{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:26:06Z","timestamp":1788780366852,"version":"build-2803163510"},"reference-count":41,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"U54 EACHC","award":["U54CA254518"],"award-info":[{"award-number":["U54CA254518"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,24]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"\n Objective<\/jats:title>\n The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high-grade cervical intraepithelial lesions.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did not receive excisional treatment for cervical intraepithelial lesions between 2009 and 2022 was enrolled. Adverse pregnancy outcomes (preterm delivery and pregnancy loss) in women with and without HIV, untreated or treated for cervical dysplasia, were recorded and analysed. The significance of the obtained results was judged at the 5% level.<\/jats:p>\n <\/jats:sec>\n \n Study settings<\/jats:title>\n The study was conducted at all Academic Model Providing Access to Healthcare-Kenya satellite sites, which offer cervical cancer screening and treatment for cervical dysplasia in western Kenya. The Moi Teaching and Referral Hospital was also included.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A cohort of 488 women aged between 20 years and 49 years, with and without HIV, diagnosed and treated for high-grade cervical intraepithelial neoplasia, and those followed up for low-grade cervical intraepithelial neoplasia between 2009 and 2022, were included.<\/jats:p>\n <\/jats:sec>\n \n Outcomes measured<\/jats:title>\n The study was interested in adverse pregnancy outcomes, particularly pregnancy loss and preterm delivery following cervical excision treatment for high-grade cervical intraepithelial lesions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n After adjustment for confounding factors, excisional treatment involving the uterine cervix\u2014particularly cold knife conisation\u2014was associated with higher odds of adverse pregnancy outcomes (OR 13.1; 95% CI 1.1 to 137.1; p=0.032). A prior history of adverse pregnancy outcomes was also strongly associated with subsequent adverse outcomes after treatment (OR 37.7; 95% CI 13.8 to 102.7; p<0.001). In contrast, maternal HIV infection was not independently associated with adverse pregnancy outcomes after adjustment (p=0.125).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Adverse pregnancy outcomes after excisional treatment of the uterine cervix for high-grade squamous intraepithelial lesions are multifactorial and were associated with cold knife conisation and prior adverse pregnancy outcomes, while maternal HIV infection was not independently associated with adverse outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105559","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T15:10:30Z","timestamp":1771427430000},"page":"e105559","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Pregnancy outcomes among women with and without HIV infections who underwent excisional treatment for high-grade cervical intraepithelial neoplasia: a retrospective cohort study in low-resource settings"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8444-1425","authenticated-orcid":false,"given":"Poli Philippe","family":"Amubuomombe","sequence":"first","affiliation":[{"name":"Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Usin Gishu, Kenya"},{"name":"Reproductive Health, Moi University, Eldoret, Usin Gishu, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Itsura","sequence":"additional","affiliation":[{"name":"Reproductive Health, Moi University College of Health Sciences, Eldoret, Rift Valley, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philiph K","family":"Tonui","sequence":"additional","affiliation":[{"name":"Reproductive Health, Moi University, Eldoret, Usin Gishu, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elkanah Omenge","family":"Orang\u2019o","sequence":"additional","affiliation":[{"name":"Reproductive Health, Moi University, Eldoret, Usin Gishu, Kenya"},{"name":"Obstetrics and Gynecology, The Aga Khan University Hospital Nairobi, Eldoret, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Elly","family":"Odongo","sequence":"additional","affiliation":[{"name":"Reproductive Health, Moi University College of Health Sciences, Eldoret, Rift Valley, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Joseph","family":"Loehrer","sequence":"additional","affiliation":[{"name":"Oncology, Indiana University, Bloomington, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Cu-Uvin","sequence":"additional","affiliation":[{"name":"Obstetrics& Gynecology, Brown University, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"2026021807101197000_16.2.e105559.1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/ijgo.12611","article-title":"Cancer of the cervix uteri","volume":"143","author":"Bhatla","year":"2018","journal-title":"Intl J Gynecol Obste"},{"key":"2026021807101197000_16.2.e105559.2","unstructured":"World Health Organization . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention: supplemental material: GRADE evidence-to-recommendation tables and evidence profiles for each recommendation. World Health Organization; 2013. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241548694 [Accessed 18 Aug 2024]."},{"key":"2026021807101197000_16.2.e105559.3","doi-asserted-by":"crossref","DOI":"10.1177\/1073274819845872","article-title":"Precancerous Cervical Lesion Among HIV-Positive Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis","volume":"26","author":"Weldegebreal","year":"2019","journal-title":"Cancer Control"},{"key":"2026021807101197000_16.2.e105559.4","unstructured":"World Health Organization . