https://doi.org/10.5812/archcid.91355

An Argument: The Safety of Human Papillomavirus (HPV) in Pregnancy

authors:

avatar Masoud Mardani ORCID 1 , *

Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Archives of Clinical Infectious Diseases: Vol.14, issue 1; e91355
published online: March 16, 2019
article type: Editorial
received: March 8, 2019
accepted: March 8, 2019

How To Cite Mardani M. An Argument: The Safety of Human Papillomavirus (HPV) in Pregnancy. Arch Clin Infect Dis. 2019;14(1):e91355. https://doi.org/10.5812/archcid.91355.

The rate of HPV infection in pregnant females is high and in case of condyloma development, rapid growth can be seen. Hormonal changes and the suppression of the immune system during pregnancy are predisposing factors. Mothers who have a latent infection or genital warts are at low-risk of the encounter with HPV transmission to neonate via oropharyngeal mucosa; hence, a critical factor for prediction of transmission is the time between the rapture of the amnion and delivery (1).

In the study by Garland et al. pregnancy and infant outcome in females who received the prophylactic quadrivalent HPV vaccine (QHPVV) before pregnancy were surveyed and no significant differences were observed among them in a live birth and fetal loss or spontaneous abortion. In this study, neonatal congenital anomalies were not observed in both vaccine recipient and placebo groups. Thus according to this study, the administration of quadrivalent HPV vaccine before pregnancy does not increase fetal risk (2). In another study by Faber et al. in Denmark among females born 1975 - 1992 from nationwide health registries, pregnancy outcome and infant mortality in HPV vaccinated among 522 - 722 pregnant females were surveyed and no significant differences were reported in spontaneous abortion, stillbirth, and infant mortality (3).

Nevertheless, it is important to know that patients who are immunosuppressed, such as those with AIDS and those currently receiving immunosuppressive therapy, are more likely to develop persistent HPV infection and subsequent dysplasia and malignancy (4). Although HPV vaccination during pregnancy has its limitations, there are several studies showing that prenatal HPV infection could lead to spontaneous abortion and preterm delivery. Also, the severity of unpleasant side effects related to HPV infection in pregnancy is highly dependent on viral load (5-7). Therefore, it seems that QHPVV may eliminate or decreases the prevalence of HPV infection, especially in high-risk groups such as pregnant females. To establish the fact that adverse pregnancy outcome could be caused by HPV infection, more cohort studies should be carried out to explore an appropriate HPV vaccination program during pregnancy (8).

Acknowledgements

References

  • 1.

    Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital warts among 18- to 59-year-olds in the United States, national health and nutrition examination survey, 1999--2004. Sex Transm Dis. 2008;35(4):357-60. [PubMed ID: 18360316]. https://doi.org/10.1097/OLQ.0b013e3181632d61.

  • 2.

    Garland SM, Ault KA, Gall SA, Paavonen J, Sings HL, Ciprero KL, et al. Pregnancy and infant outcomes in the clinical trials of a human papillomavirus type 6/11/16/18 vaccine: A combined analysis of five randomized controlled trials. Obstet Gynecol. 2009;114(6):1179-88. [PubMed ID: 19935017]. https://doi.org/10.1097/AOG.0b013e3181c2ca21.

  • 3.

    Faber MT, Duun-Henriksen AK, Dehlendorff C, Tatla MK, Munk C, Kjaer SK. Adverse pregnancy outcomes and infant mortality after quadrivalent HPV vaccination during pregnancy. Vaccine. 2019;37(2):265-71. [PubMed ID: 30503078]. https://doi.org/10.1016/j.vaccine.2018.11.030.

  • 4.

    Reusser NM, Downing C, Guidry J, Tyring SK. HPV carcinomas in immunocompromised patients. J Clin Med. 2015;4(2):260-81. [PubMed ID: 26239127]. [PubMed Central ID: PMC4470124]. https://doi.org/10.3390/jcm4020260.

  • 5.

    Ambuhl LM, Baandrup U, Dybkaer K, Blaakaer J, Uldbjerg N, Sorensen S. Human papillomavirus infection as a possible cause of spontaneous abortion and spontaneous preterm delivery. Infect Dis Obstet Gynecol. 2016;2016:3086036. [PubMed ID: 27110088]. [PubMed Central ID: PMC4826700]. https://doi.org/10.1155/2016/3086036.

  • 6.

    Niyibizi J, Zanre N, Mayrand MH, Trottier H. The association between adverse pregnancy outcomes and maternal human papillomavirus infection: A systematic review protocol. Syst Rev. 2017;6(1):53. [PubMed ID: 28284227]. [PubMed Central ID: PMC5346269]. https://doi.org/10.1186/s13643-017-0443-5.

  • 7.

    Cho G, Min KJ, Hong HR, Kim S, Hong JH, Lee JK, et al. High-risk human papillomavirus infection is associated with premature rupture of membranes. BMC Pregnancy Childbirth. 2013;13:173. [PubMed ID: 24011340]. [PubMed Central ID: PMC3846597]. https://doi.org/10.1186/1471-2393-13-173.

  • 8.

    Feily A, Lotti T, Lange CS, Gianfaldoni S, Ramirez-Fort MK. Is HPV vaccination of pregnant women really safe? Dermatol Ther. 2018;31(3). e12593. [PubMed ID: 29479844]. https://doi.org/10.1111/dth.12593.