The potential role of HPV vaccination in the prevention of infectious complications of pregnancy

Bonde, Ulla; Joergensen, Jan Stener; Mogensen, Ole; Lamont, Ronald F.

doi:10.1586/14760584.2014.944164

Cited by 15 publications

(18 citation statements)

References 44 publications

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“…HPV vaccination programs have been implemented in many countries worldwide to prevent the high mortality from cervical cancer and to lower the incidence of dysplasia and genital warts [42]. Considering the high prevalence of HPV infection in spontaneous abortion, preterm birth, and male and female infertility, it remains uncertain whether such vaccination programs will improve the pregnancy outcome and infertility, and further investigation is required.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Human Papillomavirus Infection for Spontaneous Abortion, Spontaneous Preterm Birth, and Pregnancy Rate of Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

Xiong

Luo

et al. 2018

Gynecol Obstet Invest

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Aims: To estimate the impact of human papillomavirus (HPV) infection on spontaneous abortion, spontaneous preterm birth (sPTB), pregnancy rate of females undergoing assisted reproductive technologies (ART), and spontaneous abortion of ART pregnancy. Methods: PubMed, Medline, Embase, and the Cochrane Library were searched until December 16, 2016. The OR or relative risk (RR) with its corresponding 95% CI were selected as effect size. Subgroup analysis of HPV genotype infection (high-risk HPV [HR-HPV] or indiscriminate genotype) was performed. Statistical analysis was conducted using STATA 12.0. Results: Eighteen studies were included. Eight studies revealed no significant association between HPV infection and spontaneous abortion (OR 1.40, 95% CI 0.56–3.50). However, subgroup analysis showed indiscriminate genotype HPV infection increased the ratio of spontaneous abortion with OR of 2.24 (95% CI 1.37–3.65), while HR-HPV infection had no significant effect (OR 0.65, 95% CI 0.21–1.98). The results indicated that HR-HPV infection was a risk for sPTB with a pooled OR of 2.84 (95% CI 1.95–4.14). HPV infection was found to be independent of the ART-based clinical pregnancy rate (RR 1.04, 95% CI 0.64–1.70) and spontaneous abortion of ART pregnancy (RR 1.47, 95% CI 0.86–2.50). Conclusions: Indiscriminate HPV genotype infection can increase the risk of spontaneous abortion and HR-HPV infection was a risk factor for sPTB. However, there was not enough evidence to indicate the association between HPV infection and pregnancy rate of ART, and spontaneous abortion of ART pregnancy. Different genotypes of HPV infection may play a discrepant role in adverse pregnancy outcomes.

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Section: Discussionmentioning

confidence: 99%

The Risk of Human Papillomavirus Infection for Spontaneous Abortion, Spontaneous Preterm Birth, and Pregnancy Rate of Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

Xiong

Luo

et al. 2018

Gynecol Obstet Invest

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“…Two reviews [46, 47] both published in 2014 have focused on the question of HPV and pregnancy complications. Bonde et al reviewed the association between HPV infection and infertility, APO, and the risk of vertical transmission of HPV [46].…”

Section: Introductionmentioning

confidence: 99%

“…Bonde et al reviewed the association between HPV infection and infertility, APO, and the risk of vertical transmission of HPV [46]. This review did not follow any systematic approach to document and synthesize the existing literature.…”

Section: Introductionmentioning

confidence: 99%

“…This review did not follow any systematic approach to document and synthesize the existing literature. After a narrative assessment of the literature, the authors concluded that more research was necessary to reach firm conclusions on the association between pregnancy outcomes and HPV [46]. Conversely, Huang et al conducted a meta-analysis and found a twofold increased risk of preterm birth in pregnant women infected by HPV (pooled OR 2.12, 95% CI 1.51–2.98) [47].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, widespread implementation of HPV vaccination programs is expected to reduce HPV prevalence and diseases related to HPV [49, 52]. Especially, HPV vaccination is expected to reduce incidence of cervical cancer and pre cancers, which will reduce the need for cervical excision and therefore the number of preterm birth [46, 50, 53]. However, there is insufficient evidence on the potential harmful effect of HPV on pregnancy outcomes to support this potential benefit of HPV vaccine on pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The association between adverse pregnancy outcomes and maternal human papillomavirus infection: a systematic review protocol

