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Hsieh TYJ, Chen TYT, Liao PL, Huang JY, Ma KSK, Hung YM, Chang R, Wei JCC. Maternal human papillomavirus infection and the risk of congenital malformations: A nationwide population-based cohort study. J Med Virol 2024; 96:e29549. [PMID: 38563352 DOI: 10.1002/jmv.29549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
Previous research has explored theories regarding the vertical transmission of human papillomavirus (HPV) infection and its association with adverse pregnancy and perinatal outcomes. However, the impact of maternal HPV infection on congenital anomalies (CAs) in offspring remains relatively understudied. We conducted a population-based cohort study linking the Taiwan Birth Registry, Taiwan Death Registry, and National Health Insurance Research Database, in which newborns born in Taiwan between 2009 and 2015 were included. We established a maternal HPV infection cohort comprising 37 807 newborns and matched them with a comparison group of 151 228 newborns at a 1:4 ratio based on index year, age, and sex. The study examined a composite outcome and subgroups of different types of congenital malformations. Differences in cumulative incidence of CAs were assessed using Kaplan-Meier curves and log-rank tests. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazard regressions. No significant association was found between HPV infection and the broad spectrum of CAs (aHR: 1.04, 95% confidence interval [CI]: 0.98-1.10; log-rank test p = 0.14). However, we observed a 19% increased risk of musculoskeletal CAs in the maternal HPV infection group (aHR: 1.19; 95% CI: 1.05-1.34) compared to those without maternal HPV exposure. Other factors, including the type of HPV (aHR: 0.65; 95% CI: 0.16-2.63), the timing of exposure (during or before pregnancy), and maternal age (aHR for <30 years: 1.02, 95% CI: 0.94-1.1; aHR for 30-39 years: 1.05, 95% CI: 0.99-1.11; aHR for ≥40 years: 0.88, 95% CI: 0.67-1.17), did not significantly affect the risk for any CA. In conclusion, gestation detection of HPV infection was associated with musculoskeletal CAs but not other major CAs. Prospective studies are warranted to elucidate the necessity of prenatal screening in populations at risk.
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Affiliation(s)
- Tina Yi Jin Hsieh
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Bioinformatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Yen Ting Chen
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Lun Liao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yao-Min Hung
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital Taitung Branch, Taipei, Taiwan
- Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung, Taiwan
- College of Health and Nursing, Meiho University, Pingtung, Taiwan
| | - Renin Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
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Khayargoli P, Mayrand MH, Niyibizi J, Audibert F, Laporte L, Lacaille J, Carceller AM, Lacroix J, Comète É, Coutlée F, Trottier H. Association between Human Papillomavirus 16 Viral Load in Pregnancy and Preterm Birth. Viruses 2024; 16:298. [PMID: 38400073 PMCID: PMC10892609 DOI: 10.3390/v16020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Recent evidence shows increased preterm birth risk with human papillomavirus-16 (HPV16) infection during pregnancy. This study aimed to measure the association between HPV16 viral load during pregnancy and preterm birth. We used data from participants in the HERITAGE study. The Linear Array assay was used for HPV DNA testing on vaginal samples collected during the first and third trimesters of pregnancy. The HPV16 viral load was measured with a real-time polymerase chain reaction. We used logistic regression to measure the associations between HPV16 viral load during pregnancy and preterm birth (defined as birth before 37 weeks of gestation). The adjusted odd ratios (aORs) and the 95% confidence intervals [CIs] were estimated with inverse probability treatment weighting of the propensity score. This study included 48 participants who tested positive for HPV16 during the first trimester of pregnancy. The aOR for the association between first-trimester HPV16 viral load (higher viral load categorized with a cutoff of 0.5 copy/cell) was 13.04 [95% CI: 1.58-107.57]). Similar associations were found using different cutoffs for the categorization of viral load during the first and third trimesters. Our findings suggest a strong association between a high HPV16 viral load during pregnancy and preterm birth, demonstrating a biological gradient that reinforces the biological plausibility of a causal association.
