Meta-analysis Of The Association Between High Risk Human Papillomavirus Infection And Adverse Pregnancy Outcomes

Objective: High-risk HPV infection is an independent risk factor for cervical cancer.It occurs in the childbearing age.The HPV infection rate during pregnancy is 16.82%.The genital environment changes due to the decrease of cellular immune function during pregnancy and the changes of hormone levels during pregnancy.It makes HPV more susceptible to infection during pregnancy and is more difficult to self-clear.Defining the relationship between high-risk human papillomavirus infection and adverse pregnancy outcomes can help guide pregnant women before and during pregnancy.Methods: Searched the Pubmed,Embase,and Ovid-Medline databases for the earliest available search for English literature on high-risk HPV infection and pregnancy outcomes by December 19,2017.After independently screening the literature,extracting data,and evaluating the methodological quality of the included studies according to inclusion and exclusion criteria,meta-analysis was performed using stata 12.0 software: the relationship between high-risk hpv infection and several adverse pregnancy outcomes,including preterm birth,premature rupture of membranes,pre-eclampsia,abortion,and Intrauterine growth and development limitation.Results: 1.A total of 12 articles were finally included consistingof 11 cohort studies and 1 case-control study.2.Meta-analysis results: Based on the random effects model(I2>50%),pregnant women with high-risk HPV infection had higher abortion rates than high-risk HPV negative pregnant women,the difference between the two was not statistically significant.[RR=1.87,95% CI(0.94,3.69)];3.The study of premature rupture of membranes as a target of homogeneity(I2<50%),the meta-analysis based on the fixed-effects model showed that pregnant women with high-risk HPV infection were more likely to have Premature rupture of membranes than high-risk HPV-negative pregnant women,combined with RR of 1.80 [95% CI(1.24,2.61)],statistically significant;4.The study with preterm birth as the outcome index was heterogeneous(I2>50%),and the random effects model showed that the preterm birth rate of pregnant women with high-risk HPV infection was higher than that of the control group [RR=1.71,95% CI(1.29,2.25)];5.The pre-eclampsia study was heterogeneous(I2>50%).Subgroup analysis showed that the pre-eclampsia rate of pregnant women with high-risk HPV infection in the subgroup of cervical tissues was higher than that of the control group[RR=1.88,95%CI(1.12,3.17)];The detection site was a subgroup of placental tissue,regarding the incidence of preeclampsia,the high-risk HPV infection-positive pregnant women were not significantly different from the control group [RR=2.77,95% CI(0.10,80.13)];6.Meta-analysis based on the fixed-effects model showed that pregnant women with high-risk HPV infection had a higher probability of Intrauterine growth and development limitation than the negative control group [RR=1.34,95% CI(1.06,1.69)].The difference was statistically significant with two groups.Conclusion: 1.High-risk HPV infection is a direct or indirect cause of premature rupture of membranes and preterm birth.2.High-risk HPV infection increases risk of pre-eclampsia.3.High-risk HPV infection increases the risk of Intrauterine growth and development limitation.4.High-risk HPV infections increase the risk of adverse pregnancy outcomes,and effective prevention of high-risk HPV infections has an important role in reducing adverse pregnancy outcomes.