Female Human Papillomavirus Infection Associated with Increased Risk of Ectopic Pregnancy: Early Evidence from Taiwan Population-Based Cohort Study.

Li-Chuan Hsu,Hui-Yuan Chen,Hei-Tung Yip,Renin Chang,Ting-Yu Tu,Jim Jinn-Chyuan Sheu,Kuan-Hao Tsui,James Cheng-Chung Wei,Mei-Chia Chou

doi:10.3390/jpm12020172

Abstract

Background: This is an investigation of the human papillomavirus (HPV) infection and its correlation with the risk of ectopic pregnancy (EP). Methods: The cohort study includes 11,239 patients with newly diagnosed HPV infections between 2000 and 2012, and by using computer-generated random numbers, patients who do not have HPV infections are selected randomly as the comparison cohort. The HPV infection cohort is matched to comparison individuals at a 1:10 ratio by age and index year. All individuals included in the study were followed up to the point they developed EP, pulled-out from the insurance program, lost to follow-up, or until the end of 2013. A Cox proportional-hazards regression analysis was used to analyze the risk of EP with the hazard ratios (HRs) and 95% confidence intervals (CIs) between the HPV and control cohort. Results: The adjusted hazard ratio (aHR) of EP for HPV patients relative to controls is 1.70 (95% CI = 1.04, 2.78), indicating a positive correlation between EP and HPV in the 13-year follow-up period, after adjusting for age and relevant comorbidities. The sensitivity analyses yield similar results. Conclusions: A history of HPV infection is a potential risk factor associated with the development of subsequent EP in Taiwanese individuals, especially those diagnosed with an HPV infection within 3 years.

Highlights

The main cause of maternal morbidity in the first trimester is ectopic pregnancy (EP), which leads to about 9% of maternal deaths with an incidence rate of around 10–20 out of every 1000 pregnancies [1]
The risk of EP was increased in patients with benign neoplasm of the ovary, in patients with pelvic inflammatory disease (PID), and in those with myomectomy
In the co-morbidity subgroup analysis, human papillomavirus (HPV) infection was found to have a significant impact on the risk of EP in patients without the comorbidities mentioned in Table 1

Summary

Introduction

The main cause of maternal morbidity in the first trimester is ectopic pregnancy (EP), which leads to about 9% of maternal deaths with an incidence rate of around 10–20 out of every 1000 pregnancies [1]. Pelvic infection may change the tubal function and result in pelvic adhesive disease and tubal obstruction. This is an investigation of the human papillomavirus (HPV) infection and its correlation with the risk of ectopic pregnancy (EP). The HPV infection cohort is matched to comparison individuals at a 1:10 ratio by age and index year. Results: The adjusted hazard ratio (aHR) of EP for HPV patients relative to controls is 1.70 (95% CI = 1.04, 2.78), indicating a positive correlation between EP and HPV in the 13-year follow-up period, after adjusting for age and relevant comorbidities. Conclusions: A history of HPV infection is a potential risk factor associated with the development of subsequent EP in Taiwanese individuals, especially those diagnosed with an HPV infection within 3 years

Methods

Results

Discussion

Conclusion