Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
BMC Pregnancy Childbirth. 2019 Aug 19;19(1):302. doi: 10.1186/s12884-019-2425-1.
To assess whether the peri-conceptional or pregnancy exposure of human papillomavirus (HPV) vaccination would increase the risk of spontaneous abortion.
We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for clinical trials and observational studies that investigated the association between exposure of HPV vaccines (2vHPV, 4vHPV or 9vHPV) during peri-conceptional period or pregnancy and spontaneous abortion before 28 gestational weeks. We pooled data from 2vHPV, 4vHPV and 9vHPV separately. Subgroup analyses were conducted according to data sources, and raw data or adjusted data.
Seven observational studies were eligible and all studies were low risk of bias. Meta-analyses suggested that 2vHPV vaccination did not increase the risk of spontaneous abortion regardless of exposure period during 90 days before last menstrual period (LMP) or pregnancy: risk ratio, 95% confidence intervals (RR, 95% CI), 1.15 (0.95-1.39), and 45 days before LMP or pregnancy: 1.28 (0.96-1.70). However, 2vHPV vaccination during Pre-45 days to LMP seemed to increase the risk of spontaneous abortion: 1.59 (1.04-2.45). The current evidence did not support the association between 4vHPV vaccination and spontaneous abortion regardless of exposure period during 45 days before LMP or pregnancy: 0.88 (0.73-1.06); and 45 days before LMP: 1.00 (0.80-1.24). Additionally, 9vHPV during within 30 days of conception also seemed to increase the risk: 2.04 (1.28-3.24).
The association between peri-conceptional or pregnancy exposure of HPV vaccine and spontaneous abortion is still uncertain, and additional research is warranted to assess the impact of exposure of HPV vaccination on spontaneous abortion.
评估人乳头瘤病毒（HPV）疫苗的围孕期或孕期暴露是否会增加自然流产的风险。
我们检索了 PubMed、Embase 和 Cochrane 对照试验中心注册库，以寻找调查 HPV 疫苗（2vHPV、4vHPV 或 9vHPV）在围孕期或孕期暴露与 28 孕周前自然流产之间关系的临床试验和观察性研究。我们分别对 2vHPV、4vHPV 和 9vHPV 的数据进行了汇总。根据数据来源、原始数据或调整后数据进行了亚组分析。
有 7 项观察性研究符合条件，所有研究的偏倚风险均较低。Meta 分析表明，无论在末次月经前 90 天（LMP）还是孕期暴露 2vHPV 疫苗均不会增加自然流产的风险：风险比，95%置信区间（RR，95%CI），1.15（0.95-1.39）和 LMP 前 45 天：1.28（0.96-1.70）。然而，在 LMP 前 45 天至 LMP 前 Pre-45 天接种 2vHPV 疫苗似乎会增加自然流产的风险：1.59（1.04-2.45）。目前的证据并不支持 4vHPV 疫苗接种与自然流产之间的关联，无论在 LMP 前 45 天还是孕期暴露：0.88（0.73-1.06）；在 LMP 前 45 天：1.00（0.80-1.24）。此外，在受孕后 30 天内接种 9vHPV 疫苗似乎也会增加风险：2.04（1.28-3.24）。
围孕期或孕期 HPV 疫苗暴露与自然流产之间的关联仍不确定，需要进一步研究评估 HPV 疫苗暴露对自然流产的影响。
