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A history of cesarean section and future maternal long-term risk for neoplasms: a population-based cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Mode of delivery has long-term implications on the mother, including recent data regarding the level of transmission of fetal microchimeric cells (FMc) and their possible effect on cancer development. We aimed to evaluate the association between cesarean section (CS) and future risk for neoplasms.

Study design

A population-based cohort analysis comparing the long-term risk for neoplasms between patients that delivered only by CS to those that delivered only vaginally (VD). Neoplasms were pre-defined based on ICD-9 codes. Deliveries occurred between the years 1991–2017 in a tertiary medical center. Kaplan–Meier survival curves were used to compare the cumulative incidence of neoplasms and Cox proportional hazards models were constructed to control for confounders.

Results

During the study period 105,992 patients met the inclusion criteria; 14150 (13.4%) of patients had only CS and 91842 (86.6%) had VD (comparison group). The CS group had significantly higher incidence of benign and malignant neoplasms (4.73 per 1000 patient-years versus 3.88 per 1000 patient-years, OR = 1.26, 95% CI 1.16–1.37; p = 0.001; 2.19 per 1000 patient-years of follow up versus 1.93 per 1000 patient-years, OR = 1.16, 95% CI 1.03–1.31; p = 0.013). Specifically, the CS group had higher incidence of uterine cancer (1.2 versus 0.06 per 1000 patient-years, OR = 1.97, 95% CI 1.14–3.39; p = 0.013). The cumulative incidence of benign, malignant and uterine neoplasms was significantly higher in the CS group (Log rank test p = 0.001; 0.036 and 0.014; respectively). Importantly, no significant association was found with breast and ovarian malignancies.”

When performing a Cox regression model controlling for confounders, the risk for malignancy-related hospitalizations remained significant (adjusted HR = 1.22, 95% CI 1.01–1.48; p = 0.031) but not for uterine cancer (adjusted HR = 1.6, 95% CI 0.9–2.8; p = 0.103).

Conclusion

Our findings provide support to linkage between delivery by cesarean section and future maternal malignancy.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel

    P. Schwarzman, E. Sheiner & R. Kessous

  2. Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    R. Sergienko

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  1. P. Schwarzman
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  2. E. Sheiner
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  3. R. Sergienko
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  4. R. Kessous
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Contributions

Dr. PS, Conceptualization, Methodology, Investigation, Writing—Original Draft; Review & Editing. Prof. ES, Investigation, Review & Editing; Mr. RS, Methodology, Formal analysis, Writing—Review & Editing; Dr. RK, Methodology, Investigation, Writing—Original Draft; Review & Editing.

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Correspondence to P. Schwarzman.

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The authors declare no conflicts of interest relevant to this article. We confirm that no honorarium, grant, or other form of payment was given to any of the authors to produce the manuscript. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Schwarzman, P., Sheiner, E., Sergienko, R. et al. A history of cesarean section and future maternal long-term risk for neoplasms: a population-based cohort study. Arch Gynecol Obstet 308, 499–505 (2023). https://doi.org/10.1007/s00404-022-06698-8

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  • DOI: https://doi.org/10.1007/s00404-022-06698-8

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