Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study
Open accessAbstract
OBJECTIVE: To explore the association between preterm delivery and treatment at colposcopy. DESIGN: Retrospective-prospective cohort study using record linkage. SETTING: 12 National Health Service hospitals in England. PARTICIPANTS: Women who had a cervical histology sample taken between 1987 and 2009. These women were linked by hospital episode statistics to hospital obstetric records between 1998 and 2009 for the whole of England to identify singleton live births between 20-43 gestational weeks before or after cervical histology. MAIN OUTCOME MEASURES: Proportion of preterm births (<37 weeks); the relative risk for the strength of association between preterm births and treatment for cervical intraepithelial neoplasia. RESULTS: 18,441 singleton births occurred: 4176 before histology and 14,265 after histology. Of the singleton births after histology, 9.0% (n=1284) were preterm compared with 6.7% of all births in England over the same period (excess risk 2.3 per 100 births, 95% confidence interval 1.8% to 2.8%). Among first births after histology, the adjusted relative risk associated with previous treatment was 1.19 (95% confidence interval 1.01 to 1.41); among first births before histology the relative risk associated with subsequent treatment was 1.47 (1.05 to 2.05). Combining these, the relative risk associated with treatment adjusted for timing relative to histology was 0.91 (0.66 to 1.26) corresponding to an absolute difference of -0.25 (-2.61 to 2.11) per 100 singleton births. Among 372 women who gave birth both before and after treatment, there were 30 preterm births after treatment and 32 before treatment (relative risk 0.94, 0.62 to 1.43). CONCLUSION: The risk of preterm delivery in women treated by colposcopy in England was substantially less than that in many other studies, predominantly from Nordic countries. The increased risk may be a consequence of confounding and not caused by treatment. Although this study is reassuring for large loop excision of the transformation zone overall, it is possible that deep conisation or repeated treatment leads to an increased risk of preterm delivery.
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Untreated women attending for colposcopy have a higher risk of preterm birth than women without CIN, probably explained by inherent characteristics and genetic, epigenetic, or microbiome factors.
“Untreated women attending for colposcopy have a higher risk of preterm birth than do women without CIN, probably explained by inherent characteristics and genetic, epigenetic, or microbiome factors.40, 41, 42”
From Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis (2022) · cites this paper as [40]
The Results (Internal comparison; page not provided) report a preterm-birth rate of 8.3% after punch biopsy only, while Table 2 reports 6.7% for births in England. The paper does not directly compare untreated colposcopy attendees with women confirmed not to have CIN. The Discussion (Strengths and limitations; page not provided) considers pre-existing risk factors and disease-related confounding, but does not identify genetic, epigenetic, or microbiome factors as the probable explanation. (LLM, conf=0.84)
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Kyrgiou, M., Athanasiou, A., Paraskevaidi, M., Mitra, A., Kalliala, I., Martin-Hirsch, P., Arbyn, M., Bennett, P., & Paraskevaidis, E. (2016) · BMJ · doi:10.1136/bmj.i3633 · Cited by 495 · see citing works
Athanasiou, A., Veroniki, A. A., Efthimiou, O., Kalliala, I., Naci, H., Bowden, S., Paraskevaidi, M., Arbyn, M., Lyons, D., Martin-Hirsch, P., et al. (2022) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00334-5 · Cited by 85 · see citing works
Kyrgiou, M., Valasoulis, G., Stasinou, S., Founta, C., Athanasiou, A., Bennett, P., & Paraskevadis, E. (2015) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2014.07.038 · Cited by 74 · see citing works
- Authors
- Castanon, A., Brocklehurst, P., Evans, H., Peebles, D., Singh, N., Walker, P., Patnick, J., Sasieni, P., & for the PaCT Study Group
- Affiliations
- University College London (GB)
- Royal Free London NHS Foundation Trust (GB)
- Barts Health NHS Trust (GB)
- Queen Mary University of London (GB)
- Corresponding author
- Sasieni, P.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-08-16
- Volume
- 345
- Issue
- aug16 2
- Pages
- e5174-e5174
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3421237
- OpenAlex
- W1997592201
- Cited by
- 120
- References
- 0
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 9 · 2020: 2 · 2019: 5 · 2018: 10 · 2017: 12 · 2016: 9 · 2015: 20 · 2014: 20 · 2013: 14 · 2012: 2
- FWCI
- 13.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by-nc)
- Funders
- National Institute for Health and Care Research (PB-PG-1208-16187)
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- preterm birth, cervical intraepithelial neoplasia, colposcopy, LLETZ, cervical cancer screening, cervical histology, singleton live births, confounding, pregnancy outcomes, England, data linkage, Hospital Episode Statistics, obstetric records, confounding by treatment, confounding by indication
- MeSH terms
- Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Cervix Uteri, Colposcopy, England, Female, Humans, Infant, Newborn, Pregnancy, Prospective Studies, Retrospective Studies, Risk, Premature Birth
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