Abstract:
Objective The standard treatment for high-grade
squamous intraepithelial lesions is excisional involving
the uterine cervix, while surveillance is an acceptable
approach for low-grade squamous intraepithelial lesions.
There is controversy about excisional treatment on
pregnancy outcomes. The objective of this study was to
determine pregnancy outcomes in women living with and
without HIV who underwent excisional treatment for high-
grade cervical intraepithelial lesions.
Design This retrospective cohort study compared the
pregnancy outcomes of women with and without HIV who
were or were not treated for cervical intraepithelial lesions.
A cohort of 488 women with and without HIV infection
who did or did not receive excisional treatment for cervical
intraepithelial lesions between 2009 and 2022 was
enrolled. Adverse pregnancy outcomes (preterm delivery
and pregnancy loss) in women with and without HIV,
untreated or treated for cervical dysplasia, were recorded
and analysed. The significance of the obtained results was
judged at the 5% level.
Study settings The study was conducted at all Academic
Model Providing Access to Healthcare-Kenya satellite sites,
which offer cervical cancer screening and treatment for
cervical dysplasia in western Kenya. The Moi Teaching and
Referral Hospital was also included.
Participants A cohort of 488 women aged between 20
years and 49 years, with and without HIV, diagnosed and
treated for high-grade cervical intraepithelial neoplasia,
and those followed up for low-grade cervical intraepithelial
neoplasia between 2009 and 2022, were included.
Outcomes measured The study was interested in
adverse pregnancy outcomes, particularly pregnancy loss
and preterm delivery following cervical excision treatment
for high-grade cervical intraepithelial lesions.
Results After adjustment for confounding factors,
excisional treatment involving the uterine cervix—
particularly cold knife conisation—was associated with
higher odds of adverse pregnancy outcomes (OR 13.1;
95% CI 1.1 to 137.1; p=0.032). A prior history of adverse
pregnancy outcomes was also strongly associated with
subsequent adverse outcomes after treatment (OR 37.7;
95% CI 13.8 to 102.7; p<0.001). In contrast, maternal HIV
infection was not independently associated with adverse
pregnancy outcomes after adjustment (p=0.125).
Conclusion Adverse pregnancy outcomes after excisional
treatment of the uterine cervix for high-grade squamous
intraepithelial lesions are multifactorial and were
associated with cold knife conisation and prior adverse
pregnancy outcomes, while maternal HIV infection was not
independently associated with adverse outcomes.
