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Systematic review A meta-analysis of the association between adolescent pregnancy and the risk of gynecological cancers
Bita Azmi-Naei1orcid , Fatemeh Shahbazi2orcid , Nazanin Azmi-Naei3orcid , Jalal Poorolajal1orcid
Epidemiol Health 2024;e2024094
DOI: https://doi.org/10.4178/epih.e2024094 [Accepted]
Published online: November 26, 2024
1Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical, Hamadan, Iran
2Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran, Hamadan, Iran
3Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran, Shahrud, Iran
4Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran, Hamadan, Iran
5Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran, Hamadan, Iran
Corresponding author:  Jalal Poorolajal,
Email: poorolajal@umsha.ac.ir
Received: 15 August 2024   • Revised: 15 November 2024   • Accepted: 17 November 2024
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Abstract

OBJECTIVES
Despite several investigations, the association between adolescent pregnancy and gynecological cancers has yet to be conclusively established. To further explore this association, we conducted a meta-analysis of observational studies.
METHODS
We conducted a comprehensive search of databases such as PubMed, Web of Science, and Scopus to identify studies investigating the link between adolescent pregnancy and gynecologic cancers. This search continued until February 20, 2023. To assess the heterogeneity among the studies, we used the I2 statistics. We also explored the potential presence of publication bias using the Begg and Egger tests. The overall effect sizes were reported as either risk ratio (RR) or odds ratio (OR), accompanied by a 95% confidence interval (CI), using a random-effects model.
RESULTS
From an initial pool of 25,436 studies, a total of 76 studies involving 13,991,683 participants met the predefined eligibility criteria. The analysis indicated that the overall effect size for individuals having their first pregnancy at age 20 or older, compared to those having it before age 20, was 0.54 (95% CI, 0.50-0.59) for cervical cancer, 0.82 (95% CI, 0.77-0.88) for ovarian cancer, and 0.96 (95% CI, 0.89-1.04) for uterine cancer.
CONCLUSIONS
Our findings suggest that experiencing one’s initial pregnancy at the age of 20 or above is associated with a significantly reduced risk of cervical and ovarian cancer. However, no significant association was found between first pregnancy at this age and uterine cancer.

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