F J Bruinsma1, M A Quinn. 1. Mother & Child Health Research, La Trobe University, Melbourne, Vic, Australia. f.bruinsma@latrobe.edu.au
Abstract
BACKGROUND: Studies investigating the association between treatment for precancerous changes in the cervix and risk of preterm birth have used a variety of comparison groups. OBJECTIVES: To investigate whether treatment for precancerous changes in the cervix is associated with preterm birth (<37 weeks) and to examine the impact of the type of comparison group on estimates of risk. SEARCH STRATEGY: PubMed, Embase and CENTRAL were searched for studies pubished between 1950 and 2009. SELECTION CRITERIA: Eligible studies were those that reported preterm birth outcomes for excisional and ablative treatments separately and included a comparison group. DATA COLLECTION AND ANALYSIS: Pooled relative risks (RR) and 95% confidence intervals were computed using a random effects model. MAIN RESULTS: Thirty eligible studies were located. Excisional treatment was associated with an increased odds of preterm birth, when compared with an external (RR 2.19, 95% CI 1.93-2.49) or internal (RR 1.96, 95% CI 1.46-2.64) comparison group. In comparison with women who were assessed but not treated, the risk estimate was smaller (RR 1.25, 95% CI 0.98-1.58). Ablative treatment was associated with an increased risk of preterm birth when an external comparison group (RR 1.47, 95% CI 1.24-1.74) but not an internal comparison group (RR 1.24, 95% CI 0.73-2.10) or untreated comparison group (RR 1.03, 95% CI 0.90-1.18) was used. AUTHORS' CONCLUSIONS: Excisional treatment was associated with a significantly increased risk of preterm birth. It provides new evidence that some types of ablative treatment may also be associated with a small increased risk. The type of comparison group used is an important consideration when comparing the outcomes of studies.
BACKGROUND: Studies investigating the association between treatment for precancerous changes in the cervix and risk of preterm birth have used a variety of comparison groups. OBJECTIVES: To investigate whether treatment for precancerous changes in the cervix is associated with preterm birth (<37 weeks) and to examine the impact of the type of comparison group on estimates of risk. SEARCH STRATEGY: PubMed, Embase and CENTRAL were searched for studies pubished between 1950 and 2009. SELECTION CRITERIA: Eligible studies were those that reported preterm birth outcomes for excisional and ablative treatments separately and included a comparison group. DATA COLLECTION AND ANALYSIS: Pooled relative risks (RR) and 95% confidence intervals were computed using a random effects model. MAIN RESULTS: Thirty eligible studies were located. Excisional treatment was associated with an increased odds of preterm birth, when compared with an external (RR 2.19, 95% CI 1.93-2.49) or internal (RR 1.96, 95% CI 1.46-2.64) comparison group. In comparison with women who were assessed but not treated, the risk estimate was smaller (RR 1.25, 95% CI 0.98-1.58). Ablative treatment was associated with an increased risk of preterm birth when an external comparison group (RR 1.47, 95% CI 1.24-1.74) but not an internal comparison group (RR 1.24, 95% CI 0.73-2.10) or untreated comparison group (RR 1.03, 95% CI 0.90-1.18) was used. AUTHORS' CONCLUSIONS: Excisional treatment was associated with a significantly increased risk of preterm birth. It provides new evidence that some types of ablative treatment may also be associated with a small increased risk. The type of comparison group used is an important consideration when comparing the outcomes of studies.
Authors: Jose Galaz; Roberto Romero; Yi Xu; Derek Miller; Dustyn Levenson; Robert Para; Aneesha Varrey; Richard Hsu; Anna Tong; Sonia S Hassan; Chaur-Dong Hsu; Nardhy Gomez-Lopez Journal: J Perinat Med Date: 2020-09-25 Impact factor: 1.901
Authors: Renske D M Steenbergen; Peter J F Snijders; Daniëlle A M Heideman; Chris J L M Meijer Journal: Nat Rev Cancer Date: 2014-06 Impact factor: 60.716
Authors: Hannah N Coleman; William W Greenfield; Shawna L Stratton; Rita Vaughn; Alexander Kieber; Andrea M Moerman-Herzog; Horace J Spencer; Wilbur C Hitt; Charles Matthew Quick; Laura F Hutchins; Samuel G Mackintosh; Ricky D Edmondson; Stephen W Erickson; Mayumi Nakagawa Journal: Cancer Immunol Immunother Date: 2016-03-15 Impact factor: 6.968
Authors: Shayna N Conner; Heather A Frey; Alison G Cahill; George A Macones; Graham A Colditz; Methodius G Tuuli Journal: Obstet Gynecol Date: 2014-04 Impact factor: 7.661