title: Effect of second pregnancy on maternal carriage and outcome of high-risk human papillomavirus (HPV). Experience from the prospective finnish family HPV study.
abstract: OBJECTIVE
  The effect of second pregnancy on human papillomavirus (HPV) carriage and outcome is modelled in longitudinal setting covering two subsequent pregnancies.
  
  
  METHODS
  Among 329 (baseline pregnant) women prospectively followed up in the Finnish Family HPV Study, two subcohorts were compiled: (i) 78 women (Group B) who became pregnant for the second time during the follow-up, and (ii) 100 women (Group A) who did not develop 2nd pregnancy. The effect of pregnancy on high-risk HPV (HR-HPV) carriage and outcome was analysed using Kaplan-Meier and Cox survival analyses and generalized estimating equation (GEE) modelling of the longitudinal data.
  
  
  RESULTS
  Women in the two groups were similar in their baseline HR-HPV status but significantly different in several known risk factors of HR-HPV infection. Group A women showed higher point prevalence of cervical and oral HR-HPV at the 36-month (p = 0.015) and 6-month (p = 0.024) follow-up visit, respectively. Among Group B women, prevalence of both cervical and oral HR-HPV significantly decreased during 2nd pregnancy (p = 0.005 and p = 0.002) as compared with inter-pregnancy period, but increased again after 2nd pregnancy. There was no difference in acquisition or clearance of cervical or oral HR-HPV between the two groups in univariate (Kaplan-Meier) or multivariate (Cox) survival analysis. In the GEE approach, 2nd pregnancy was not significantly associated with cervical or oral HR-HPV carriage or persistence when adjusted for all other covariates.
  
  
  CONCLUSIONS
  Second pregnancy is of little impact on carriage and persistence of oral and cervical HR-HPV infections in a longitudinal setting over time.
authors.affiliation: Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland.
authors.forename: Marja E
authors.initials: ME
authors.lastname: Sarkola
authors.forename: Seija E
authors.initials: SE
authors.lastname: Grénman
authors.forename: Marjut A M
authors.initials: MA
authors.lastname: Rintala
authors.forename: Kari J
authors.initials: KJ
authors.lastname: Syrjanen
authors.forename: Stina M
authors.initials: SM
authors.lastname: Syrjanen
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus; D002353:Carrier State; D005260:Female; D005387:Finland; D006801:Humans; D008137:Longitudinal Studies; D030361:Papillomavirus Infections / Q000453:epidemiology*; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*