Hong Jennifer N, Berggren Erica K, Campbell Sara L, Smith Jennifer S, Rahangdale Lisa
Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, HI; Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI.
Paediatr Perinat Epidemiol. 2014 Jul;28(4):297-301. doi: 10.1111/ppe.12132. Epub 2014 May 28.
Preterm delivery is a major cause of neonatal morbidity and mortality. Human papillomavirus (HPV) infection is common in reproductive-aged women. We hypothesised that abnormal cervical cancer screening tests, as a proxy for HPV infection, would be associated with preterm delivery.
We conducted a retrospective cohort study of women delivering liveborn singletons beyond 20 weeks gestation, who had a Papanicolaou (Pap) test within 1 year prior to delivery. Women with abnormal Pap or positive high-risk HPV tests, classified as having 'abnormal screening', were compared with women classified as having 'normal screening' in bivariate analysis for overall preterm delivery at less than 37 weeks gestation. Using Poisson regression, we report unadjusted (RR) and adjusted (aRR) risk ratios for spontaneous preterm delivery due to preterm labour and preterm premature rupture of membranes.
Among 2686 women meeting criteria for analysis, 213 (8%) had abnormal screening. Women with abnormal screening, compared with normal screening, were not more likely to deliver preterm (12.2% vs. 9.8%, RR 1.3 [95% confidence interval (CI) 0.9, 1.8], aRR 1.2 [95% CI 0.8, 1.7]). Women with abnormal screening, however, were at greater risk for spontaneous preterm delivery in unadjusted and adjusted analysis (8.9% vs. 4.5%; RR 2.0 [95% CI 1.2, 3.2], aRR 1.8 [95% CI 1.1, 2.9]).
There was no difference in risk of overall preterm delivery in women with abnormal compared with normal cervical cancer screening tests. Our data suggest, however, that abnormal screening in pregnancy may be associated with spontaneous preterm delivery.
早产是新生儿发病和死亡的主要原因。人乳头瘤病毒（HPV）感染在育龄妇女中很常见。我们假设，作为HPV感染替代指标的宫颈癌筛查异常与早产有关。
我们对妊娠20周后分娩单胎活产儿、且在分娩前1年内进行过巴氏试验的妇女进行了一项回顾性队列研究。将巴氏试验异常或高危HPV检测呈阳性（归类为“筛查异常”）的妇女与归类为“筛查正常”的妇女进行双变量分析，比较妊娠小于37周时总体早产情况。使用泊松回归，我们报告了因早产和胎膜早破导致的自发性早产的未调整风险比（RR）和调整后风险比（aRR）。
在2686名符合分析标准的妇女中，213名（8%）筛查异常。与筛查正常的妇女相比，筛查异常的妇女早产的可能性并不更高（12.2%对9.8%，RR 1.3 [95%置信区间（CI）0.9，1.8]，aRR 1.2 [95%CI 0.8，1.7]）。然而，在未调整和调整分析中，筛查异常的妇女发生自发性早产的风险更高（8.9%对4.5%；RR 2.0 [95%CI 1.2，3.2]，aRR 1.8 [95%CI 1.1, 2.9]）。
宫颈癌筛查异常的妇女与筛查正常的妇女相比，总体早产风险没有差异。然而，我们的数据表明，孕期筛查异常可能与自发性早产有关。
