(1018) The association between active human papillomavirus infection and cytologic abnormalities during pregnancy with preterm birth

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Human papillomavirus infection (HPV) and pregnancy result in cervical remodeling. The objective was to determine if HPV with or without cytologic abnormalities during pregnancy was associated with preterm birth (PTB) < 37 weeks. Secondary outcomes included future cytologic results and need for definitive intervention 3 years after screening as some agencies have proposed the use of HPV only testing to screen.

Study Design: This was a prospective cohort study with chart review of individuals with a singleton pregnancy who sought care and delivered at two safety-net hospitals in Texas from January 2017-December 2021 and underwent HPV and cytology screening during pregnancy. Demographic and obstetrical variables were recorded. Screening results were categorized into 4 groups: 1: normal cytology, negative HPV, 2: normal cytology, positive HPV, 3: abnormal cytology, negative HPV, and 4: abnormal cytology, positive HPV. Differences between groups were examined using chi-square or Fisher’s exact test. Multivariable regression models were used to calculate adjusted relative risk (aRR) with 95% confidence intervals (CI).

Results:

Of 712 patients who met inclusion criteria , 44% (n=314) were in Group 1, 33% (n=236) in Group 2, 12% (n=83 Group 3, and 11% (n=79) in Group 4. The overall rate of PTB was 13% (n= 89). After multivariable adjustment, there was no significant difference in the rate of PTB among the 4 groups (Table 1). Individuals with abnormal cytology were more likely to have abnormal follow-up results and a diagnostic excisional procedure (DEP). Compared to Group 1, the rate of abnormal follow-up cytology was higher in Group 3 (aRR 1.50 95% CI [1.09-2.06]) and Group 4 (aRR 1.50 95%CI [1.08-2.08]). Similarly, the rate of follow-up DEP was higher in Group 3 (aRR 3.39 95% CI [1.62-7.09]) and group 4 (aRR 2.49 95% CI [1.15-5.43])(Table 2).

Conclusion: There was no association between abnormal cytology or HPV infection and PTB. There was an increased rate of future abnormal cytology and DEP in people with abnormal cytology during pregnancy irrespective of HPV status, supporting cytology based screening.

Primary & Presenting Author(s)

Ipsita Ghose, DO
Department of Obstetrics, Gynecology, and Reproductive Services McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States

Coauthor(s)

MB
Miguel Bonilla Moreno, BS
Medical Student
University of Texas Health Science Center at Houston / McGovern Medical School
Houston, Texas, United States
LD
Leanne Dalal, BS
University of Texas-Houston Medical School
Houston, Texas, United States
KL
Katherine Lambert, BS
Medical Student
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
ST
Sanjna Tripathy, BS
University of Texas-Houston Medical School
Houston, Texas, United States
MA
Marjon Ahmadian-Tehrani, BS
University of Texas-Houston Medical School
Houston, Texas, United States
MA
Maria Acevedo, BS
University of Texas-Houston Medical School
Houston, Texas, United States
JM
Juan Martinez, BS
University of Texas-Houston Medical School
Houston, Texas, United States
KC
Kristen Cagino, MD
University of Texas-Houston Medical School
Houston, Texas, United States
HC
Han-Yang Chen, PhD
Department of Obstetrics, Gynecology and Reproductive Sciences
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Irene A. Stafford, MD, MS
Associate Professor
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States