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Affiliation(s)
- Pranamika Khayargoli
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3N 1X9, Canada; (P.K.); (M.-H.M.); (J.N.)
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Marie-Hélène Mayrand
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3N 1X9, Canada; (P.K.); (M.-H.M.); (J.N.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (J.L.); (É.C.)
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Joseph Niyibizi
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3N 1X9, Canada; (P.K.); (M.-H.M.); (J.N.)
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | - Louise Laporte
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Julie Lacaille
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (J.L.); (É.C.)
| | - Ana Maria Carceller
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada; (A.M.C.); (J.L.)
| | - Jacques Lacroix
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada; (A.M.C.); (J.L.)
| | - Émilie Comète
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (J.L.); (É.C.)
| | - François Coutlée
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3N 1X9, Canada; (P.K.); (M.-H.M.); (J.N.)
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
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Xie W, Wang Y, You K, Wang Y, Geng L, Li R. Impact of cervical intraepithelial neoplasia and treatment on IVF/ICSI outcomes. Hum Reprod 2023; 38:ii14-ii23. [PMID: 37982414 DOI: 10.1093/humrep/dead009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/20/2022] [Indexed: 11/21/2023] Open
Abstract
STUDY QUESTION Does treatment selection for cervical lesions affect the outcome of IVF/ICSI? SUMMARY ANSWER There was no difference in pregnancy outcome between treated and untreated groups, or between different types of IVF/ICSI treatment. WHAT IS KNOWN ALREADY Human papillomavirus (HPV) infection and HPV-induced cervical lesions are associated with decreased fertility, and cervical intraepithelial neoplasia (CIN) treatment may increase the risk of adverse pregnancy outcomes. STUDY DESIGN, SIZE, DURATION Between 2018 and 2020, 190 women with infertility who had abnormal HPV screening or cytology results prior to IVF/ICSI, and were diagnosed with CIN2/CIN3 by colposcopy biopsy at a tertiary hospital, were enrolled in a retrospective cohort study with follow-up until 31 December 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients with infertility who were diagnosed with CIN2/CIN3 by colposcopy biopsy were divided into the treatment and expectant management groups. The treatment group was divided into two intervention subgroups: the ablative therapy group and the surgical treatment group. The baseline data, number of oocytes retrieved, and rates of fertilization, high-quality embryos, positive serum HCG, clinical pregnancy, abortion, live birth, and cumulative pregnancy were compared among groups. MAIN RESULTS AND THE ROLE OF CHANCE Among the 190 patients included in the study, 152 were diagnosed with CIN2, and 38 patients had CIN3. There was no significant difference in the baseline data between the treatment and expectant groups. The time from confirmed lesions to the onset of gonadotrophin administration in the surgical treatment group was significantly longer than in the ablative therapy group and the expectant group (P = 0.007 and P = 0.024, respectively). For the treatment and expectant groups, respectively, the average number of oocytes retrieved (12.95 ± 8.77; 13.32 ± 9.16), fertilization rate (71.01 ± 23.86; 64.84 ± 26.24), and high-quality embryo rate (48.93 ± 30.72; 55.17 ± 34.13) did not differ, and no differences were detected between the different treatment subgroups. There were no differences among groups in rates of HCG positivity, clinical pregnancy, miscarriage, live birth, or cumulative pregnancy. The live birth rate in the surgical treatment group was slightly higher than that in the expectant groups (77.78% versus 66.67%), but the difference was not statistically significant. The 3-year cumulative pregnancy rates in the surgical treatment and expectant groups were 58.19% and 64.00%, respectively. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study, which by nature can include selection bias, and the number of cases in the expectant group was <30, which may result in a false-negative result owing to the small sample size. WIDER IMPLICATIONS OF THE FINDINGS For patients with CIN2/CIN3, the treatment of cervical lesions does not affect the outcome of IVF/ICSI. Patients with CIN2 can enroll for IVF/ICSI cycles, with close follow-up to prevent the progression of cervical lesions, in order to avoid further delay in starting ART. For patients with CIN3, ovulation induction and embryo cryopreservation can be initiated as soon as possible after cervical lesions are treated, and frozen-thawed embryo transfer can be carried out 9-12 months later. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Key Clinical Projects of the Peking University Third Hospital (to Y.W., BYSYZD2021014). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Wanyi Xie
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Ke You
