Risk factors for positive cervical cytology during early pregnancy screening and awareness of positive cytological results in Japan: a report from the Pregnant Women Health Initiative.

Objective: Cervical cancer screening rates are low in Japan. Therefore, when a woman is pregnant, this is a good opportunity to visit an obstetrics and gynecology clinic to have cervical cytology. This study aimed to clarify the association between cervical cancer screening and the management of pregnant women's health.

Methods: We prospectively examined the relationships between cervical cytological results during prenatal checkups and the following factors: participant's background, cytological sampling instruments, and awareness of cytological results.

Results: Of the 2725 participants, 71 showed abnormal results defined as atypical squamous cells of undetermined significance or higher grade (ASC-US⁺). ASC-US⁺ detection rates were higher in smokers, younger participants, those with a low education, those without cancer screening in the past 2 years, and those who received cytology using a spatula or brush. A multivariable logistic regression analysis identified smoking (adjusted odds ratio: 2.99 [95% confidence interval: 1.41-6.33]) and a spatula/brush (adjusted odds ratio: 2.46 [95% confidence interval: 1.09-5.53]) as independent variables associated with detecting ASC-US⁺. Among the participants, 39.4% (28/71) self-reported "no abnormalities," despite obtaining an ASC-US⁺ result.

Conclusions: Pre-pregnancy smoking and cytological sampling tools may contribute to detecting ASC-US⁺. Patients with detected abnormalities need accurate information and reliable follow-up.