Vertical transmission of HPV in pregnancy. A prospective clinical study of HPV-positive pregnant women

Abstract

Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection. Data reporting vertical transmission of HPV from the mother to the fetus are inconsistent and scant. Vertical transmission may occur by hematogenic route (transplacental), or by ascending contamination, or through the birth canal, which may result in the dreaded and rare laryngeal papillomatosis. Infected sperm at fertilization is a potential route of infection, too. Objective: The objective of the study was to evaluate the rate of vertical transmission of HPV in HPV-positive pregnant women to their newborn infants, as well as the risk factors of HPV vertical transmission. Material and methods: The clinical material was provided by 136 pregnant women, aged 18-45 years. Out of this group, 30 (22.05%) women with abnormal Pap test and positive DNA HPV test were prospectively observed. Neonatal status, i.e. DNA HPV from the nasopharyngeal smear, was recorded in all infants during the perinatal period. The conventional Pap test was performed with the cervix brush in all women. The Bethesda 2011 classification system was applied. Results: An average C Reactive Protein (CRP) concentration in the studied pregnant women was 11.6083 (Std Dev – 12.93). The most frequent cytological findings in the cervical smears from the examined women were ASCUS, n=13 (43.3%), then – LSIL, n=10 (33.3%), HSIL- n=5 (16.7%) and AGC- n=2 (6.7%). In the neonates, the presence of LR HPV DNA was detected in 9 cases (30.0%) and HR HPV DNA in 7 cases (23.3%). Fourteen neonates (46.7%) tested HPV DNA negative in the perinatal period. Conclusions: HPV infection (incidental or chronic) is observed in approximately 22% of pregnant women from the Małopolska province. Neonatal HPV infection in HPV-positive women was observed in 53.3% of the subjects. CRP concentration > 10 mg/dl in the serum of pregnant women statistically significantly (p 0.001) reduces the risk of vertical transmission of HPV from the mother to the fetus.