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Yingxi Wang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Li Geng
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
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McClymont E, Faber MT, Belmonte F, Kjaer SK. Spontaneous preterm birth risk among HPV-vaccinated and -unvaccinated women: a nationwide retrospective cohort study of over 240 000 singleton births. BJOG 2023; 130:358-365. [PMID: 36424904 DOI: 10.1111/1471-0528.17349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether prior human papillomavirus (HPV) vaccination contributes to preterm birth risk. DESIGN Population-based retrospective cohort study. SETTING Denmark. POPULATION A cohort of 243 136 primiparous females born in the period 1961-2004 who had a singleton delivery at >22 weeks of gestation occurring from October 2006 to December 2018. METHODS High-quality nationwide registries were linked to provide information on demographics, birth outcomes, HPV vaccination status, smoking, body mass index (BMI), and cervical lesions and treatment history. MAIN OUTCOME MEASURES We assessed the association between HPV vaccination status and spontaneous preterm birth using logistic regression. To address age at vaccination, we performed a stratified analysis by vaccination before and after 17 years of age. RESULTS In age-adjusted and fully adjusted models, there was a nonsignificant difference in the odds of spontaneous preterm birth between vaccinated and unvaccinated women (OR 1.05 (95% CI 0.99-1.12) and OR 1.04 (95% CI 0.98-1.10), respectively). There was no difference in the odds of spontaneous preterm birth in relation to time between vaccination and pregnancy. In contrast, compared with unvaccinated women, the odds of preterm birth were lower among women vaccinated before the age of 17 years (fully adjusted OR 0.87, 95% CI 0.75-1.00). This association was not present for women vaccinated at ≥17 years of age. CONCLUSIONS In this large, population-based cohort, we found reduced odds of spontaneous preterm birth among women vaccinated against HPV at an early age compared with women who were unvaccinated. It seems conceivable that HPV vaccination may not only reduce the incidence of cervical cancer and severe precursors, but also reduce the risk of preterm birth related to HPV infection.
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Affiliation(s)
- Elisabeth McClymont
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mette T Faber
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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5
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Perkins RB, Saslow D, Oliver K. Long-Term Effectiveness of Human Papillomavirus Vaccination: Implications for Future Reduction in Cancer. Ann Intern Med 2022; 175:1037-1038. [PMID: 35576588 DOI: 10.7326/m22-1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Debbie Saslow
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
| | - Kristin Oliver
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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Perkins RB, Werner C, Wentzensen N. What Contributes to Pregnancy Complications Among Women With Cervical Intraepithelial Neoplasia Grade 3? Ann Intern Med 2022; 175:293-294. [PMID: 35130047 DOI: 10.7326/m21-4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Claudia Werner
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicolas Wentzensen
- Department of Clinical Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Condrat CE, Filip L, Gherghe M, Cretoiu D, Suciu N. Maternal HPV Infection: Effects on Pregnancy Outcome. Viruses 2021; 13:2455. [PMID: 34960724 PMCID: PMC8707668 DOI: 10.3390/v13122455] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
The human papilloma virus (HPV) infection, caused by a ubiquitous virus typically transmitted through the direct contact of infected organs, either through the skin or mucosa, is the most common sexually transmitted infection, placing young women at a high risk of contracting it. Although the vast majority of cases spontaneously clear within 1-2 years, persistent HPV infection remains a serious concern, as it has repeatedly been linked to the development of multiple malignancies, including cervical, anogenital, and oropharyngeal cancers. Additionally, more recent data suggest a harmful effect of HPV infection on pregnancy. As the maternal hormonal environment and immune system undergo significant changes during pregnancy, the persistence of HPV is arguably favored. Various studies have reported an increased risk of adverse pregnancy outcomes among HPV-positive women, with the clinical impact encompassing a range of conditions, including preterm birth, miscarriage, pregnancy-induced hypertensive disorders (PIHD), intrauterine growth restriction (IUGR), low birth weight, the premature rupture of membranes (PROM), and fetal death. Therefore, understanding the mechanisms employed by HPV that negatively impact pregnancy and assessing potential approaches to counteract them would be of interest in the quest to optimize pregnancy outcomes and improve child survival and health.
