Abstract
ObjectiveBy identifying pregnancy-related risk factors for endometrial neoplasia, women’s risk of developing this disease after childbirth can be predicted and high-risk women can be screened for early detection.MethodsStudy data from women who gave birth in Korea in 2007 were collected from the Korea National Health Insurance (KNHI) claims database between 2007 and 2015. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of endometrial neoplasia were estimated by multivariate Cox proportional hazards models.ResultsData from 386,614 women were collected for this study. By 2015, 3,370 women from the initial cohort had been diagnosed with endometrial neoplasia secondary to delivery. Multivariate Cox proportional hazards regression revealed that preeclampsia (HR 1.55, 95% CI 1.29, 1.86), advanced maternal age (≥ 35; HR 1.52, 95% CI 1.39, 1.66), multifetal pregnancy (HR 1.81, 95% CI 1.46, 2.23), multiparity (HR 1.16, 95% CI 1.08, 1.24), cesarean section (HR 1.15, 95% CI 1.07, 1.23) and delivery of a large-for-gestational-age infant (HR 1.19, 95% CI 1.02, 1.39) were independent risk factors for future endometrial neoplasia. The risk for endometrial neoplasia increased as the number of risk factors increased (risk factors ≥3: HR 2.11, 95% CI 1.86–2.40).ConclusionThis study showed that six pregnancy-related factors—advanced maternal age, multiparity, multifetal pregnancy, cesarean section, delivery of a large-for-gestational-age infant, and preeclampsia—are positively correlated with future development of endometrial neoplasia, including endometrial hyperplasia or cancer. Close observation and surveillance are warranted to enable early diagnosis of endometrial diseases, including endometrial cancer after pregnancy in high-risk women. However, due to unavailability of clinical information, many clinical/epidemiological factors can become confounders. Further research is needed on factors associated with the risk of endometrial neoplasia.
Highlights
Pregnancy can affect the endometrium in a variety of ways
Pregnancy and endometrial neoplasia variables required for the analysis are as follows
ICD-10 codes: N85.1A hyperplasia of endometrium, atypical, D07.0 carcinoma in situ of endometrium, and C54.1 malignant neoplasm of endometrium: endometrial cancer Parity, multifetal pregnancy (O30.0), C/S (O82.8, 82.9, 82.0, 82.1, 84.2), preeclampsia (O11, 14.0, 14.1, 14.9, 15.0, 15.1, 15.2), postpartum hemorrhage (O72.1), placental abruption (O45.0, 45.8, 45.9), placenta previa (O44.1) Preterm birth (P07.20, 07.21, 07.22, 07.23, 07.24, 07.30, 07.31, 07.39), neonatal birthweight (P07.00, 07.01, 07.02, 07.09, 07.11, 07.12, 07.13, 07.14, 07.19, neonatal birthweight and gender were extracted from the Korean national Health Screening Program for Infant and Children)."
Summary
Pregnancy can affect the endometrium in a variety of ways. During pregnancy, the size and number of glands and blood vessels in the endometrium increase significantly. Previous studies have shown that pregnancy reduces the risk of endometrial cancer by reducing estrogen exposure [2]; it has been reported that some pregnancy-related factors, such as placental growth factor (PlGF) and placenta-specific protein 1 (PLAC-1), are associated with endometrial cancer [3,4,5,6,7]. Some epidemiologic studies have suggested that pregnancy reduces the incidence of endometrial cancer, and that the risk of endometrial cancer is further reduced by a greater number of pregnancies [13]. The results of previous studies examining associations between preeclampsia and endometrial cancer have been inconsistent [12, 14, 15], we hypothesized that pregnancyrelated factors such as preeclampsia may be associated with endometrial neoplasia. More intensive risk-based screening of women after childbirth might lead to earlier detection pregnancy-related endometrial neoplasia
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