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Risk factors for placental human papillomavirus infection
  1. Joseph Niyibizi1,2,
  2. Marie-Hélène Mayrand3,4,
  3. Francois Audibert5,
  4. Patricia Monnier6,
  5. Paul Brassard7,
  6. Louise Laporte2,
  7. Julie Lacaille4,
  8. Monica Zahreddine2,
  9. Marie-Josée Bédard3,
  10. Isabelle Girard8,
  11. Diane Francoeur5,
  12. Ana Maria Carceller9,
  13. Jacques Lacroix9,
  14. William Fraser10,
  15. François Coutlée11,12,
  16. Helen Trottier1,2
  17. The HERITAGE study group
    1. 1Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
    2. 2Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
    3. 3Department of Obstetrics and Gynecology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
    4. 4Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
    5. 5Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
    6. 6Department of Obstetrics and Gynecology, McGill University and Research Institute of the McGill University Health Center, Montreal, Canada, Montreal, Quebec, Canada
    7. 7Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
    8. 8Department of Obstetrics and Gynecology, St-Mary’s Hospital Center, Montreal, Quebec, Canada
    9. 9Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
    10. 10Department of Obstetrics and Gynecology, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, Sherbrooke, Quebec, Canada
    11. 11Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montreal, Quebec, Canada
    12. 12Départements de clinique de Médecine de laboratoire et de Médecine, Services de biologie moléculaire et d’infectiologie, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
    1. Correspondence to Dr Helen Trottier, Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada; helen.trottier{at}umontreal.ca

    Abstract

    Objective Human papillomavirus (HPV) has been associated with adverse pregnancy outcomes but placental HPV infection has been rarely studied. The objective was to determine the proportion of HPV-positive placentas and the associated risk factors among HPV-positive women during pregnancy.

    Methods We analysed data from pregnant women enrolled in HERITAGE cohort study between 2010 and 2016 with positive vaginal HPV infection during the first trimester of pregnancy (n=354). Placental swabs and biopsies were collected. HPV genotyping was performed using Linear Array. The predictors of placental HPV detection were identified by generalised estimating equations models.

    Results HPV was detected in 78 placentas (22.0%) (one among 96 caesarean sections and 77 among 258 vaginal deliveries). Overall, 91% of HPV-positive placentas were positive for a genotype that was detected in vaginal samples during pregnancy. Among women who delivered vaginally, abnormal cytology (adjusted OR (aOR) 1.78 (95% CI 1.02 to 3.10)), other genitourinary infection (aOR 2.41 (95% CI 1.31 to 4.44)), presence of multiple HPV genotypes in the first trimester (aOR 2.69 (95% CI 1.76 to 4.12)) and persistence of high-risk HPV infections during pregnancy (HPV-16/18: aOR 3.94 (95% CI 2.06 to 7.55) and other than HPV-16/18: aOR 2.06 (95% CI 1.05 to 4.02)) were independently associated with placental HPV.

    Conclusions HPV was frequently detected in the placenta of women who delivered vaginally and may be associated with host immune response characteristics.

    • risk factors
    • predictors
    • pregnancy

    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Handling editor Francesca Ceccherini-Silberstein

    • Collaborators The HERITAGE study group: Helen Trottier (Principal Investigator); co-investigators: Marie-Hélène Mayrand, François Coutlée, Patricia Monnier, William Fraser, Ana Maria Carceller, Paul Brassard, Jacques Lacroix, Diane Francoeur; site investigators: Marie-Josée Bédard, Isabelle Girard, François Audibert; study managers: Louise Laporte, Joseph Niyibizi, Monica Zahreddine.

    • Contributors All authors have directly contributed to the conception and design (HT, M-HM, FC, FA, PB, M-JB, IG, DF, AMC, JL, WF, FC, JN, LL, MZ) or acquisition of data (JN, LL, MZ, HT) or analysis and interpretation (JN, HT, M-HM) of the study. JN, HT and M-HM wrote the first draft of the manuscript. All authors have subsequently read, revised and approved the version that is being submitted.

      HT is responsible for the overall content as the guarantor and had the full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This work was supported by a grant from the Canadian Institutes of Health Research (CIHR) (Grant MOP-93564 and MOP-136833) to HT. HT holds a salary award (chercheur-boursier) from the Fonds de la recherche du Québec en santé (FRQ-S), and from CIHR (new investigator salary award). M-HM held a salary award (chercheur-boursier clinicien) from the FRQ-S for the duration of this study. Funding for quality control of HPV testing was provided in part by the Réseau FRQS SIDA-MI to FC. PM was supported by the Research Institute of the McGill University Health Centre (start-up funds). WF holds a Tier 1 Canada Research Chair.

    • Competing interests FC has received grants to evaluate HPV detection tests through his institution from Becton-Dickson and Roche Molecular systems. HT has received occasional lecture fees from Merck and unrestricted grants form ViiV Healthcare. All other coauthors have no conflict of interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.