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Affiliation(s)
- Carmen Elena Condrat
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania;
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania;
| | - Lidia Filip
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania;
| | - Mirela Gherghe
- Department of Nuclear Medicine, Alexandru Trestioreanu Oncology Institute, 022328 Bucharest, Romania
| | - Dragos Cretoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania;
- Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Nicolae Suciu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania;
- Division of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
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Collins A, Motiwale T, Barney O, Dudbridge F, McParland PC, Moss EL. Impact of past obstetric history and cervical excision on preterm birth rate. Acta Obstet Gynecol Scand 2021; 100:1995-2002. [PMID: 34698370 DOI: 10.1111/aogs.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To determine the impact on preterm birth (PTB) of a history of large loop excision of the transformation zone (LLETZ)-alone compared with a history of previous preterm birth-alone (PPTB) or a history of both (LLETZ+PPTB). Secondary analyses were performed to evaluate the impact of antenatal interventions, depth of cervical excision, and patient risk factors on PTB rate in each cohort. MATERIAL AND METHODS A retrospective observational cohort study of women referred to a tertiary Antenatal Prematurity Prevention Clinic with a history of LLETZ, PPTB, or LLETZ+PPTB. Information was collated from routinely collected clinical data on patient demographics, previous obstetric history, LLETZ dimensions, antenatal investigations/interventions, and gestation at delivery. RESULTS A total of 1231 women with singleton pregnancies were included, 543 with history of LLETZ-alone, 607 with a history of PPTB-alone and 81 with a history of LLETZ+PPTB. PTB rates were 8.8% in the LLETZ-alone group, which mirrored the PTB rate in the local background obstetric population (8.9%) compared with 28.7% in the PPTB-alone and 37.0% in the LLETZ+PPTB cohorts. PTB rates were higher in LLETZ cohorts treated with antenatal intervention (cervical cerclage or progesterone pessary) and there was no evidence of an effect of intervention on risk of PTB in post-excision patients with identified shortened mid-trimester cervical length. Logistic regression modeling identified PPTB as a strong predictor of recurrent PTB. Excision depth was correlated with gestation at delivery in the LLETZ-alone group (r = -0.183, p < 0.01) although this only reached statistical significance at depths of 20 mm or more (odds ratio [OR] 3.40, 95% CI 1.04-1.11, p = 0.04). Depth of excision was not correlated with delivery gestation in the LLETZ+PPTB group (r = -0.031, p = 0.82). CONCLUSIONS PPTB has a greater impact on subsequent PTB risk compared with depth of cervical excisional treatment. The value and nature of antenatal interventions should be investigated in the post-excision population.
