HPV in Pregnancy: Implications for Screening, Vaccination, and Maternal-Fetal Health.

Abstract

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. It is highly prevalent among women of reproductive age. During pregnancy, hormonal changes and immunological modulation may promote viral persistence, thus likely increasing the risk of adverse maternal and neonatal outcomes. However, the clinical significance of HPV infection in pregnancy remains incompletely understood. This qualitative thematic analysis is aimed at evaluating the epidemiological and clinical impact of HPV during pregnancy, focusing on pathophysiological mechanisms, diagnostic challenges, obstetric and perinatal outcomes, and gaps in clinical management. A comprehensive literature search of PubMed and Scopus was conducted for peer-reviewed original studies published in the last 10 years in English. The review followed PRISMA 2020 guidelines. Of 1667 records initially identified, 34 studies met the inclusion criteria and were included in the qualitative synthesis. Study quality was assessed using the Newcastle-Ottawa Scale. Given the heterogeneity of study designs and outcomes, a thematic narrative synthesis was performed. Four major themes emerged: (1) pregnancy-related immunological, hormonal, and microbiome changes that facilitate HPV persistence; (2) diagnostic challenges arising from physiological cervical changes that affect cytology and colposcopy accuracy; (3) associations between maternal HPV infection and adverse outcomes such as preterm birth, premature rupture of membranes, miscarriage, low birth weight, and vertical transmission; and (4) disparities in screening and vaccination policies between high-income countries and low- and middle-income countries. While HPV is not directly teratogenic, evidence suggests it may indirectly compromise placental function and the integrity of the cervix. In conclusion, HPV infection during pregnancy is a clinically relevant concern with potential implications for both maternal and fetal health. Standardized screening strategies, improved vaccination coverage, and longitudinal studies are needed to guide evidence-based clinical practice and policy development.