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. World Health Organization; 2021. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240030824 [Accessed 18 Aug 2024]."},{"key":"2026021807101197000_16.2.e105559.5","article-title":"Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors","volume":"5","author":"Arbyn","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2026021807101197000_16.2.e105559.6","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1111\/aogs.13547","article-title":"Management and treatment of cervical intraepithelial neoplasia in the Netherlands after referral for colposcopy","volume":"98","author":"Aitken","year":"2019","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026021807101197000_16.2.e105559.7","doi-asserted-by":"crossref","unstructured":"Kyrgiou M , Athanasiou A , Kalliala IEJ , et al . Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev 1996;2017. doi:10.1002\/14651858.CD012847","DOI":"10.1002\/14651858.CD012847"},{"key":"2026021807101197000_16.2.e105559.8","doi-asserted-by":"crossref","first-page":"C118","DOI":"10.12968\/hmed.2016.77.8.C118","article-title":"Cervical intraepithelial neoplasia: screening and management","volume":"77","author":"Mitra","year":"2016","journal-title":"Br J Hosp Med"},{"key":"2026021807101197000_16.2.e105559.9","unstructured":"Ministry of Heath . National cancer screening guidelines. 2018. Available: http:\/\/guidelines.health.go.ke\/#\/category\/7\/406\/meta [Accessed 18 Aug 2024]."},{"key":"2026021807101197000_16.2.e105559.10","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/00006254-200208000-00015","article-title":"The 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology","volume":"57","author":"Solomon","year":"2002","journal-title":"Obstet Gynecol Surv"},{"key":"2026021807101197000_16.2.e105559.11","doi-asserted-by":"publisher","DOI":"10.1200\/JGO.17.00175"},{"key":"2026021807101197000_16.2.e105559.12","unstructured":"World Health Organization . WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions 2019. World Health Organization: Geneva; 2022. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241550598 [Accessed 20 Aug 2024]."},{"key":"2026021807101197000_16.2.e105559.13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13027-020-00326-3","article-title":"Loop electrosurgical excision procedure combined with cold coagulation for cervical intraepithelial neoplasia and adenocarcinoma in-situ: a feasible treatment with a low risk of residual\/recurrent disease","volume":"15","author":"Yang","year":"2020","journal-title":"Infect Agents Cancer"},{"key":"2026021807101197000_16.2.e105559.14","unstructured":"World Health Organization . WHO guidelines for the treatment of cervical intraepithelial neoplasia 2-3 and adenocarcinoma in situ: cryotherapy, large loop excision of the transformation zone, and cold knife conization. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241506779 [Accessed 20 Aug 2024]."},{"key":"2026021807101197000_16.2.e105559.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0165276","article-title":"Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study","volume":"12","author":"Weinmann","year":"2017","journal-title":"PLoS One"},{"key":"2026021807101197000_16.2.e105559.16","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.2309","article-title":"Preterm Birth Following Active Surveillance vs Loop Excision for Cervical Intraepithelial Neoplasia Grade 2","volume":"7","author":"Lycke","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026021807101197000_16.2.e105559.17","article-title":"Fertility and early pregnancy outcomes after conservative treatment for cervical intraepithelial neoplasia","volume":"2015","author":"Kyrgiou","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2026021807101197000_16.2.e105559.18","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/3086036","article-title":"Human Papillomavirus Infection as a Possible Cause of Spontaneous Abortion and Spontaneous Preterm Delivery","volume":"2016","author":"Amb\u00fchl","year":"2016","journal-title":"Infect Dis Obstet Gynecol"},{"key":"2026021807101197000_16.2.e105559.19","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007975005433"},{"key":"2026021807101197000_16.2.e105559.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003641","article-title":"Associations of treated and untreated human papillomavirus infection with preterm delivery and neonatal mortality: A Swedish population-based study","volume":"18","author":"Wiik","year":"2021","journal-title":"PLoS Med"},{"key":"2026021807101197000_16.2.e105559.21","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.25308","article-title":"Association Between Human Papillomavirus Infection Among Pregnant Women and Preterm Birth","volume":"4","author":"Niyibizi","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026021807101197000_16.2.e105559.22","doi-asserted-by":"crossref","DOI":"10.1097\/01.AOG.0000514690.21416.7c","article-title":"Maternal Human Papillomavirus Infection Increases the Risk of Premature Rupture of Membranes [19M]","volume":"129","author":"Cotton-Caballero","year":"2017","journal-title":"Obstet Gynecol"},{"key":"2026021807101197000_16.2.e105559.23","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dem404"},{"key":"2026021807101197000_16.2.e105559.24","doi-asserted-by":"crossref","DOI":"10.1016\/j.xagr.2022.100121","article-title":"Patterns of pregnancy loss among women living with and without HIV in Brazil, 2008-2018","volume":"2","author":"Yang","year":"2022","journal-title":"AJOG Glob Rep"},{"key":"2026021807101197000_16.2.e105559.25","doi-asserted-by":"crossref","DOI":"10.1038\/s43856-023-00331-8","article-title":"Adverse perinatal outcomes