There is no association between pre-pregnancy LEEP and preterm birth or pregnancy loss before 20 weeks, according to a 7-year multicenter cohort study.
The study, by George A. Macones, MD, and colleagues from Washington University in St. Louis, contradicts earlier findings that suggested women who had undergone LEEP were at increased risk for preterm birth.
Macones said that prior research overestimated the association, and that there were “unmeasured confounding variables between women who’ve never had an abnormal Pap and those who have had LEEP.”
The study compared pregnancy outcomes of women with prior LEEP to two control groups: women with a prior history of normal Pap smears and women with a prior cervical punch biopsy. Subjects were identified through a review of pathology records at nine hospitals, including both community and tertiary hospitals, and records for all procedures were obtained. Trained research nurses conducted closed-ended phone interviews to obtain historical and medical data that was not available in charts.
In the LEEP group (n=625), 7.3% delivered prior to 34 weeks, compared with 7.7% of women in the cervical punch biopsy group (n=602), and 5.5% in the normal Pap group (n=616).
Women with prior LEEP were more likely to be older, African-American, and have diabetes.
Macones emphasized that the variety of hospital types and multiple control groups resulted in highly generalizable results.
A history including LEEP “should not influence pre-obstetrical care,” he concluded, and these patients “do not require increased surveillance or intervention for the prevention of preterm birth or early pregnancy loss.”
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