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Pregnancy outcomes improving after treatment for high-grade cervical neoplasia

Annals of Internal Medicine
Reuters Health - 07/02/2022 - The risk for pregnancy-related complications following treatment for grade-3 cervical intraepithelial neoplasia (CIN 3) has declined over time, thanks to advances in treatment, a new study indicates.

However, women treated for CIN 3 should still be managed as "high risk" to reduce risk of preterm birth, infant sepsis, and other adverse outcomes, researchers write in Annals of Internal Medicine.

Treatment for CIN 3 removes or destroys part of the cervix and might subsequently influence pregnancy outcomes. However, over the years, treatment for CIN 3 has advanced, with more conservative treatment methods used today.

The researchers used data from five national Swedish registries to investigate pregnancy outcomes in women diagnosed with CIN 3 between 1973 and 2018. They identified 78,450 births after a maternal CIN 3 diagnosis and matched them to 784,500 births to women without a CIN 3 diagnosis.

Even after accounting for family factors, a history of treatment for CIN 3 was significantly associated with adverse pregnancy outcomes, including preterm birth, especially extremely preterm (odds ratio, 3.00) or spontaneous preterm (OR, 2.12); infection-related outcomes, including chorioamnionitis (OR, 3.23) and infant sepsis (OR, 1.72); and early neonatal death (OR, 1.83).

A sibling-comparison analysis that included 23,199 babies born to women diagnosed with CIN 3 and 28,135 born to their sisters without a CIN 3 diagnosis rendered largely similar results.

Of note, say the researchers, the risk for all pregnancy complications in women treated for CIN 3 declined over the 46-year study period time and the risk for infant death disappeared. A possible explanation for this is less-invasive treatment methods for CIN 3.

"Our results indicate that caution should be taken when applying a screen-and-treat approach to women of reproductive age, given that over treatment of the cervix may have a detrimental effect on future pregnancies," write Dr. Wei He with Karolinska Institutet in Stockholm and colleagues.

"In the context of a screen-and-treat strategy in countries where diagnostic resources are limited, patients are often treated after a positive result on a screening test, without additional diagnostic confirmation. As such, a large proportion of women with low-grade lesions or with a healthy cervix may be treated unnecessarily, which may consequently lead to adverse outcomes in future pregnancies," they caution.

The authors of an editorial agree that pregnancies after treatment of CIN 3 should be managed as high risk to decrease adverse outcomes, but say "the optimal clinical care remains unclear."

"We currently lack specific obstetric interventions or care algorithms to mitigate the risk for pregnancy complications associated with CIN 3 diagnoses," write Dr. Rebecca Perkins with Boston Medical Center and co-authors.

"Excision is the treatment of choice in the United States, whereas ablative therapies are favored in other locations; both are associated with adverse obstetric outcomes. Nondestructive treatments for CIN 3 currently under investigation, including therapeutic vaccines and topical agents, may lead to improved obstetric outcomes, but their efficacy has not been established," the editorialists note.

"In the decades to come, primary prevention of HPV (human papillomavirus) through vaccination will likely lead to a substantial reduction of adverse obstetric outcomes. Already, data from Australia have shown a 3.2% population-wide decrease in preterm births and a 9.8% decrease in small-for-gestational-age infants after widespread HPV vaccination," they note.

This research had no commercial funding.

SOURCE: https://bit.ly/3uud6vp and https://bit.ly/3Gsn96l Annals of Internal Medicine, online February 7, 2022.

By Reuters Staff

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