attributable to HIV in sub-Saharan Africa from 1990 to 2020: Systematic review and meta-analyses","volume":"3","author":"Murray","year":"2023","journal-title":"Commun Med (Lond)"},{"key":"2026021807101197000_16.2.e105559.26","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000022670","article-title":"Association between maternal human immunodeficiency virus infection and preterm birth: A matched case-control study from a pregnancy outcome registry","volume":"100","author":"Elenga","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"2026021807101197000_16.2.e105559.27","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.bpobgyn.2021.05.007","article-title":"Morbidity after local excision of the transformation zone for cervical intra-epithelial neoplasia and early cervical cancer","volume":"75","author":"Kyrgiou","year":"2021","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2026021807101197000_16.2.e105559.28","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/0002-9378(93)90060-V","article-title":"Detection of human papillomavirus deoxyribonucleic acid sequences in amniotic fluid during different periods of pregnancy","volume":"169","author":"Armbruster-Moraes","year":"1993","journal-title":"Am J Obstet Gynecol"},{"key":"2026021807101197000_16.2.e105559.29","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.ejogrb.2013.07.002","article-title":"Human papillomavirus infection and spontaneous abortion: a case-control study performed in Mexico","volume":"170","author":"Conde-Ferr\u00e1ez","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2026021807101197000_16.2.e105559.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-024-06958-2","article-title":"Human papillomavirus infections during pregnancy and adverse pregnancy outcomes: a Scandinavian prospective mother-child cohort study","volume":"24","author":"V\u00e6rnesbranden","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026021807101197000_16.2.e105559.31","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/00006254-199603000-00015","article-title":"Fertility and Pregnancy Outcome Following Large Loop Excision of the Cervical Transformation Zone","volume":"51","author":"Cruickshank","year":"1996","journal-title":"Obstet Gynecol Surv"},{"key":"2026021807101197000_16.2.e105559.32","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ijgo.2014.07.038","article-title":"Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes","volume":"128","author":"Kyrgiou","year":"2015","journal-title":"Intl J Gynecol Obste"},{"key":"2026021807101197000_16.2.e105559.33","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s12916-022-02276-6","article-title":"Associations between cervical intraepithelial neoplasia during pregnancy, previous excisional treatment, cone-length and preterm delivery: a register-based study from western Sweden","volume":"20","author":"Wiik","year":"2022","journal-title":"BMC Med"},{"key":"2026021807101197000_16.2.e105559.34","first-page":"100668","article-title":"Obstetric outcomes after cervical loop electrosurgical excision procedure","volume":"34","author":"\u00c5str\u00f6m","year":"2023","journal-title":"Cancer Treat Res Commun"},{"key":"2026021807101197000_16.2.e105559.35","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/aogs.13256","article-title":"Risk of preterm birth in women with cervical intraepithelial neoplasia grade one: a population-based cohort study","volume":"97","author":"Heinonen","year":"2018","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026021807101197000_16.2.e105559.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003665","article-title":"Cervical intraepithelial neoplasia and the risk of spontaneous preterm birth: A Dutch population-based cohort study with 45,259 pregnancy outcomes","volume":"18","author":"Loopik","year":"2021","journal-title":"PLoS Med"},{"key":"2026021807101197000_16.2.e105559.37","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/jog.15848","article-title":"Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis","volume":"50","author":"Jia","year":"2024","journal-title":"J Obstet Gynaecol Res"},{"key":"2026021807101197000_16.2.e105559.38","doi-asserted-by":"crossref","DOI":"10.3390\/medicina60071056","article-title":"Cold Knife Versus Carbon Dioxide for the Treatment of Preinvasive Cervical Lesion","volume":"60","author":"Ferrari","year":"2024","journal-title":"Medicina (Kaunas)"},{"key":"2026021807101197000_16.2.e105559.39","doi-asserted-by":"crossref","DOI":"10.3389\/fgwh.2022.820759","article-title":"Preterm Birth in Women With HIV: The Role of the Placenta","volume":"3","author":"Ikumi","year":"2022","journal-title":"Front Glob Womens Health"},{"key":"2026021807101197000_16.2.e105559.40","doi-asserted-by":"crossref","first-page":"S691","DOI":"10.1093\/infdis\/jiab494","article-title":"HIV, Placental Lesions, and Adverse Perinatal Outcomes","volume":"224","author":"Maswime","year":"2021","journal-title":"J Infect Dis"},{"key":"2026021807101197000_16.2.e105559.41","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines13040391","article-title":"No Increased Risk of Autoimmune Diseases Following HPV Vaccination: A Systematic Review and Meta-Analysis","volume":"13","author":"Ferrari","year":"2025","journal-title":"Vaccines (Basel)"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-105559","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T15:10:38Z","timestamp":1771427438000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-105559"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,18]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-105559"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-105559","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}