Loop electrosurgical excision procedure and perinatal outcomes post-human papillomavirus cervical screening: A longitudinal cohort study.
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OBJECTIVE: This study examines the associations between the loop electrosurgical excision procedure (LEEP) and the risk of adverse perinatal outcomes among women who have undergone primary human papillomavirus (HPV) screening. METHODS: In this longitudinal cohort study, women who received HPV screening and were followed up in a randomized trial in British Columbia (BC), Canada, were linked to a province-wide perinatal registry; those with a singleton live birth after screening (index birth) were included (N = 1765). Adjusted odds ratios (aORs) were calculated to compare the risk of preterm birth (PTB, gestational week <37) and low birthweight (LBW, birthweight <2500 g) by LEEP status prior to index birth. Crude rates of LEEP, PTB, and LBW in the HPV-screened cohort (HPV group) and the provincial cytology-screened population (cytology group) were reported. RESULTS: Risks of PTB and LBW were not significantly higher in LEEP-treated women (PTB: aOR 1.32, 95% confidence interval [CI], 0.63-2.80); LBW: (aOR 1.33, 95% CI, 0.50-3.55). In the HPV and cytology groups, 1.5% and 0.6% were referred for LEEP, respectively. Rates of PTB were 9.1% and 10.5% and LBW were 4.8% and 6.1% in the HPV and cytology groups, respectively. CONCLUSION: Among HPV-screened women, the risks of PTB and LBW were not statistically significantly associated with LEEP. HPV-based screening might lead to more treatments than cytology-based screening, yet the overall risks of PTB and LBW remained similar across groups.