Washington, DC -- Women who undergo loop electrosurgical excision procedure (LEEP) for treatment of cervical intraepithelial neoplasia (CIN) have an increased risk delivering preterm and having low birth weight (LBW) infants, according to a study in the February issue of Obstetrics & Gynecology.

LEEP is one method to treat CIN, a condition in which abnormal cells grow on the cervix that, if not treated or do not go away on their own, could lead to cervical cancer. LEEP is approximately a 10-minute outpatient procedure in which the cervix is numbed and a thin wire in the shape of a loop is used to remove a few thin layers of cells on the cervix. Other methods to treat CIN include cryosurgery, electrocautery, laser, and cone biopsy. The decision regarding which method to use depends on how much cervical tissue needs to be removed and where on the cervix the abnormal cells are located.

Researchers in Nova Scotia studied a group of 571 reproductive-age women who had LEEP between 1992 and 1999 and who had subsequent pregnancies of 20 weeks of gestation or greater. They compared the birth outcomes to a control group of 571 women who had not had LEEP. Women were excluded from both groups if they had known risk factors for preterm delivery, including previous preterm delivery and/or carried two or more fetuses. The researchers discovered that women in the LEEP group had a 7.9% rate of spontaneous preterm delivery before 37 weeks gestation compared with 2.5% in the control group. The LEEP group also had a significantly higher rate of giving birth to LBW infants compared with the control group (5.4% vs 1.9%).

Since LEEP is now the most widely used treatment for CIN and many women who need treatment for CIN are of reproductive age, the researchers say it is important to counsel women about the increased risk of preterm delivery in subsequent pregnancies after LEEP. LEEP is still an appropriate first-line treatment for CIN, they note, but consideration should also be given to other treatment options. They add that the potential risks of LEEP on future pregnancies is one more reason that low-grade CIN should followed closely for a period of time instead of being immediately treated since most low-grade CIN will spontaneously regress and will not need treatment.

Contact: Dr. Sheri-Lee Samson, Dalhousie University, Fredericton, New Brunswick, at ssamson@dal.ca.

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