LOOP ELECTROSURGICAL EXCISION PROCEDURE, CERVICAL DYSPLASIA, AND RISK OF PRETERM DELIVERY: A RETROSPECTIVE COHORT STUDY

Objectives To evaluate whether cervical dysplasia with or without loop electrosurgical excision procedure (LEEP) was associated with risk of preterm delivery. Methods This retrospective cohort study linked a provincial perinatal database and a provincial colposcopy database. All women aged ? 45years with a singleton delivery > 20 weeks’ gestation between 1995 and 2012 were included. The exposure groups included women with dysplasia treated with LEEP (Group 1) and women with dysplasia who were not treated (Group 2). The comparison group included women who did not have dysplasia or LEEP (Group 3). The primary outcome was rate of spontaneous preterm birth Results There were 4265 women in Group 1, 3147 women in Group 2, and 63345 unexposed (Group 3) women. Relative to the unexposed women, women in Group 1 were more likely to deliver preterm (aHR 1.22; CI 1.06-1.39), but women in Group 2 were not (aHR 1.01; CI 0.86-1.19). Subgroup analysis showed that untreated high grade dysplasia, but not low grade dysplasia, was not associated with sPTB (aHR 0.67, 95% CI 0.52-0.88). Conclusions Treatment with LEEP was associated with a higher risk of sPTB, and this association was not heterogeneous by grade. High grade dysplasia, but not low grade dysplasia, was associated with a higher risk of sPTB.