Association between cervical conization and pregnancy outcomes: A nationwide population-based cohort study

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Public Health

Background:

• Cervical conization is a standard treatment for cervical intraepithelial neoplasia (CIN).
• The impact of cervical conization on subsequent pregnancy outcomes is not fully understood and remains controversial.
• Understanding these risks is crucial for patient counseling and management.

Purpose of the Study:

• To investigate the association between prior cervical conization and a range of adverse pregnancy outcomes.
• To quantify the risks of specific obstetric complications in women who have undergone cervical conization.
• To inform clinical practice regarding prenatal care for women with a history of cervical conization.

Main Methods:

• Population-based retrospective cohort study using Korean National Health Insurance System data (2006-2022).
• Included 199,826 singleton primiparous women (≥19 years); 18,602 had prior conization.
• Multivariable logistic regression analyzed adjusted odds ratios (aOR) for obstetric complications.

Main Results:

• Conization was linked to significantly higher risks of cervical incompetence (aOR 3.15), preterm labor (aOR 1.44), and preterm premature rupture of membranes (aOR 1.67).
• Elevated risks were also observed for placenta previa, gestational diabetes, and intrauterine growth restriction.
• Subgroup analysis indicated that women who underwent both conization and cerclage faced even greater risks for preterm labor and preterm premature rupture of membranes.

Conclusions:

• Cervical conization is associated with a heightened risk of multiple adverse obstetric complications.
• These findings underscore the necessity for tailored prenatal care strategies for women with a history of cervical conization.
• Further prospective research is warranted to confirm these associations and explore management options.