Maternal human papillomavirus infections at mid-pregnancy and delivery in a Scandinavian mother–child cohort study

Magdalena R Værnesbranden,Karin C Lødrup Carlsen,Sigrid Sjelmo,Yvonne Sandberg,Eva Maria Rehbinder,Anbjørg Rangberg,Anne Cathrine Staff,Riyas Vettukattil,Johanna Wiik,Gunilla Hedlin,Guttorm Haugen,Katarina Hilde,Björn Nordlund,Cilla Söderhäll,Knut Rudi,Camilla Furlund Nystrand ,Håvard Ove Skjerven ,Katrine Dønvold Sjøborg ,Corina S Rueegg ,Christine Monceyron Jonassen

doi:10.1016/j.ijid.2021.05.064

Abstract

ObjectivesHuman 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. MethodsIn 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. ResultsAny-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. ConclusionHPV prevalence was higher at mid-gestation compared with delivery, and low viral load was associated with clearance of HPV at delivery.

Highlights

While human papillomavirus (HPV) is a known cause of cervical cancer, its clinical impact on pregnancy, obstetrical outcomes and future non-communicable diseases is less studied
At least one of Any-HPV genotypes was detected in 291/757 (38%) of pregnancies at mid-gestation and in 209/757 (28%) at delivery
In univariable logistic regression models (Supplementary Table 10), persistence of HPV16 was less common if the child’s father originated from Sweden. 7 most carcinogenic HR-HPV genotypes (7HR-HPV) and high-risk HPVs (HR-HPV) persistence were higher if the mother lived in the countryside, there were only small numbers in these groups

Summary

Introduction

While human papillomavirus (HPV) is a known cause of cervical cancer, its clinical impact on pregnancy, obstetrical outcomes and future non-communicable diseases is less studied. The lifetime risk for HPV infections in women is approximately 80% (McDonnold et al, 2014) and approximately 70% clear their infection within 1 year (Westrich et al, 2017). The peak prevalence of genital HPV infections occurs in young women, being among the most prevalent infection during reproductive years (Baseman and Koutsky, 2005; Clifford et al, 2006; Muñoz et al, 1994). The Finnish Family HPV study found an HPV prevalence of 16% in the third pregnancy trimester (Louvanto et al, 2010)

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