Cancer-associated human papillomavirus types are selectively increased in the cervix of women in the first trimester of pregnancy,☆☆,,★★

https://doi.org/10.1016/S0002-9378(96)70593-8Get rights and content

Abstract

OBJECTIVE: Because of incomplete data in the current literature, we sought to determine whether pregnancy is an independent risk for the detection of human papillomavirus infection. STUDY DESIGN: Pregnant patients in their first trimester who are seen for routine care at an obstetrics clinic and nonpregnant patients receiving routine care at a sexually transmitted diseases clinic and a gynecology clinic were recruited. Cervical cells were collected by saline solution lavage, and deoxyribonucleic acid was extracted and tested for the presence of human papillomavirus deoxyribonucleic acid with the hybrid capture assay. This assay detects the deoxyribonucleic acid of five “low cancer risk” and nine “high cancer risk” human papillomavirus types with two separate pools of deoxyribonucleic acid probes. RESULTS: Results from 245 pregnant women, 248 patients from the sexually transmitted diseases clinics, and 246 gynecology clinic patients were analyzed. Human papillomavirus deoxyribonucleic acid was detected in samples from 31% of the pregnant patients compared with 17.7% and 18.6% of the sexually transmitted diseases clinic and gynecology clinic patients, respectively. There was no significant difference in positivity for the “low-risk” human papillomavirus types among the three groups (positivity rates from 8.9% to 12.7%), but the pregnant patients had a significantly higher positivity rate for the “high-risk” human papillomavirus types (24.9% compared with 13.3% and 11.4% for the sexually transmitted diseases and gynecology clinic patients, respectively; p < 0.001). A multiple logistic regression analysis showed that pregnancy was an independent predictor of a positive test result for a “high-risk” human papillomavirus type (odds ratio 1.79, 95% confidence interval 1.11 to 2.89) but not a positive test result for a “low-risk” type. CONCLUSIONS: Because sexual activity was not greater among the pregnant patients, we propose that the increased detection of “high-risk” human papillomavirus types among the pregnant patients represents a selective activation of these viruses by hormonal or immunologic factors associated with pregnancy. (AM J OBSTET GYNECOL 1996;174:1487-93.)

Section snippets

Patients and specimens

Patients were recruited from a municipal hospital obstetrics clinic and a gynecology clinic, as well as a sexually transmitted diseases (STD) clinic located about one block away from the other two clinics. Written informed consent was obtained from all patients in accordance with United States Department of Health and Human Services guidelines and a document approved by the Indiana University – Purdue University at Indianapolis Committee on Protection of Human Subjects. Pregnant patients were

Patient demographics and behavior characteristics

A total of 739 patients were enrolled (245 from the obstetrics clinic, 246 from the gynecology clinic, and 248 from the STD clinic). The demographic characteristics are shown in Table I. There were two potentially important differences among the patient groups. The mean age of the obstetrics clinic patients was significantly lower, 22.8 years compared with 28.2 years for the STD clinic patients and 29.2 years for the gynecology patients (p < 0.001). The STD clinic patients had significantly

COMMENT

There is a general impression among clinicians that overt HPV infections worsen during pregnancy and often improve in the postpartum period. Whereas such anecdotal observations and clinical experience have been widely accepted and even enshrined as facts in textbooks,16 there are few data from carefully controlled studies to support or refute this concept. An understanding of the interactions between the pregnant patient and infecting HPV is important for several reasons. There are concerns

References (25)

  • EA Kemp et al.

    Human papillomavirus prevalence in pregnancy

    Obstet Gynecol

    (1992)
  • B Gloss et al.

    The upstream regulatory region of the human papilloma virus-16 contains an E2 protein-independent enhancer which is specific for cervical carcinoma cells and regulated by glucocorticoid hormones

    EMBO J

    (1987)
  • Cited by (66)

    • Human papilloma virus infection and miscarriage: is there an association?

      2020, Taiwanese Journal of Obstetrics and Gynecology
      Citation Excerpt :

      Sexual behavior, including age of the first sexual intercourse and number of sexual partners, is the main risk factor for HPV infection [3,4]. Notably, HPV infection is more prevalent in pregnant than in age-matched non-pregnant women [5–7]. The prevalence of HPV infection also increases as pregnancy progresses [7–9].

    • Clinical outcome of high-grade cervical intraepithelial neoplasia during pregnancy: A 10-year experience

      2019, European Journal of Obstetrics and Gynecology and Reproductive Biology
    • Identification of novel human papillomavirus lineages and sublineages in HIV/HPV-coinfected pregnant women by next-generation sequencing

      2016, Virology
      Citation Excerpt :

      HPV clearance is lower during the first two trimesters of pregnancy, suggesting a compromised immune response (Hernandez-Giron et al., 2005; Nobbenhuis et al., 2002). Pregnancy is thus associated with increased HPV prevalence, and with more rapid progression to intraepithelial lesion (Armbruster-Moraes et al., 2000; Fife et al., 1996; Hernandez-Giron et al., 2005; Palle et al., 2000). HPV belongs to the Papillomaviridae family, and over 200 different HPV types have been described so far, based on their genetic distances, particularly in the L1 gene (http://www.hpvcenter.se/html/refclones.html).

    • Human papillomavirus infection and spontaneous abortion: A case-control study performed in Mexico

      2013, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      It is important to study HPV detection in pregnancy, which represents a special immunological state that may be a risk factor for HPV infection [30]. Some studies have shown a higher frequency of HPV cervical infection in pregnant women compared to non-pregnant controls, possibly because of an effect of elevated estrogens which may affect the viral replication, or due to the altered immunity [31–34]. Nevertheless, in some settings the routine Pap smear is usually postponed for pregnant women, as mentioned in European guidelines [35].

    • Epidermodysplasia verruciformis-associated and genital-mucosal high-risk human papillomavirus DNA are prevalent in nevus sebaceus of Jadassohn

      2008, Journal of the American Academy of Dermatology
      Citation Excerpt :

      Most high risk GM HPV infections occur in younger individuals and clear within several years.61-63 However, an increase in cervical HPV infection with high-risk GM HPV types has been observed during pregnancy64; this increase could potentially affect the conceptus. In this study, histologic and molecular evidence of HPV DNA infection was prevalent and persistent in NS as its absence was not associated with increasing age.

    View all citing articles on Scopus

    From the Departments of Medicine,a Microbiology and Immunology,b Pathology,c and Obstetrics and Gynecology,d Indiana University School of Medicine.

    ☆☆

    Supported in part by grant AI 31494 (Project 4) from the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

    Reprint requests: Kenneth H. Fife, MD, PhD, Division of Infectious Diseases, 545 Barnhill Dr., Room 435, Indianapolis, IN 46202-5124.

    ★★

    0002-9378/96 $5.00 + 0 6/1/69616

    View full text