm birth in the present study. This is in line with previous study ( 21 , 22 ). Nitecki et al found that 2.9% (118/4087) of patients conceived at least 3 months after fertility-sparing surgery for stage I cervical cancer and had higher odds of preterm birth and neonatal morbidity ( 21 ).…”

“…This is in line with previous study ( 21 , 22 ). Nitecki et al found that 2.9% (118/4087) of patients conceived at least 3 months after fertility-sparing surgery for stage I cervical cancer and had higher odds of preterm birth and neonatal morbidity ( 21 ). There was no difference in rates of SGA, stillbirth, caesarean delivery and maternal morbidity.…”

Laparoscopic Radical Trachelectomy after Neoadjuvant Chemotherapy for Fertility Preservation in Early-Stage Bulky Cervical Cancer: A Case Report and Literature Review

“…In addition, it was reported that radical trachelectomy may diminish ovarian reserve, since a decreased response to controlled ovarian stimulation had been reported after radical trachelectomy procedures [18]. On top of that, patients who conceived after FSS had a higher chance of preterm delivery between 32 and 37 gestation weeks, as well as higher neonatal morbidity risk, compared to the controls [19].…”

Assessing gaps in motherhood after cancer: development and psychometric testing of the Survivorship Oncofertility Barriers Scale

“…Cancer survivors face higher risks of infertility than their age-matched peers, and report lower pregnancy rates and long-term infertility-related distress 4–7. In particular, women with breast or gynecological cancers have increased risks owing to the cancer and from potentially gonadotoxic treatments such as chemotherapy, pelvic radiation, hormone therapy, or surgery to the uterus or ovaries 8–12…”

“…Studies suggest that pregnancy and the use of assisted reproductive technology in cancer survivors is safe and feasible, and that many women desire motherhood after cancer 3–13. With advances in fertility preservation over the past 15 years, we now have a growing cohort of women pursuing survivorship fertility care 1 3 7–11. However, survivors report difficulty in making decisions about whether to pursue fertility care, pregnancy timing, and how to access and pay for care 14 15.…”