Preterm Birth Following Active Surveillance vs Loop Excision for Cervical Intraepithelial Neoplasia Grade 2

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Oncology

Background:

• Active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) is increasingly adopted in high-income nations.
• Excisional treatment for CIN2 is linked to increased preterm birth risk.
• The impact of active surveillance on preterm birth risk, considering dysplasia's own association with preterm birth, remains unclear.

Purpose of the Study:

• To compare the risk of preterm birth in women diagnosed with CIN2 who undergo active surveillance versus immediate loop electrosurgical excision procedure (LEEP).

Main Methods:

• A historical, population-based cohort study in Denmark (1998-2018) included women with a first-time CIN2 diagnosis and a subsequent singleton birth.
• Women were grouped into active surveillance or immediate LEEP based on initial management.
• Preterm birth risk was assessed using modified Poisson regression with inverse probability treatment weighting.

Main Results:

• The study included 10,537 women with CIN2; 42% had active surveillance, 58% had immediate LEEP.
• Preterm birth risk was comparable between active surveillance and immediate LEEP groups (RR, 1.03).
• Women undergoing delayed LEEP after active surveillance had a 30% higher risk of preterm birth compared to immediate LEEP (RR, 1.29).

Conclusions:

• Active surveillance for CIN2 did not increase preterm birth risk compared to immediate LEEP.
• Delayed LEEP following active surveillance was associated with a significantly higher risk of preterm birth.
• Risk stratification at CIN2 diagnosis is crucial to identify women who might benefit from immediate treatment to mitigate preterm birth risk.