Human Papillomavirus and Adverse Pregnancy Outcomes: An Opportunity for Prevention?

Successfully Pregnancy Outcome After LLETZ in Women with Cervical Intraepithelial Neoplasia: A Case Series

BACKGROUND: Human papillomavirus (HPV) has an important role in cervical cancer development and the incidence of cervical intraepithelial neoplasia (CIN) was 1.3–2.7/1000 pregnancies. The HPV and its treatments such as loop electrosurgical excisional procedure (LEEP) or large loop electrosurgical excisional procedure (LLETZ) have an association with poor obstetric outcomes. CASE REPORT: Here, we present four case studies of successful live birth after treatment of CIN. We reported that four patients had been performed LLETZ, with abnormal colposcopy results and liquidbased cytology results were one ASCUS, one ASCH, and two HSIL. The histopathology results were one CIN 1, one CIN 2, and two CIN 3. There was a higher rate of pregnancy for treated women than untreated women. The higher the CIN grades, the more prevalence of cesarean section rate. CONCLUSION: The HPV testing or cotesting at 3-year intervals is recommended after treatment due to the sensitivity of HPV testing. Although pregnancy could delay the progression of precancerous lesions, it is recommended to follow the individualized algorithm in the ASCCP guideline to reduce the risk of cervical cancer progression.

Has Human Papillomavirus (HPV) Vaccination Prevented Adverse Pregnancy Outcomes? Population-Level Analysis After 8 Years of a National HPV Vaccination Program in Australia

Background

Human papillomavirus (HPV) infection, and its sequelae of precancerous cervical lesions and their subsequent treatment, have been linked with an increased risk of adverse pregnancy outcomes. Publicly funded HPV vaccination of female adolescents began in Australia in 2007 with initial catch-up to age 26 years.

Methods

Using data from the National Perinatal Data Collection we compared rates of preterm births and small-for-gestational-age infants born in Australia 2000–2015. We used generalized linear models, assuming a Poisson distribution and log link function, with single-year categories of infant birth year, maternal age, and age-specific HPV vaccination coverage as independent variables.

Results

In maternal cohorts with 60%–80% HPV vaccination coverage as achieved in Australia, there was a relative rate reduction of 3.2% (95% confidence interval, 1.1%–5.3%) in preterm births and 9.8% (8.2% to 11.4%) in small-for-gestational-age infants, after adjustment for infant’s birth year and maternal age.

Conclusion

This analysis provides provisional population-level evidence of a reduction in adverse pregnancy outcomes in cohorts of women offered HPV vaccination. Confounding by smoking or other variables and/or ecological analysis limitations, however, cannot be excluded. These findings indicate potential broader benefits of HPV vaccination than have been documented to date.