Aldhous Marian C, Bhatia Ramya, Pollock Roz, Vragkos Dionysis, Cuschieri Kate, Cubie Heather A, Norman Jane E, Stock Sarah J
Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, UK.
HPV Research Group, Division of Pathology, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK.
Wellcome Open Res. 2019 Mar 8;4:48. doi: 10.12688/wellcomeopenres.15140.1. eCollection 2019.
We aimed to investigate whether infection with high-risk (HR) types of human papilloma virus (HPV) or HPV-associated cervical disease were associated with preterm birth (<37 weeks gestation). In a sub-group of younger women who were eligible for the HPV vaccine, we aimed to determine whether prior vaccination against the specific HPV-types, HPV-16 and -18 modified preterm birth risk. This was a data-linkage study, which linked HPV-associated viral and pathological information (from the Scottish HPV Archive) from women aged 16-45 years to routinely collected NHS maternity- and hospital-admission records from 1999-2015. Pregnancy outcomes from 5,598 women with term live birth (≥37 weeks gestation, n=4,942), preterm birth (<37 weeks gestation, n=386) or early miscarriage (<13 weeks gestation, n=270). Of these, data from HPV vaccine-eligible women (n=3,611, aged 16-25 years) were available, of whom 588 had been vaccinated. HPV-associated disease status was defined as: HR HPV-positive no disease, low-grade abnormalities or high-grade disease. High-grade HPV-associated cervical disease was associated with preterm birth (odds ratio=1.843 [95% confidence interval 1.101-3.083], p=0.020) in adjusted binary logistic regression analysis, in all women, but there were no associations with HR HPV-infection alone or with low-grade abnormalities. No associations between any HPV parameter and preterm birth were seen in vaccine-eligible women, nor was there any effect of prior vaccination. HPV-associated high-grade cervical disease was associated with preterm birth, but there were no associations with HR HPV-infection or low-grade cervical disease. Thus HPV-infection alone (in the absence of cervical disease) does not appear to be an independent risk factor for preterm birth. For women who have undergone treatment for CIN and become pregnant, these results demonstrate the need to monitor for signs of preterm birth.
我们旨在调查感染高危（HR）型人乳头瘤病毒（HPV）或HPV相关的宫颈疾病是否与早产（妊娠<37周）有关。在一组符合HPV疫苗接种条件的年轻女性亚组中，我们旨在确定先前针对特定HPV类型（HPV-16和-18）的疫苗接种是否会改变早产风险。这是一项数据关联研究，将16至45岁女性的HPV相关病毒和病理信息（来自苏格兰HPV档案库）与1999年至2015年常规收集的NHS产妇和医院入院记录相联系。5598名女性的妊娠结局包括足月活产（妊娠≥37周，n=4942）、早产（妊娠<37周，n=386）或早期流产（妊娠<13周，n=270）。其中，有符合HPV疫苗接种条件的女性（n=3611，年龄16至25岁）的数据，其中588人接种过疫苗。HPV相关疾病状态定义为：HR HPV阳性无疾病、低度异常或高度疾病。在所有女性的校正二元逻辑回归分析中，高度HPV相关的宫颈疾病与早产相关（比值比=1.843[95%置信区间1.101-3.083]，p=0.020），但单独的HR HPV感染或低度异常与之无关联。在符合疫苗接种条件的女性中，未发现任何HPV参数与早产之间存在关联，先前接种疫苗也没有任何影响。HPV相关的高度宫颈疾病与早产相关，但与HR HPV感染或低度宫颈疾病无关联。因此，单独的HPV感染（在无宫颈疾病的情况下）似乎不是早产的独立危险因素。对于接受过CIN治疗并怀孕的女性，这些结果表明需要监测早产迹象。
