Approaches to Intraepithelial Cervical Neoplasia Management in Pregnancy: A Narrative Review

Abstract

This narrative review examines current evidence on the management of cervical intraep ithelial neoplasia (CIN) during pregnancy, a clinical scenario requiring a balance between maternal oncologic safety and fetal well-being. A qualitative synthesis was conducted using major databases (PubMed, Google Scholar, Cochrane Library, and ScienceDirect), focusing on studies published between 2019 and 2025, supplemented by key earlier publications. A total of 37 studies and international guidelines were included. Available evidence suggests that pregnancy does not substantially alter the natural history of human papillomavirus infection. Although CIN is generally associated with low progression rates and notable postpartum regression, findings remain heterogeneous and largely based on retrospective data. Colposcopy is essential for excluding invasive disease, while invasive procedures are reserved for suspected malignancy. Most guidelines support conservative management with surveillance during pregnancy and postpartum reassessment. HPV testing offers higher sensitivity, whereas cytology remains widely used due to its specificity. The impact of delivery mode remains inconclusive. Overall, current recommendations rely on limited evidence and should be interpreted with caution. Further prospective studies are needed to refine pregnancy-specific management strategies.