The Effect of Human Papillomavirus Infection on Pregnancy Outcomes: A Scoping Review

Background: Human papillomavirus (HPV) is the most common sexually transmitted viral infection worldwide. Moreover, the prevalence of HPV infection is twice as high in pregnant women as in non-pregnant individuals. The aim of this review was to examine adverse pregnancy outcomes associated with cervicovaginal or placental HPV infection confirmed by a sensitive molecular method. Methods: We conducted searches on major medical databases including PubMed, EMBASE, Global Health, and the Cochrane Library to identify all studies examining HPV infection during pregnancy. Additionally, other online sources were consulted for relevant studies. Thirty-four records out of the initial 1868 identified were included in this review for thematic synthesis. The PRISMA-ScR guidelines were followed. Results: This scoping review included a total of 28 original observational studies, 1 systematic review, and 5 meta-analyses. Active HPV infection appears to significantly increase the risk of preterm premature rupture of membranes and preterm birth, as indicated by findings from published meta-analyses and systematic reviews. Determining the association of HPV infection with certain adverse pregnancy outcomes is challenging due to their frequency (such as miscarriage) or rarity (such as intrauterine fetal death). For conditions like preeclampsia and intrauterine fetal growth restriction, the limited number of heterogeneous studies precludes definitive conclusions. Moreover, the causes of these outcomes are typically multifactorial. The presence of HPV in trophoblasts and placental tissue is considered crucial for potential adverse pregnancy outcomes. There appears to be a strong correlation between cervicovaginal or urinary HPV infections and placental HPV infections in pregnant women. Conclusions: Persistent HPV infection seems to elevate the risk of preterm premature rupture of membranes and preterm birth. However, the currently available observational evidence does not allow for definitive conclusions regarding causality, and the reported findings should be interpreted as associations rather than proof of a causal relationship. The changes in frequency of certain perinatal complications in populations of women with high HPV vaccination rates may shed more light on this connection.