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Affiliation(s)
- Anna Collins
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Tanushree Motiwale
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Olivia Barney
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penelope C McParland
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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Yuill S, Velentzis LS, Smith M, Egger S, Wrede CD, Bateson D, Arbyn M, Canfell K. The impact of HPV vaccination beyond cancer prevention: effect on pregnancy outcomes. Hum Vaccin Immunother 2021; 17:3562-3576. [PMID: 34506257 PMCID: PMC8437490 DOI: 10.1080/21645515.2021.1936860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/22/2021] [Indexed: 10/20/2022] Open
Abstract
While the benefits of human papillomavirus (HPV) vaccination relating to cervical cancer prevention have been widely documented, recent published evidence is suggestive of an impact on adverse pregnancy outcomes (APOs) in vaccinated mothers and their infants, including a reduction in rates of preterm births and small for gestational age infants. In this review, we examine this evidence and the possible mechanisms by which HPV vaccination may prevent these APOs. Large-scale studies linking HPV vaccination status with birth registries are needed to confirm these results. Potential confounding factors to consider in future analyses include other risk factors for APOs, and historical changes in both the management of cervical precancerous lesions and prevention of APOs. If confirmed, these additional benefits of HPV vaccination in reducing APO rates will be of global significance, due to the substantial health, social and economic costs associated with APOs, strengthening the case for worldwide HPV immunization.
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Affiliation(s)
- Susan Yuill
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Louiza S. Velentzis
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Megan Smith
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Sam Egger
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - C. David Wrede
- Department of Oncology & Dysplasia, Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Family Planning NSW, Australia
- Discipline of Obstetrics, Gynaecology & Neonatology, Faculty of Medicine and Health, The University of Sydney School of Medicine, Sydney, Australia
| | - Marc Arbyn
- Unit Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
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10
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Davies-Oliveira JC, Smith MA, Grover S, Canfell K, Crosbie EJ. Eliminating Cervical Cancer: Progress and Challenges for High-income Countries. Clin Oncol (R Coll Radiol) 2021; 33:550-559. [PMID: 34315640 DOI: 10.1016/j.clon.2021.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
In 2020, the World Health Organization launched a major initiative to eliminate cervical cancer globally. The initiative is built around the three key pillars of human papillomavirus (HPV) vaccination, cervical screening and treatment, with associated intervention targets for the year 2030. The '90-70-90' targets specify that 90% of adolescent girls receive prophylactic HPV vaccination, 70% of adult women receive a minimum twice-in-a-lifetime cervical HPV test and 90% receive appropriate treatment for preinvasive or invasive disease. Modelling has shown that if these targets are met, the elimination of cervical cancer, defined as fewer than four cases per 100 000 women per annum, will be achieved within a century. Many high-income countries are well positioned to eliminate cervical cancer within the coming decades, but few have achieved '90-70-90' and many challenges must still be addressed to deliver these critical interventions effectively. This review considers the current status of cervical cancer control in relation to each of the three elimination pillars in high-income countries and discusses some of the developments that will assist countries in reaching these ambitious targets by 2030.
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Affiliation(s)
- J C Davies-Oliveira
- Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK; Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M A Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - S Grover
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.
| | - E J Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK; Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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11
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Niyibizi J, Mayrand MH, Audibert F, Monnier P, Brassard P, Laporte L, Lacaille J, Zahreddine M, Bédard MJ, Girard I, Francoeur D, Carceller AM, Lacroix J, Fraser W, Coutlée F, Trottier H. Association Between Human Papillomavirus Infection Among Pregnant Women and Preterm Birth. JAMA Netw Open 2021; 4:e2125308. [PMID: 34524433 PMCID: PMC8444026 DOI: 10.1001/jamanetworkopen.2021.25308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Preterm birth remains a leading cause of perinatal mortality and lifelong morbidity worldwide. The cause of most preterm births is unknown, although several infectious processes have been implicated. OBJECTIVE To assess whether human papillomavirus (HPV) infection, a frequent infection among women of childbearing age, is associated with