Review Results Link HPV Infections With Pregnancy Outcomes

Human papillomavirus (HPV) infections positivity and some adverse pregnancy outcomes are significantly associated, along with a range of expression for children in infancy to childhood related to maternal HPV infections, according to the results of a review published in Microorganisms.

Investigators aimed to provide an overview of the epidemiology, expression, and treatment of HPV infections during both pregnancy and childhood, while also emphasizing the importance of vaccination.

In the review, investigators concluded that the prevalence of HPV in pregnant women was greater in those who were in less developed countries or those with certain disorders. Pregnancy outcomes that were significantly associated with HPV included preterm premature rupture of membranes, premature rupture of membranes, and preterm births.

Investigators also concluded that fetal death, intrauterine growth restriction, and low birth weight were significantly associated with HPV infection during pregnancy, but they said the findings include suboptimal bias control in the studies used.

HPV screening is not common practice among children, so there is limited data for inferences. However, the results of 1 study from Finland showed that of offspring born to HPV-seronegative mothers, seroconverted to HPV-positive at 21%, 38%, and 21%, for the 12-, 24-, 36-month follow-ups, respectively. Additionally, in those with HPV-seropositive mothers, the offspring ranged from 9% to 25%, 8% to 38%, and 0% to 33%, respectively.

For the presentation of HPV, the most common is verruca vulgaris, which can commonly occur on the back of hands, fingers, or knees, but can also be present in the oral cavity and genitalia.

Additionally, condyloma acuminata, which are present in the anogenital region as hyper-pigmented plaques or papules, can occur.

As a child becomes older, the less likely vertical transmission becomes, so screening for sexual abuse should be considered in all cases of anogenital or oral warts that first present in children aged 3 to 4 years or older.

Another common manifestation of HPV in children occurs as oral squamous papilloma, which are benign pink, red, or white oral lesions.

However, focal epithelial hyperplasia can also occur, but as an uncommon, benign oral disorder associated with HPV types 13, 32, or both. It can manifest as multiple small papules and white-to-pinkish plaques in the oral cavity, typically on the lower lip. It is most common in children and young adults who are of Native Alaskan or Native American descent.

Malignant mucosal lesions are also uncommon in children, with the occurrence taking approximately 5 years for individuals who are immunodeficient up to 30 years after HPV infection.

HPV 6 and 11 can also cause juvenile onset recurrent respiratory papillomatosis (JRRP), a rare disease that presents as the recurrent growth of papillomas in the upper-respiratory tract in children aged 2 to 6 years. The presentation of JRRP includes choking episodes, failure to thrive, hoarseness, and a weak cry. It has been associated with visible external genital warts in the mother and children born through the vaginal canal, firstborn children, and those born to vaccinated mothers.

Retinoblastoma is the most prevalent intraocular malignancy in children.

Because of the higher prevalence of sporadic retinoblastoma in less developed areas, it is hypothesized that this increases the risk of the infection to turn malignant investigators said.

Finally, conjunctival papillomas is also prevalent in 1% to 10% of adolescents and children but has a higher prevalence in sexually active adults aged 20 to 40 years. Conjunctival papillomas is a slowly progressive benign tumor. The number of conjunctival papillomas in each eye is higher in adolescents and children.

Although the CDC does not recommend HPV vaccination during pregnancy, the results of multiple studies indicate that there is no association between HPV and adverse pregnancy outcomes. However, in 1 trial, 172 women were vaccinated within 30 days of the estimated conception date, and investigators found that there was a higher rate of spontaneous abortion after 9-valent HPV vaccine exposures at 20% then the 4-valent vaccine exposure at 9.2%.

Reference

Ardekani A, Taherifard E, Mollalo A, Hemadi E, et al. Human papillomavirus infection during pregnancy and childhood: a comprehensive review. Microorganisms. 2022;10(10):1932. doi: 10.3390/microorganisms10101932