Association between Cervical Dysplasia and Adverse Pregnancy Outcomes

Abstract

Objective The aim of this study was to determine if cervical dysplasia during pregnancy is associated with pregnancy complications, including preterm delivery and pre-eclampsia.

Study Design A retrospective cohort analyses was performed with propensity-score matching to compare complication rates between pregnant women without history of abnormal cervical cancer screening and pregnant women referred for cervical dysplasia assessment to colposcopy clinic. A composite outcome of pregnancy complications included intra-amniotic infection, preterm premature rupture of membranes, pre-eclampsia, preterm delivery, low birth weight, oligohydramnios, and intrauterine fetal demise. Complication rates were compared between women with and without cervical dysplasia using logistic regression models.

Results Overall cohort included 2,814 women, 279 of whom attended colposcopy clinic for cervical dysplasia assessment. Propensity score–matched cohort included 1,459 women, 274 of whom attended colposcopy clinic. Composite complications of pregnancy rates were not significantly different between control and colposcopy groups in both cohorts (25.3% and 29.0%, P = 0.20; 26.5% and 29.3%, P = 0.45). Dysplasia was not associated with composite pregnancy complications in overall and matched cohorts (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.77–1.56) and (OR = 1.03, 95% CI: 0.72–1.49). When cervical dysplasia was determined on biopsy or colposcopy, dysplasia was not associated with complications in the overall and matched cohorts.

Conclusion Biopsy and/or colposcopy determined cervical dysplasia during pregnancy was not associated with pregnancy complications.

Keywords

cervical dysplasia - colposcopy - human papillomavirus - pregnancy

• References

• 1 Bonde U, Joergensen JS, Mogensen O, Lamont RF. The potential role of HPV vaccination in the prevention of infectious complications of pregnancy. Expert Rev Vaccines 2014; 13 (11) 1307-1316
• 2 Mazzoni SE, Bienenfeld SL, Krull MB, Metz TD, Alston MJ. Perinatal high-grade cervical cytology: a case series from a safety net institution. J Low Genit Tract Dis 2015; 19 (04) 329-332
• 3 Eppel W, Worda C, Frigo P, Ulm M, Kucera E, Czerwenka K. Human papillomavirus in the cervix and placenta. Obstet Gynecol 2000; 96 (03) 337-341
• 4 Ruffin IV MT, Bailey JM, Roulston D. , et al. Human papillomavirus in amniotic fluid. BMC Pregnancy Childbirth 2006; 6: 28
• 5 Sarkola ME, Grénman SE, Rintala MA, Syrjänen KJ, Syrjänen SM. Human papillomavirus in the placenta and umbilical cord blood. Acta Obstet Gynecol Scand 2008; 87 (11) 1181-1188
• 6 Weyn C, Thomas D, Jani J. , et al. Evidence of human papillomavirus in the placenta. J Infect Dis 2011; 203 (03) 341-343
• 7 Uribarren-Berrueta O, Sánchez-Corona J, Montoya-Fuentes H, Trujillo-Hernández B, Vásquez C. Presence of HPV DNA in placenta and cervix of pregnant Mexican women. Arch Gynecol Obstet 2012; 285 (01) 55-60
• 8 Rombaldi RL, Serafini EP, Mandelli J, Zimmermann E, Losquiavo KP. Transplacental transmission of human papillomavirus. Virol J 2008; 5: 106
• 9 Koskimaa HM, Waterboer T, Pawlita M, Grénman S, Syrjänen K, Syrjänen S. Human papillomavirus genotypes present in the oral mucosa of newborns and their concordance with maternal cervical human papillomavirus genotypes. J Pediatr 2012; 160 (05) 837-843
• 10 Freitas AC, Mariz FC, Silva MA, Jesus AL. Human papillomavirus vertical transmission: review of current data. Clin Infect Dis 2013; 56 (10) 1451-1456
• 11 Hahn HS, Kee MK, Kim HJ. , et al. Distribution of maternal and infant human papillomavirus: risk factors associated with vertical transmission. Eur J Obstet Gynecol Reprod Biol 2013; 169 (02) 202-206
• 12 Jach R, Galarowicz B, Huras H. , et al. Vertical transmission of HPV in pregnancy. A prospective clinical study of HPV-positive pregnant women. Ginekol Pol 2014; 85 (09) 672-676
• 13 Gomez LM, Ma Y, Ho C, McGrath CM, Nelson DB, Parry S. Placental infection with human papillomavirus is associated with spontaneous preterm delivery. Hum Reprod 2008; 23 (03) 709-715
• 14 Zuo Z, Goel S, Carter JE. Association of cervical cytology and HPV DNA status during pregnancy with placental abnormalities and preterm birth. Am J Clin Pathol 2011; 136 (02) 260-265
• 15 Skoczyński M, Goździcka-Józefiak A, Kwaśniewska A. Prevalence of human papillomavirus in spontaneously aborted products of conception. Acta Obstet Gynecol Scand 2011; 90 (12) 1402-1405
• 16 He Y, Wu YM, Wang T, Song F, Wang Y, Zhu L. Perinatal outcomes of pregnant women with cervical intraepithelial neoplasia. Arch Gynecol Obstet 2013; 288 (06) 1237-1242
• 17 Kwon JY, Romero R, Mor G. New insights into the relationship between viral infection and pregnancy complications. Am J Reprod Immunol 2014; 71 (05) 387-390
• 18 Slatter TL, Hung NG, Clow WM, Royds JA, Devenish CJ, Hung NA. A clinicopathological study of episomal papillomavirus infection of the human placenta and pregnancy complications. Mod Pathol 2015; 28 (10) 1369-1382
• 19 You H, Liu Y, Agrawal N. , et al. Multiple human papillomavirus types replicate in 3A trophoblasts. Placenta 2008; 29 (01) 30-38
• 20 You H, Liu Y, Carey MJ, Lowery CL, Hermonat PL. Defective 3A trophoblast-endometrial cell adhesion and altered 3A growth and survival by human papillomavirus type 16 oncogenes. Mol Cancer Res 2002; 1 (01) 25-31
• 21 Boulenouar S, Weyn C, Van Noppen M. , et al. Effects of HPV-16 E5, E6 and E7 proteins on survival, adhesion, migration and invasion of trophoblastic cells. Carcinogenesis 2010; 31 (03) 473-480
• 22 Hong LJ, Oshiro BT, Chan PJ. HPV-16 exposed mouse embryos: a potential model for pregnancy wastage. Arch Gynecol Obstet 2013; 287 (06) 1093-1097
• 23 Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev 2003; 16 (01) 1-17
• 24 Ho DE, Imai K, King G, Stuart E. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 2011; 42: 1-28
• 25 Venables WN, Ripley BD. Modern Applied Statistics with S. 4th ed. New York: Springer-Verlag; 2002