preterm birth. DESIGN, SETTING, AND PARTICIPANTS The prospective HERITAGE cohort study was conducted at 3 academic hospitals in Montreal, Québec, Canada, among 899 pregnant women recruited between November 8, 2010, and October 16, 2016. Follow-up was completed on June 15, 2017. Statistical analysis was conducted from February 6, 2020, to January 21, 2021. EXPOSURES Vaginal HPV DNA detection in the first and third trimesters of pregnancy and placental HPV infection. MAIN OUTCOMES AND MEASURES The main outcome was preterm birth (defined as a live birth or stillbirth between 20 weeks and 0 days and 36 weeks and 6 days of gestation). The association between HPV DNA detection and preterm birth was measured using logistic regression. Odds ratios (ORs) and 95% CIs were adjusted by inverse probability of treatment weights of the propensity score. RESULTS The study included 899 women (mean [SD] age, 31.3 [4.6] years [range, 19-47 years]) with singleton pregnancies. A total of 378 women (42.0%) had HPV DNA detected in vaginal samples collected during the first trimester, and it was detected in 91 of 819 placentas (11.1%) at delivery. Fifty-five participants experienced preterm birth (38 spontaneous and 17 medically indicated). Persistent vaginal HPV-16/18 detection was significantly associated with all preterm births (adjusted OR [aOR], 3.72; 95% CI, 1.47-9.39) and spontaneous preterm births (aOR, 3.32; 95% CI, 1.13-9.80), as was placental HPV infection (all preterm births: aOR, 2.53; 95% CI, 1.06-6.03; spontaneous preterm births: aOR, 2.92; 95% CI, 1.09-7.81). Results were similar when restricting the analysis to participants without a history of cervical intraepithelial neoplasia treatment. CONCLUSIONS AND RELEVANCE The study's results suggest that persistent HPV-16/18 infection is associated with an increased risk of preterm birth, independent of cervical treatment. Future studies should investigate the association of HPV vaccination and vaccination programs with the risk of preterm birth.
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Affiliation(s)
- Joseph Niyibizi
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Mayrand
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Patricia Monnier
- Department of Obstetrics and Gynecology, McGill University, Montreal, Québec, Canada
- Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Paul Brassard
- Research Institute of the McGill University Health Center, Montreal, Québec, Canada
- Division of Clinical Epidemiology, McGill University, Montreal, Québec, Canada
| | - Louise Laporte
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Julie Lacaille
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Monica Zahreddine
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, St-Mary’s Hospital Center, Montreal, Québec, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Ana Maria Carceller
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - François Coutlée
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
- Département Clinique de Médecine de Laboratoire, Service de Biologie Moléculaire, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Département de Médecine, Service d’Infectiologie, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Québec, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
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12
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Human papillomavirus (HPV) in pregnancy - An update. Eur J Obstet Gynecol Reprod Biol 2021; 264:340-348. [PMID: 34385080 DOI: 10.1016/j.ejogrb.2021.07.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
Human papilloma viruses (HPV) are small epitheliotropic DNA viruses, of which there are 200 genotypes, 40 of which are known to cause genital infections and are also oncogenic. HPV is the most common sexually transmitted infection. Clinical features vary from asymptomatic (identified at routine cervical cancer screening) to large lesions on the vulva, vagina, cervix and some extragenital sites. Its prevalence in pregnancy varies from 5.5% to 65% depending on age, geography and gestational age (increasing with gestational age). Infection in pregnancy has been associated with adverse outcomes such as spontaneous miscarriage, preterm birth, placental abnormalities and fetal growth restriction. However, the evidence for these adverse outcomes is varied. Besides being oncogenic (and thus associated with cancer of the cervix in pregnancy), vertical transmission to the fetus/neonate can cause neonatal infections, especially juvenile-onset recurrent oral and respiratory papillomatosis (JORRP). Where there are very large lesions on the vulva, delivery may be obstructed. Diagnosis in pregnancy is mainly by viral PCR or from the clinical appearance of the characteristic lesions on the vulva. Treatment is local by either surgical or laser excision or application of trichloroacetic acid. Podophyllin/podophyllotoxin is contraindicated in pregnancy. HPV Infection is not an indication for caesarean delivery as this has not been shown to prevent vertical transmission. For those diagnosed at routine cervical cancer screening, management should follow guidelines for cervical cancer screening in pregnancy. Vaccination is currently not recommended for pregnant women, although studies on those inadvertently vaccinated in pregnancy have not shown any adverse effects on either the fetus or mother.
