背景:人乳头瘤病毒(HPV)疫苗对预防宫颈癌至关重要,全球135个国家的相当数量的妇女可能由于缺乏定期妊娠检测而在怀孕期间或怀孕期间在不知情的情况下接种了疫苗.先前关于妊娠前后接种疫苗的妊娠结局安全性的研究尚未得出明确的结论。因此,我们细分了疫苗接种时间范围,并进行了一项更新研究,以进一步检查在妊娠期或围药期接触HPV疫苗是否会增加不良妊娠结局的可能性.
方法:2023年8月1日之前发表的临床试验和队列研究来自PubMed,Embase,WebofScience,和Cochrane中央控制试验登记册。采用纽卡斯尔-渥太华量表和Cochrane偏倚风险评估工具对纳入研究的偏倚风险进行评估。此外,使用ReviewManager5.4软件进行质量评估,使用Stata16软件进行荟萃分析。
结果:确定了11项研究。结果显示,在围感或妊娠期接受4vHPV与自然流产风险增加无关,死产,早产,出生缺陷,小于胎龄,和异位妊娠。无论是接受2vHPV还是9vHPV都与较高的死产风险相关。早产,出生缺陷,小于胎龄,和异位妊娠;然而,在末次月经期(LMP)前45天至LMP期间接受2vHPV和在LMP前90天至LMP后45天期间接受9vHPV似乎与自然流产风险增加相关(RR=1.59,95%CI:1.04~2.45,RR=2.04,95%CI:1.28~3.24).
结论:结论:不能完全排除在观念周或妊娠期由HPV疫苗接种导致自然流产风险升高的可能性.鉴于缺乏证据,需要进一步的研究来检查HPV疫苗接种对自然流产的影响.
BACKGROUND: The human papillomavirus (HPV) vaccine is crucial in preventing cervical cancer, and a significant number of women in 135 countries worldwide may have unknowingly received the vaccine during peri-pregnancy or pregnancy due to a lack of regular pregnancy testing. Previous studies on the safety of pregnancy outcomes with vaccination before and after pregnancy have not reached definitive conclusions. Thus, we subdivided the vaccination time frame and conducted an updated study to further examine whether exposure to the HPV vaccine during pregnancy or the periconceptional period increases the likelihood of adverse pregnancy outcomes.
METHODS: The clinical trials and cohort studies published before August 1, 2023, were retrieved from PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The Newcastle-Ottawa Scale and Cochrane risk of bias assessment tool were adopted to evaluate the risk of bias in the included studies. In addition, the quality assessment was carried out using the Review Manager 5.4 Software, and a meta-analysis was conducted using the Stata 16 Software.
RESULTS: Eleven studies were located. The results showed that receiving 4vHPV during the periconceptional or gestational period had no relationship with an increased risk of spontaneous abortion, stillbirth, preterm birth, birth defects, small for gestational age, and ectopic pregnancy. Neither receiving 2vHPV nor 9vHPV was associated with a higher risk of stillbirth, preterm birth, birth defects, small for gestational age, and ectopic pregnancy; however, receiving 2vHPV during the period from 45 days before last menstrual period (LMP) to LMP and 9vHPV during the period from 90 days before LMP to 45 days after LMP seemed to be related to an increased risk of spontaneous abortion (RR = 1.59, 95% CI: 1.04-2.45, RR = 2.04, 95% CI: 1.28-3.24).
CONCLUSIONS: In conclusion, the likelihood of an elevated risk of spontaneous abortion caused by HPV vaccination during the periconceptional or gestational period could not be completely ruled out. Given the lack of evidence, further research is needed to examine the effect of HPV vaccination on spontaneous abortion.