et al. 2017

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BackgroundHuman papillomavirus (HPV) is the most prevalent genital infection, especially in young women of reproductive age. In vitro and animal model experiments provide compelling evidence of the harmful effect of HPV on pregnancy outcomes, but results from epidemiologic studies are inconclusive. We aim to determine the strength of the relationship between adverse pregnancy outcomes (APO) and HPV infection and assess its consistency across studies, by systematically reviewing the literature.MethodsThe search strategy has been developed on the basis of the PICOS framework: Population (pregnant women); Exposure (HVP infection confirmed by HPV testing); Comparator (pregnant women without HPV infection); Outcomes (miscarriage, spontaneous preterm birth, low birth weight, preterm premature rupture of membranes, pregnancy-induced hypertensive disorders and intrauterine growth restriction) and Study design (observational studies). We will search three information sources: (1) electronic databases (MEDLINE, EMBASE, and EBM Reviews databases); (2) Grey literature (Google Scholar and Web of Science conference proceedings); and (3) citing and cited articles of included studies. Two reviewers (JN, NZ) will independently and in duplicate screen identified articles, select eligible studies, and extract data. Discrepancies will be resolved by consensus and otherwise by discussion with the other authors (MHM, HT). Quality of included studies will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. We will narratively synthesize extracted data whether meta-analysis is conducted or not. Meta-analysis of each outcome will be performed, and where appropriate, an average measure of association will be computed. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess and grade the strength of confidence in cumulative estimate.DiscussionComprehensive and high-quality evidence of a negative effect of HPV on pregnancy outcomes might be an additional motivation for HPV vaccination. Absence of such relationship could dispel anxiety and reassure HPV-infected pregnant women and clinicians. Findings of a poor level of confidence will allow identification of current knowledge gaps on HPV-pregnancy outcome relationship that need further research.Systematic review registrationPROSPERO CRD42016033425 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0443-5) contains supplementary material, which is available to authorized users.

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A specific bacterial DNA signature in the vagina of Australian women in midpregnancy predicts high risk of spontaneous preterm birth (the Predict1000 study)

Payne

Newnham

Doherty

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: Intrauterine infection accounts for a quarter of the cases of spontaneous preterm birth; however, at present, it is not possible to efficiently identify pregnant women at risk to deliver preventative treatments. OBJECTIVE: This study aimed to establish a vaginal microbial DNA test for Australian women in midpregnancy that will identify those at increased risk of spontaneous preterm birth. STUDY DESIGN: A total of 1000 women with singleton pregnancies were recruited in Perth, Australia. Midvaginal swabs were collected between 12 and 23 weeks' gestation. DNA was extracted for the detection of 23 risk-related microbial DNA targets by quantitative polymerase chain reaction. Obstetrical history, pregnancy outcome, and demographics were recorded. RESULTS: After excluding 64 women owing to losses to follow-up and insufficient sample for microbial analyses, the final cohort consisted of 936 women of predominantly white race (74.3%). The overall preterm birth rate was 12.6% (118 births); the spontaneous preterm birth rate at <37 weeks' gestation was 6.2% (2.9% at 34 weeks' gestation), whereas the preterm premature rupture of the membranes rate was 4.2%. No single individual microbial target predicted increased spontaneous preterm birth risk. Conversely, women who subsequently delivered at term had higher amounts of Lactobacillus crispatus, Lactobacillus gasseri, or Lactobacillus jensenii DNA in their vaginal swabs (13.8% spontaneous preterm birth vs 31.2% term; P¼.005). In the remaining women, a specific microbial DNA signature was identified that was strongly predictive of spontaneous preterm birth risk, consisting of DNA from Gardnerella vaginalis (clade 4), Lactobacillus iners, and Ureaplasma parvum (serovars 3 and 6). Risk prediction was improved if Fusobacterium nucleatum detection was included in the test algorithm. The final algorithm, which we called the Gardnerella Lactobacillus Ureaplasma (GLU) test, was able to detect women at risk of spontaneous preterm birth at <37 and 34 weeks' gestation, with sensitivities of 37.9% and 44.4%, respectively, and likelihood ratios (plus or minus) of 2.22 per 0.75 and 2.52 per 0.67, respectively. Preterm premature rupture of the membranes was more than twice as common in GLU-positive women. Adjusting for maternal demographics, ethnicity, and clinical history did not improve prediction. Only a history of spontaneous preterm birth was more effective at predicting spontaneous preterm birth than a GLU-positive result (odds ratio, 3.6). CONCLUSION: We have identified a vaginal bacterial DNA signature that identifies women with a singleton pregnancy who are at increased risk of spontaneous preterm birth and may benefit from targeted antimicrobial therapy.

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The potential role of HPV vaccination in the prevention of infectious complications of pregnancy

Cited by 15 publications

References 44 publications

The Risk of Human Papillomavirus Infection for Spontaneous Abortion, Spontaneous Preterm Birth, and Pregnancy Rate of Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

The Risk of Human Papillomavirus Infection for Spontaneous Abortion, Spontaneous Preterm Birth, and Pregnancy Rate of Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

The association between adverse pregnancy outcomes and maternal human papillomavirus infection: a systematic review protocol

A specific bacterial DNA signature in the vagina of Australian women in midpregnancy predicts high risk of spontaneous preterm birth (the Predict1000 study)

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