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13
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Værnesbranden MR, Wiik J, Sjøborg K, Staff AC, Carlsen KCL, Haugen G, Hedlin G, Hilde K, Nordlund B, Nystrand CF, Rangberg A, Rehbinder EM, Rudi K, Rueegg CS, Sandberg Y, Sjelmo S, Skjerven HO, Söderhäll C, Vettukattil R, Jonassen CM. Maternal human papillomavirus infections at mid-pregnancy and delivery in a Scandinavian mother-child cohort study. Int J Infect Dis 2021; 108:574-581. [PMID: 34077798 DOI: 10.1016/j.ijid.2021.05.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) infections are common, especially during women's reproductive years, with unclear obstetrical impact. This study aimed to identify HPV prevalence at mid-gestation and delivery, type-specific persistence from mid-gestation to delivery, and risk factors for HPV infection and persistence. METHODS In 757 women from a Scandinavian prospective mother-child cohort, HPV was analyzed in first-void urine samples at mid-gestation and delivery. We used Seegene Anyplex II HPV28 PCR assay for genotyping and semi-quantifying 28 genital HPV genotypes, including 12 high-risk HPVs (HR-HPV). Socio-demographic and health data were collected through e-questionnaires. RESULTS Any-HPV genotype (any of 28 assessed) was detected in 38% of the study cohort at mid-gestation and 28% at delivery, and HR-HPVs in 24% and 16%, respectively. The most prevalent genotype was HPV16: 6% at mid-gestation and 4% at delivery. Persistence of Any-HPV genotype was 52%, as was HR-HPV genotype-specific persistence. A short pre-conception relationship with the child's father and alcohol intake during pregnancy increased HPV infection risk at both time points. Low viral load at mid-gestation was associated with clearance of HPV infections at delivery. CONCLUSION HPV prevalence was higher at mid-gestation compared with delivery, and low viral load was associated with clearance of HPV at delivery.
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Affiliation(s)
- Magdalena R Værnesbranden
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Kalnes, Norway; University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.
| | - Johanna Wiik
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Kalnes, Norway; Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katrine Sjøborg
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Kalnes, Norway
| | - Anne Cathrine Staff
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Guttorm Haugen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Hilde
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Camilla F Nystrand
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Anbjørg Rangberg
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Eva Maria Rehbinder
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
| | - Knut Rudi
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Yvonne Sandberg
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Sigrid Sjelmo
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Kalnes, Norway
| | - Håvard O Skjerven
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Riyas Vettukattil
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine M Jonassen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway; Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
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14
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Xu X, Woolner A, Bhattacharya S, Cotton S, Zhao F, Cruickshank M. Has the human papillomavirus (HPV) immunization programme improved obstetric outcomes in spontaneous delivery? An ecological study. Eur J Obstet Gynecol Reprod Biol 2021; 262:221-227. [PMID: 34082145 DOI: 10.1016/j.ejogrb.2021.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure the rates of adverse obstetric outcomes in spontaneous delivery in a population of young women with high uptake of the bivalent human papillomavirus (HPV) vaccine. STUDY DESIGN This was a population-based ecological study with data from the Aberdeen Maternity and Neonatal Databank, UK. All women born between 1986-1996 with spontaneous singleton live birth at age 20-30 years were included for analysis. Exposure was defined according to maternal year of birth and HPV immunisation eligibility: pre-immunisation cohort (1986-1990), catch-up immunisation cohort (1991-1994) and routine immunisation cohort (1995-1996). Outcomes were defined as spontaneous preterm birth (PTB), low birth weight (LBW) and pre-labour preterm rupture of membranes (pPROM). Generalized estimating equation models were applied, adjusted for deprivation, smoking status, marital status, body mass index, parity, maternal age and year of infant delivery. RESULTS A total of 6515 spontaneous singleton live births were included in final analysis, with 5134 births included in the pre-immunisation cohort, 1250 in the catch-up immunisation cohort and 131 in the routine immunisation cohort. Compared with the pre-immunisation cohort, no statistically significant reduction on PTB, LBW or pPROM were observed in either immunised cohorts. The adjusted odds ratio (aOR) on PTB was 0.64 (95 % confidence interval, 0.40-1.03) in the catch-up cohort and 0.71 (0.28-1.77) in the routine cohort. The corresponding aOR were 0.88 (0.54-1.45) and 0.51 (0.16-1.62) for LBW and 1.62 (0.58-4.54) and 1.51 (0.21-11.01) for pPROM. CONCLUSIONS We did not observe a significant reduction on PTB, LBW or pPROM among spontaneous singleton live birth in either HPV immunised cohorts, although the additional benefit in improving obstetric outcomes cannot be excluded because of the limits of the sample size and the study design. Further demonstration is warranted when more women in the fully HPV immunised cohorts embark on pregnancy.
