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Active surveillance of cervical intraepithelial neoplasia and adverse pregnancy outcomes: A register-based cohort
Kirstine Kold Katholm1,2, Lotte Krog Eriksen1,3, Kathrine Dyhr Lycke1,3
1Department of Obstetrics and Gynecology, University Clinic for Gynecological HPV-Related Disease, Gødstrup Hospital, Herning, Denmark.
Introduction:
Previous studies have suggested that human papillomavirus (HPV) and HPV-related disease may be associated with increased risk of adverse pregnancy outcomes, e.g., hypertensive disorders of pregnancy, small for gestational age (SGA), and gestational diabetes mellitus (GDM). As active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) leaves the lesion and underlying infection untreated, we aimed to investigate whether the risk of adverse pregnancy outcomes differs between women who undergo active surveillance for CIN2 compared to women having an immediate large loop excision of the transformation zone (LLETZ).
Material And Methods:
We conducted a nationwide register-based cohort study in Denmark. Individual-level data was collected from Danish healthcare registers. We included women aged 18-40 with a first-time diagnosis of CIN2 between January 1, 1998, and December 31, 2018, and a subsequent singleton birth. We estimated the risk of hypertensive disorder of pregnancy, SGA, and/or GDM in a subsequent pregnancy. We calculated crude and adjusted relative risks (aRR) adjusting for potential confounders using modified Poisson regression.
Results:
We included 10 537 women with CIN2 and a subsequent singleton birth; 4430 women (42%) underwent active surveillance, and 6107 women (58%) had a LLETZ. We identified 548 (5.2%) cases of hypertensive disorders of pregnancy, 379 cases of SGA (3.6%), and 315 cases of GDM (3.0%). For all three outcomes, the adjusted relative risk was comparable between active surveillance and immediate LLETZ (aRR 1.08 (95% CI 0.91-1.29), aRR 0.94 (95% CI 0.74-1.19), aRR 0.92 (95% CI 0.73-1.16), respectively). Stratified analyses revealed insignificant differences in the risk of hypertensive disorders of pregnancy, SGA, and GDM.
Conclusions:
No association was found between CIN2 management and risks of hypertensive disorders, SGA, or GDM in later pregnancy. These findings suggest that untreated HPV-related lesions do not increase adverse pregnancy risks and may help reassure women during clinical counseling about future pregnancies after CIN2 treatment.
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