High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum.
We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 non-pregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any difference between high-risk human papilloma virus clearance in pregnant and non-pregnant women? Women were monitored 3-4 monthly by cytology, colposcopy, and high-risk human papilloma virus testing. The median follow-up time was 33 months (range 3-74). Non-pregnant women showed prevalence rates of high-risk human papilloma virus of 64, 57, 53, and 50%, respectively, in four subsequent 3-months periods since the start of the study. These high-risk human papilloma virus rates were higher than in the three trimesters of pregnancy, and during the first 3 months postpartum, i.e. 50, 44, 45, and 31%, respectively. Postpartum only, this difference was statistically significant (P=0.004). Paired comparisons of high-risk human papilloma virus prevalence rates of the different trimesters with the postpartum rate showed (McNemar test) decreased rates: first trimester: 18% (P=0.02), second trimester: 13% (P=0.02) and third trimester: 23% (P<0.005). Such a phenomenon was not found in non-pregnant women. Pregnant women showed a trend for increased high-risk human papilloma virus clearance during the third trimester and postpartum compared to non-pregnant women (hazard ratios 3.3 (0.8-13.7) and 4.6 (1.6-12.8), respectively). These results suggest a lowered immune-response against human papilloma virus during the first two trimesters of pregnancy with a catch-up postpartum.
Nobbenhuis
M A E
MA
Department of Pathology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Helmerhorst
T J M
TJ
van den Brule
A J C
AJ
Rozendaal
L
L
Bezemer
P D
PD
Voorhorst
F J
FJ
Meijer
C J L M
CJ
D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007107:Immune System / Q000502:physiology; D008875:Middle Aged; D027383:Papillomaviridae / Q000276:immunology / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000276:immunology*; D016133:Polymerase Chain Reaction; D049590:Postpartum Period / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology* / Q000821:virology*; D011261:Pregnancy Trimester, First / Q000276:immunology; D011262:Pregnancy Trimester, Second / Q000276:immunology; D015995:Prevalence; D014412:Tumor Virus Infections / Q000453:epidemiology / Q000276:immunology*
D004279:DNA, Viral