Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China.
Acta Obstet Gynecol Scand. 2024 Oct;103(10):1943-1954. doi: 10.1111/aogs.14881. Epub 2024 Aug 6.
The human papillomavirus (HPV) vaccine is crucial in preventing cervical cancer, and a significant number of women in 135 countries worldwide may have unknowingly received the vaccine during peri-pregnancy or pregnancy due to a lack of regular pregnancy testing. Previous studies on the safety of pregnancy outcomes with vaccination before and after pregnancy have not reached definitive conclusions. Thus, we subdivided the vaccination time frame and conducted an updated study to further examine whether exposure to the HPV vaccine during pregnancy or the periconceptional period increases the likelihood of adverse pregnancy outcomes.
The clinical trials and cohort studies published before August 1, 2023, were retrieved from PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The Newcastle-Ottawa Scale and Cochrane risk of bias assessment tool were adopted to evaluate the risk of bias in the included studies. In addition, the quality assessment was carried out using the Review Manager 5.4 Software, and a meta-analysis was conducted using the Stata 16 Software.
Eleven studies were located. The results showed that receiving 4vHPV during the periconceptional or gestational period had no relationship with an increased risk of spontaneous abortion, stillbirth, preterm birth, birth defects, small for gestational age, and ectopic pregnancy. Neither receiving 2vHPV nor 9vHPV was associated with a higher risk of stillbirth, preterm birth, birth defects, small for gestational age, and ectopic pregnancy; however, receiving 2vHPV during the period from 45 days before last menstrual period (LMP) to LMP and 9vHPV during the period from 90 days before LMP to 45 days after LMP seemed to be related to an increased risk of spontaneous abortion (RR = 1.59, 95% CI: 1.04-2.45, RR = 2.04, 95% CI: 1.28-3.24).
In conclusion, the likelihood of an elevated risk of spontaneous abortion caused by HPV vaccination during the periconceptional or gestational period could not be completely ruled out. Given the lack of evidence, further research is needed to examine the effect of HPV vaccination on spontaneous abortion.
人乳头瘤病毒（HPV）疫苗在预防宫颈癌方面至关重要，由于缺乏定期妊娠检测，全球 135 个国家的许多女性可能在围孕期或孕期无意中接种了该疫苗。此前关于妊娠前后接种疫苗对妊娠结局安全性的研究尚未得出明确结论。因此，我们将接种时间细分，并进行了一项更新的研究，以进一步探讨孕期或围孕期接种 HPV 疫苗是否会增加不良妊娠结局的可能性。
检索了 2023 年 8 月 1 日前在 PubMed、Embase、Web of Science 和 Cochrane 对照试验中心注册库发表的临床试验和队列研究。采用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险评估工具评估纳入研究的偏倚风险。此外，使用 Review Manager 5.4 软件进行质量评估，并使用 Stata 16 软件进行荟萃分析。
共检索到 11 项研究。结果表明，在围孕期或妊娠期接种 4vHPV 与自然流产、死胎、早产、出生缺陷、小于胎龄儿和异位妊娠的风险增加无关。接种 2vHPV 或 9vHPV 均与死胎、早产、出生缺陷、小于胎龄儿和异位妊娠的风险增加无关；然而，在最后一次月经（LMP）前 45 天至 LMP 期间接种 2vHPV 和在 LMP 前 90 天至 LMP 后 45 天期间接种 9vHPV 似乎与自然流产的风险增加有关（RR=1.59，95%CI：1.04-2.45，RR=2.04，95%CI：1.28-3.24）。
综上所述，不能完全排除 HPV 疫苗在围孕期或孕期接种导致自然流产风险增加的可能性。鉴于证据不足，需要进一步研究 HPV 疫苗对自然流产的影响。
