1. Women with high-risk HPV were more likely to develop preeclampsia.
2. Women who were HPV-positive were more likely to experience preterm delivery.
Evidence Rating Level: 2 (Good)
Study Rundown: This study found that infection with high risk HPV (LSIL, HSIL, ASCUS, ASCUS r/o HSIL) was associated with increased odds of preeclampsia and preterm delivery. Prior studies have suggested that HPV is associated with increased risk of spontaneous abortions, premature rupture of membranes and preterm delivery but this is the first to identify a link with preeclampsia.
Limitations of this study include a retrospective design and small sample size. Additionally, authors did not control for nulliparity, a documented risk factor (first pregnancy) for preeclampsia. Additionally, nulliparity was more prevalent in women with HPV, suggesting nulliparity may well confound the observed association. Future studies might include a large, prospective cohort to determine whether the observed association holds true in a more diverse population. To further explore the benefits of the HPV vaccine, future studies might also evaluate the likelihood of preeclampsia among women who have and have not received the vaccine.
In-Depth [retrospective cohort study]: This study used medical records of high-risk HPV positive (n=314) and HPV-negative (n=628) women delivering at a single academic medical center to evaluate the likelihood of developing preeclampsia. Measured outcomes included preeclampsia, severity of preeclampsia, gestational age at onset of preeclampsia, and preterm delivery.
Factors associated with high-risk HPV infection included younger age, nulliparity, lower BMI, lower blood pressure and smoking. Women who were HPV-positive were more likely to develop preeclampsia (OR 2.18, CI 1.31-3.65). The exposed group was also more likely to have any preterm delivery <35 weeks (OR 2.58, CI 1.19-5.37) and spontaneous preterm delivery <37 weeks (OR 1.83, CI 1.83-3.26).
By Denise Pong, MPH and Leah Hawkins, MD, MPH
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