Pre-eclampsia is not associated with an increased risk for endometrial cancer, according to a study in BMC Women’s Health.
The systematic review and meta-analysis evaluated current evidence regarding the association between pre-eclampsia diagnosed during pregnancy and the risk for endometrial cancer.
Researchers conducted a literature search in the EMBASE, MEDLINE, and Web of Science databases from inception until March 2022. Titles and abstracts were screened independently, and relevant abstracts were reviewed independently by at least 2 reviewers.
Eligible studies reported a risk estimate and 95% confidence interval (CI) or sufficient information to calculate an estimate. The risk estimates and 95% CIs were converted to log values, and a random-effects model was used to statistically pool the findings.
The analysis included 7 studies, 3 conducted in Europe and 4 in Asia. Of these studies, 5 studies had a cohort design, 1 used a nested case-control approach, and 1 was a case-control study. A total of 714,286 women with 11,724 identified endometrial cancer cases were included in the analysis,.
The pooled analysis for all studies demonstrated no significant association between pre-eclampsia and the risk for endometrial cancer, with moderate heterogeneity (pooled hazard ratio [HR], 1.07; 95% CI, 0.79-1.46; I2=34.1%).
A subgroup analysis based on study quality yielded similar results (Newcastle-Ottawa Scale [NOS] score ≥7: pooled HR, 1.05; 95% CI, 0.72-1.54; I2=50.7%; NOS score <7: pooled HR, 0.90; 95% CI, 0.39-2.08; I2=0.0%).
A sensitivity analysis investigating the risk for any subtype of endometrial neoplasia found that pre-eclampsia was associated with an increased risk for carcinoma in situ, atypical hyperplasia, or cancer, with a pooled HR of 1.34 (95% CI, 1.15-1.57) with moderate heterogeneity (I2=38.5%).
Among several limitations, only 7 studies are included, and misclassification of exposure is possible and may have affected the results. Also, varying definitions for pre-eclampsia are used, only observational studies are included, and all studies were conducted in European or Asian populations.
“Overall, the findings from this systematic review and meta-analysis suggested no association between pre-eclampsia and subsequent risk of endometrial cancer,” wrote the researchers. “To further elucidate the relationship between pre-eclampsia and endometrial cancer risk, future studies are required and should aim to include large prospective cohorts using validated data to investigate pre-eclampsia onset, as well as endometrial cancer type and precursor conditions.”
Jordao H, Herink K, Eastwood KA, McVicker L, Kearns C, McMenamin UC. Pre-eclampsia during pregnancy and risk of endometrial cancer: a systematic review and meta-analysis. BMC Womens Health. Published online May 12, 2023. doi: 10.1186/s12905-023-02408-x