Factors that influence the rate of epithelial maturation in the cervix in healthy young women.
OBJECTIVE
To examine the longitudinal changes in the epithelial topography of the cervix in healthy young women; and to determine the sociodemographic, behavioral, and biological factors associated with the rate of cervical epithelial maturation.


METHODS
Healthy young women were enrolled from October 2000 to September 2002 as part of a larger study of human papillomavirus (HPV). At interval visits, interviews, infection testing, and colpophotography (3% acetic acid; 10x, 16x magnifications) were performed. Areas of total cervical face and cervical immaturity, defined as columnar and early squamous metaplasia, were quantitatively measured using computerized planimetry. Cervical immaturity was expressed as percentage of total cervical face. This analysis includes the first consecutive 145 women with greater than 10% immaturity at baseline. The rate of cervical maturation was defined as change in percent-immaturity. Predictors included sociodemographics, sexual behaviors, and infections. Data analyses included multivariate generalized linear models with repeated measures.


RESULTS
The baseline mean age was 17.8 years. Colpophotographs were available from 815 total visits, representing 2.7 years mean follow-up per woman and 5.9-month mean intervals. Women began the study with a median of 39% immaturity and ended with 8% immaturity. After adjusting for time and baseline percent-immaturity, an increased rate of cervical maturation was associated with oral contraceptive pill use (parameter estimate -.023, p =.04) and smoking (-.039, p =.01).


CONCLUSIONS
Cervical maturation was documented during relatively short time periods for the vast majority of these women. Oral contraceptive pills and smoking may accelerate the maturational process, representing increased cell proliferation and thus a possible greater vulnerability to HPV.
Hwang
Loris Y
LY
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California. Electronic address: HwangL@peds.ucsf.edu.
Ma
Yifei
Y
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Benningfield
Susanna Miller
SM
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Clayton
Lisa
L
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Hanson
Evelyn N
EN
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Jay
Julie
J
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Jonte
Janet
J
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Godwin de Medina
Cheryl
C
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
Moscicki
Anna-Barbara
AB
Department of Pediatrics. Division of Adolescent Medicine, University of California-San Francisco, San Francisco, California.
D000293:Adolescent; D000704:Analysis of Variance; D002584:Cervix Uteri / Q000166:cytology / Q000187:drug effects / Q000254:growth & development*; D003268:Contraception Behavior; D003276:Contraceptives, Oral / Q000494:pharmacology*; D004848:Epithelium / Q000254:growth & development; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D010781:Photography; D012907:Smoking / Q000503:physiopathology*; D012959:Socioeconomic Factors; D055815:Young Adult
D003276:Contraceptives, Oral