Cervical human papillomavirus deoxyribonucleic acid persists throughout pregnancy and decreases in the postpartum period,☆☆,

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Abstract

Objective: Our goal was to determine the persistence of human papillomavirus infection of the cervix in a prospectively evaluated cohort of pregnant women observed from the first trimester until after delivery. Study Design: A group of 232 women were enrolled in the first trimester of pregnancy and had cervico-vaginal lavage specimens collected for detection of the deoxyribonucleic acid of human papillomavirus. They underwent sampling again in the third trimester (146 patients available) and at 4 to 12 weeks after delivery (83 patients available). Human papillomavirus deoxyribonucleic acid was detected by means of the Hybrid Capture assay. Results: In the first trimester of pregnancy, 31% of the patients had positive test results for human papillomavirus deoxyribonucleic acid, whereas 35.6% had positive results in the third trimester (P = 1.0). A comparison of first-trimester test results with postpartum results (paired data available from 83 patients) showed a decline from 39.8% positivity to 26.5% (P = .04). Comparing third-trimester results with postpartum results (paired data available from 74 patients) showed a decline from 35.1% to 25.7% positivity (P = .12). When specimens positive for human papillomavirus were divided between those containing “high cancer risk” types (9 virus types often associated with dysplasia or malignancy) and “low cancer risk” types (5 types usually found in benign lesions), similar trends were seen, although not all comparisons were statistically significant. Conclusion: The increased prevalence, during pregnancy, of detectable human papillomavirus deoxyribonucleic acid, which was previously reported (Fife et al, Am J Obstet Gynecol 1996;174:1487-93), persists at a similar level throughout pregnancy but declines in the postpartum period. This observation is most consistent with activation of the virus by the physiologic changes of pregnancy. (Am J Obstet Gynecol 1999;180:1110-4.)

Section snippets

Patients and specimens

Details of the patient populations and specimens collected are contained in our previous report.11 This report contains data derived only from the cohort of pregnant patients. Written informed consent was obtained from all patients in accordance with US Department of Health and Human Services guidelines and with the use of a document approved by the Indiana University–Purdue University at Indianapolis Committee on Protection of Human Subjects. All patients were ≥18 years old and were enrolled

Patient characteristics

As previously reported,11 245 pregnant women were enrolled in the first trimester of pregnancy and complete data were available for 232. Paired results from the first and third trimesters were available for 146 patients, results comparing the first-trimester and postpartum periods were available for 83 patients, and results comparing the third-trimester and postpartum periods were available for 74 patients. The demographic and behavioral characteristics of the patients initially enrolled, those

Comment

The concept that HPV infections are more prominent in pregnancy is one that many clinicians accept on the basis of clinical experience.15 Most of the clinical experience is based on observations of external genital warts, but it is logical that HPV infection at other sites (such as the cervix) would be similarly influenced. Although many published reports attempting to document this phenomenon in a more controlled fashion have been consistent with the anecdotal observation,1, 2, 3, 4, 7, 11, 12

Acknowledgements

We thank Judy Roush, RNC, for her assistance in the collection of specimens and information.

References (20)

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Supported by grant AI31494 (Project 4) from the National Institute of Allergy and Infectious Diseases.

☆☆

Reprint requests: Kenneth H. Fife, MD, PhD, 545 Barnhill Dr, Emerson Hall 435, Indianapolis, IN 46202-5124.

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