Effect of Second Pregnancy on Maternal Carriage and Outcome of High-Risk Human Papillomavirus (HPV)

Abstract

Objectives: The effect of second pregnancy on human papillomavirus (HPV) carriage and outcome is modelled in longitudinal setting covering two subsequent pregnancies. Study Design: Among 329 (baseline pregnant) women prospectively followed up inthe Finnish Family HPV Study, two subcohorts were compiled: (i) 78 women (Group B) who became pregnant for the second time during the follow-up, and (ii) 100 women (Group A) who did not develop 2nd pregnancy. The effect of pregnancy on high-risk HPV (HR-HPV) carriage and outcome was analysed using Kaplan-Meier and Cox survival analyses and generalized estimating equation (GEE) modelling of the longitudinal data. Results: Women in the two groups were similar in their baseline HR-HPV status but significantly different in several known risk factors of HR-HPV infection. Group A women showed higher point prevalence of cervical and oral HR-HPV at the 36-month (p = 0.015) and 6-month (p = 0.024) follow-up visit, respectively. Among Group B women, prevalence of both cervical and oral HR-HPV significantly decreased during 2nd pregnancy (p = 0.005 and p = 0.002) as compared with inter-pregnancy period, but increased again after 2nd pregnancy. There was no difference in acquisition or clearance of cervical or oral HR-HPV between the two groups in univariate (Kaplan-Meier) or multivariate (Cox) survival analysis. In the GEE approach, 2nd pregnancy was not significantly associated with cervical or oral HR-HPV carriage or persistence when adjusted for all other covariates. Conclusions: Second pregnancy is of little impact on carriage and persistence of oral and cervical HR-HPV infections in a longitudinal setting over time.

Genotype‐Specific Persistence of Genital Human Papillomavirus (HPV) Infections in Women Followed for 6 Years in the Finnish Family HPV Study

“…We found a clear 3-fold increase in HPV prevalence from the baseline to the 12-month visit. This corroborates our recent data from this cohort, where a clear association was disclosed between HPV carriage (point prevalence) and timing of 2 pregnancies (index pregnancy and second pregnancy) [40]. There was a significantly increased carriage of high-risk HPV in both cervical and oral mucosa during the interpregnancy period, compared with the second pregnancy or the index pregnancy.…”

“…According to their clinical behavior, 15 HPV types are classified as high-risk types (HPV types 16,18,31,33,35,39,45, 51, 52, 56, 58, 59, 68, 73, and 82), 12 are classified as low-risk HPV types (HPV types 6,11,40,42,44,54,61,70,72,81, and CP6108), whereas 3 are probable high-risk types (HPV types 26, 53, and 66) [3]. Worldwide, the 8 most common HPV types found in cervical cancer are all included either in species 7 (HPV types 18 and 45) or species 9 (HPV types 16,31,33,35,52, and 58) [4].…”

Incident cervical infections with high- and low-risk human papillomavirus (HPV) infections among mothers in the prospective Finnish Family HPV Study

“…No previous data are available from a similar setting where newly delivered mothers were prospectively followed-up. We have recently shown that women committed to the second child did not share many of the known life-style behavioural risk factors of HPV-infection [32], and this could be the likely explanation for this significant (IRR = 0.32,95%CI0.17-0.61) protective effect of a new pregnancy against incident species 7/9 HPV-infections in the present analysis. Some recent data suggest that parity was protective especially against LR-HPV-types [10].…”

HPV clearance in postpartum period of HIV-positive and negative women: a prospective follow-up study

“…Some recent studies did not observe differences in HPV status over time, during pregnancy [23-25]. Most authors, however, have found a reduction in HPV positivity during the postpartum period [26-29]. Minkoff et al [30] evaluated HIV-positive women and documented higher numbers of new HPV types at the postpartum period than during pregnancy, but their study did not asses HPV clearance.…”