Niyibizi Joseph, Zanré Nadège, Mayrand Marie-Hélène, Trottier Helen
Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Pavilion 7101, Avenue du Parc, Montreal, QC, H3N 1X7, Canada.
Department of Social and Preventive Medicine, Sainte-Justine Hospital Research Center, Université de Montréal, 3175 Côte Sainte-Catherine, Room A-830, Montreal, H3T 1C5, QC, Canada.
Syst Rev. 2017 Mar 11;6(1):53. doi: 10.1186/s13643-017-0443-5.
Human papillomavirus (HPV) is the most prevalent genital infection, especially in young women of reproductive age. In vitro and animal model experiments provide compelling evidence of the harmful effect of HPV on pregnancy outcomes, but results from epidemiologic studies are inconclusive. We aim to determine the strength of the relationship between adverse pregnancy outcomes (APO) and HPV infection and assess its consistency across studies, by systematically reviewing the literature.
The search strategy has been developed on the basis of the PICOS framework: Population (pregnant women); Exposure (HVP infection confirmed by HPV testing); Comparator (pregnant women without HPV infection); Outcomes (miscarriage, spontaneous preterm birth, low birth weight, preterm premature rupture of membranes, pregnancy-induced hypertensive disorders and intrauterine growth restriction) and Study design (observational studies). We will search three information sources: (1) electronic databases (MEDLINE, EMBASE, and EBM Reviews databases); (2) Grey literature (Google Scholar and Web of Science conference proceedings); and (3) citing and cited articles of included studies. Two reviewers (JN, NZ) will independently and in duplicate screen identified articles, select eligible studies, and extract data. Discrepancies will be resolved by consensus and otherwise by discussion with the other authors (MHM, HT). Quality of included studies will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. We will narratively synthesize extracted data whether meta-analysis is conducted or not. Meta-analysis of each outcome will be performed, and where appropriate, an average measure of association will be computed. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess and grade the strength of confidence in cumulative estimate.
Comprehensive and high-quality evidence of a negative effect of HPV on pregnancy outcomes might be an additional motivation for HPV vaccination. Absence of such relationship could dispel anxiety and reassure HPV-infected pregnant women and clinicians. Findings of a poor level of confidence will allow identification of current knowledge gaps on HPV-pregnancy outcome relationship that need further research.
PROSPERO CRD42016033425.
人乳头瘤病毒（HPV）是最常见的生殖器感染，尤其在育龄期年轻女性中。体外和动物模型实验提供了HPV对妊娠结局有害影响的有力证据，但流行病学研究结果尚无定论。我们旨在通过系统回顾文献，确定不良妊娠结局（APO）与HPV感染之间关系的强度，并评估各研究结果的一致性。
搜索策略基于PICOS框架制定：人群（孕妇）；暴露因素（经HPV检测确诊的HPV感染）；对照（未感染HPV的孕妇）；结局（流产、自发性早产、低出生体重、胎膜早破、妊娠期高血压疾病和胎儿生长受限）以及研究设计（观察性研究）。我们将检索三个信息来源：（1）电子数据库（MEDLINE、EMBASE和循证医学评论数据库）；（2）灰色文献（谷歌学术和科学网会议论文集）；（3）纳入研究的引用文献和被引用文献。两名审阅者（JN、NZ）将独立且重复地筛选已识别的文章，选择符合条件的研究，并提取数据。分歧将通过协商解决，否则将与其他作者（MHM、HT）讨论解决。将使用有效公共卫生实践项目（EPHPP）定量研究质量评估工具评估纳入研究的质量。无论是否进行荟萃分析，我们都将对提取的数据进行叙述性综合分析。将对每个结局进行荟萃分析，并在适当情况下计算关联的平均度量值。我们将使用推荐分级评估、制定与评价（GRADE）方法来评估和分级对累积估计值的置信强度。
HPV对妊娠结局产生负面影响的全面且高质量证据可能会成为HPV疫苗接种的又一推动因素。不存在这种关系则可消除焦虑，并使感染HPV的孕妇和临床医生安心。置信度较低的研究结果将有助于确定HPV与妊娠结局关系方面当前存在的知识空白，这些空白需要进一步研究。
PROSPERO CRD42016033425。