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Affiliation(s)
- Xiaoqian Xu
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom; Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andrea Woolner
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Sohinee Bhattacharya
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Margaret Cruickshank
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom.
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15
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Kalliala I, Eriksson T, Aro K, Hokkanen M, Lehtinen M, Gissler M, Nieminen P. Preterm birth rate after bivalent HPV vaccination: Registry-based follow-up of a randomized clinical trial. Prev Med 2021; 146:106473. [PMID: 33639181 DOI: 10.1016/j.ypmed.2021.106473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
A registry-based follow-up of pregnancy data until the end of 2014 was conducted based on a community-randomized trial to assess human papillomavirus (HPV) vaccination strategies and a reference cohort from the same community with no intervention. Our objective was to determine whether prophylactic HPV vaccination (three doses of Cervarix® (AS04-HPV-16/18)-vaccine) affects preterm birth (PTB) rates. All identified 80,272 residents in 1992-95 birth cohorts in Finland were eligible for the trial and 20,513 of 39,420 (51.9%) females consented to participate. The final study population consisted of age-aligned 6226 HPV16/18 vaccinated females and 1770 HBV vaccinated (Engerix® B, hepatitis B-virus vaccine) females that did not receive HPV vaccine at the age of 18 from the 1992-93 birth cohorts, and 19,849 females from the 1990-91 non-vaccinated reference birth cohorts. We compared the rates of preterm (22 + 0-36 + 6 pregnancy weeks) and early preterm (22 + 0-31 + 6) per term (at least 37 + 0) singleton births among the HPV- and non-HPV-vaccinated women, using nationwide Medical Birth Registry data. We observed 409 singleton first pregnancies lasting at least 22 + 0 weeks among 6226 HPV-vaccinated and 1923 among 21,619 non-HPV-vaccinated women. In the first pregnancy the PTB rate was 13/409 (3.2%) among the HPV-vaccinated and 98/1923 (5.1%) among the non-HPV-vaccinated (OR 0.61, 95% CI 0.34-1.09). Early preterm birth rate was 0/409 (0%) in the HPV-vaccinated women and 20/1923 (1.0%) in the non-HPV-vaccinated women (p = 0.04). PTB rate, especially early PTB rate, was lower among the HPV-vaccinated women. Reduction of PTB incidence after prophylactic HPV vaccination would lead to public health benefits globally. Trial Registration:NCT00534638.
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Affiliation(s)
- Ilkka Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland; Department of Surgery & Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Tiina Eriksson
- Fican Mid, P.O. Box 100, Tampere University, FI-33014 Tampere, Finland.
| | - Karoliina Aro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Mari Hokkanen
- Fican Mid, P.O. Box 100, Tampere University, FI-33014 Tampere, Finland.
| | - Matti Lehtinen
- Deutsches Krebsforschungszentrum, Infection & Cancer Epidemiology, Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany; Karolinska Institute, Department of Lab Medicine, Alfred Nobels Allé 8, 8th Floor, 141 52 Huddinge, Sweden.
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Mannerheimintie 166, 00300 Helsinki, Finland; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Zanderska huset, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden.
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
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