TOPLINE

Among women with cervical intraepithelial neoplasia grade 2 (CIN2), active surveillance for CIN2 was not associated with a higher risk for hypertensive disorders of pregnancy, delivery of a small-for-gestational-age infant, and gestational diabetes in a subsequent pregnancy compared with immediate large loop excision of the transformation zone (LLETZ). 

METHODOLOGY

• Using data from five Dannish registries, researchers conducted a cohort study to compare the risk for adverse pregnancy outcomes between women who underwent active surveillance for CIN2 and those who underwent immediate LLETZ.
• The researchers included 10,537 women aged 18-40 years with a first-time diagnosis of CIN2 between 1998 and 2018 who subsequently had a singleton birth.
• Within 10 months of a CIN2 diagnosis, women were grouped as those who underwent active surveillance (n = 4430), with cytology and/or biopsy follow-up, and those who underwent immediate treatment with LLETZ (n = 6107).
• Women who underwent active surveillance were further grouped as those who completed surveillance without LLETZ and those who underwent delayed LLETZ within 2 years of the surveillance period.
• Outcomes assessed were hypertensive disorders of pregnancy, delivery of a small-for-gestational-age infant, and gestational diabetes identified using standardised diagnostic codes within Danish healthcare registries.

TAKEAWAY

• Overall, 5.2% of women with CIN2 developed hypertensive disorders of pregnancy, 3.6% delivered small-for-gestational-age babies, and 3.0% developed gestational diabetes.
• Among women with hypertensive disorders of pregnancy, 2.1% were diagnosed with gestational hypertension and 3.5% with diagnosed with preeclampsia or eclampsia.
• After adjustment for potential confounders, the risks for hypertensive disorders of pregnancy (adjusted risk ratio [aRR], 1.08), delivery of a small-for-gestational-age infant (aRR, 0.94), and gestational diabetes (aRR, 0.92) were comparable between the active surveillance and LLETZ groups.
• The risks for all three adverse pregnancy outcomes were similar regardless of whether women completed active surveillance without LLETZ or underwent delayed LLETZ during the active surveillance period.

IN PRACTICE

"Women with CIN2 can be reassured that the risk of adverse pregnancy outcomes is not related to clinical management. However, when providing clinical counseling for women of reproductive age with CIN2, it is important to consider further risks and benefits as well," the authors wrote.

SOURCE

This study was led by Kirstine Kold Katholm, University Clinic for Gynecological HPV-Related Disease, Godstrup Hospital, Herning, Denmark. It was published online on July 01, 2026, in Acta Obstetricia et Gynecologica Scandinavica.

LIMITATIONS

The risk for misclassification of the CIN2 diagnosis could not be excluded. Study outcomes relied on the validity of the registration of standardised diagnostic codes within national registries, which may have introduced information bias. Data on risk factors, including socioeconomic status and comorbidities, were unavailable.

DISCLOSURES

No funding was disclosed for this study. One author declared receiving a speaker's fee from ProCare Health, and another disclosed receiving an honorarium from Exeltis.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.