High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

• Published in: British journal of cancer Vol. 87; no. 1; pp. 75 - 80
• Main Authors: NOBBENHUIS, M. A. E, HELMERHORST, T. J. M, VAN DEN BRULE, A. J. C, ROZENDAAL, L, BEZEMER, P. D, VOORHORST, F. J, MEIJER, C. J. L. M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.07.2002
• Subjects: Adult; Biological and medical sciences; Biopsy; Cancer research; Cellular biology; Cervical cancer; DNA, Viral - analysis; Epidemiology; Female; Gynecology. Andrology. Obstetrics; Human papillomavirus; Humans; Immune System - physiology; Management. Prenatal diagnosis; Medical research; Medical sciences; Middle Aged; Molecular and Cellular Pathology; Papillomaviridae - immunology; Papillomaviridae - pathogenicity; Papillomavirus Infections - epidemiology; Papillomavirus Infections - immunology; Polymerase Chain Reaction; Postpartum Period - immunology; Pregnancy; Pregnancy Complications, Infectious - immunology; Pregnancy Complications, Infectious - virology; Pregnancy Trimester, First - immunology; Pregnancy Trimester, Second - immunology; Pregnancy. Fetus. Placenta; Prevalence; Trends; Tumor Virus Infections - epidemiology; Tumor Virus Infections - immunology; Womens health; Netherlands; Infection; Papillomavirus; Virus; Pregnancy; Human; Human papillomavirus; Follow up study; Viral disease; Papovaviridae; Clearance; Puerperium
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6600367

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.