Premalignant disease of the genital tract in pregnancy

The age of women at the time of delivery of their first child has been steadily increasing in the developed world for several generations. In the United States, the average age of first-time mothers increased by 3.6 years from 21.4 years in 1970 to 25.0 years in 2006. Globally, the use of modern contraception methods has risen slightly, from 54% in 1990 to 57.4% in 2014. There remains inequality in the access to contraception in the developing world, with access remaining low in sub-Saharan Africa, and teenage pregnancy remains a major international public health problem. However, increasing contraceptive use in many parts of the developing world, especially in Asia and Latin America, enables women to delay childbirth, leading to a relative rise in the maternal age of first pregnancy. As women extend their reproductive lives into their 30s and 40s, more pregnancies will be complicated by comorbidities of premalignant diseases of the genital tract. National cervical screening programmes are generally initiated at the age of 20 or 25 years, and in many countries opportunistic screening is performed during antenatal visits. It is therefore essential that clinicians understand the natural history, risk of progression to malignancy, and pregnancy implications of premalignant disease of the genital tract, in order to guide patients through difficult management decisions regarding treatment options.