Does HPV vaccination during periconceptional or gestational period increase the risk of adverse pregnancy outcomes?—An updated systematic review and meta-analysis based on timing of vaccination

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-08-06 DOI:10.1111/aogs.14881

Jiawei Zhang, Zhirun Lian, Xiaoou Xue, Jun Li, Yuying Zhu, Nian Huang, Wei Xie

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Abstract

Introduction

The human papillomavirus (HPV) vaccine is crucial in preventing cervical cancer, and a significant number of women in 135 countries worldwide may have unknowingly received the vaccine during peri-pregnancy or pregnancy due to a lack of regular pregnancy testing. Previous studies on the safety of pregnancy outcomes with vaccination before and after pregnancy have not reached definitive conclusions. Thus, we subdivided the vaccination time frame and conducted an updated study to further examine whether exposure to the HPV vaccine during pregnancy or the periconceptional period increases the likelihood of adverse pregnancy outcomes.

Material and Methods

The clinical trials and cohort studies published before August 1, 2023, were retrieved from PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The Newcastle–Ottawa Scale and Cochrane risk of bias assessment tool were adopted to evaluate the risk of bias in the included studies. In addition, the quality assessment was carried out using the Review Manager 5.4 Software, and a meta-analysis was conducted using the Stata 16 Software.

Results

Eleven studies were located. The results showed that receiving 4vHPV during the periconceptional or gestational period had no relationship with an increased risk of spontaneous abortion, stillbirth, preterm birth, birth defects, small for gestational age, and ectopic pregnancy. Neither receiving 2vHPV nor 9vHPV was associated with a higher risk of stillbirth, preterm birth, birth defects, small for gestational age, and ectopic pregnancy; however, receiving 2vHPV during the period from 45 days before last menstrual period (LMP) to LMP and 9vHPV during the period from 90 days before LMP to 45 days after LMP seemed to be related to an increased risk of spontaneous abortion (RR = 1.59, 95% CI: 1.04–2.45, RR = 2.04, 95% CI: 1.28–3.24).

Conclusions

In conclusion, the likelihood of an elevated risk of spontaneous abortion caused by HPV vaccination during the periconceptional or gestational period could not be completely ruled out. Given the lack of evidence, further research is needed to examine the effect of HPV vaccination on spontaneous abortion.

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围孕期或妊娠期接种 HPV 疫苗是否会增加不良妊娠结局的风险？

导言：人类乳头瘤病毒（HPV）疫苗对预防宫颈癌至关重要，而由于缺乏定期的孕期检测，全球 135 个国家的大量妇女可能在围孕期或怀孕期间在不知情的情况下接种了该疫苗。以往关于妊娠前后接种疫苗对妊娠结局安全性的研究尚未得出明确结论。因此，我们对接种时间段进行了细分，并开展了一项最新研究，以进一步探讨在孕期或围孕期接种HPV疫苗是否会增加不良妊娠结局的可能性：从 PubMed、Embase、Web of Science 和 Cochrane Central Register of Controlled Trials 中检索 2023 年 8 月 1 日之前发表的临床试验和队列研究。采用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险评估工具来评估纳入研究的偏倚风险。此外，还使用 Review Manager 5.4 软件进行了质量评估，并使用 Stata 16 软件进行了荟萃分析：结果：共找到 11 项研究。结果显示，在围孕期或妊娠期接受 4vHPV 与自然流产、死胎、早产、出生缺陷、胎龄小和宫外孕风险增加没有关系。接受 2vHPV 或 9vHPV 均与死胎、早产、出生缺陷、胎龄小和宫外孕风险增加无关；然而，在末次月经前 45 天至末次月经前 45 天期间接受 2vHPV 以及在末次月经前 90 天至末次月经后 45 天期间接受 9vHPV 似乎与自然流产风险增加有关（RR = 1.59，95% CI：1.04-2.45，RR = 2.04，95% CI：1.28-3.24）：总之，不能完全排除在围孕期或妊娠期接种 HPV 疫苗导致自然流产风险升高的可能性。鉴于证据不足，需要进一步研究接种 HPV 疫苗对自然流产的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.