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References | Country | Inclusion criteria | Gestational age at sample collection (weeks) | Examined tissue type | Sample size | HPV prevalence% | HPV detection method |
Study quality |
Study strengths | Potential biases |
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[34] | Korea | Pregnant women healthy, ≥18 years of age, sonographically confirmed intrauterine pregnancy | 1st, 2nd, or 3rd trimester or postpartum | Cervix | Total: 960 1st trimester: 380 2nd trimester: 193 3rd trimester: 195 Postpartum: 192 | Total: 24.3 1st trimester: 20.5 2nd trimester: 34.2 3rd trimester: 23.1 Postpartum: 22.9 | DNA chip | Large cohort, multivariant logistic regression analysis, separate analysis for trimesters | Sample collection at different time points, including women with abnormal pap smear |
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[35] | Korea | PD healthy, <37 weeks of gestation | 6-week postpartum | Cervix | 45 | 15.6 | HCA | Multivariant logistic regression analysis | Small sample size, postpartum sampling only, HCA sensitivity limited to 13 HPV-types |
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[36] | Mexico | SA: healthy, curettage up to week 20 ND: healthy, attending for delivery at term with viable products | SA: <20 ND: before delivery | Cervix | SA: 139 ND: 138 | SA: 24.4 ND: 15.2 | PCR | Large cohort, risk analysis | Comparison of SA (first trimester) with ND (at term), HPV-related disease history unclear |
|
[37] | Korea | Pregnant women healthy, singleton, in first trimester | Cervix: 1st, 2nd, and 3rd trimester, postpartum Placenta, umbilical cord blood: at birth | Cervix, placenta, umbilical cord blood | Cervix: 153 Placenta: 152 | Cervix: 24 Placenta: 3.3 Umbilical cord blood: 1.3 | DNA chip | Large cohort, longitudinal follow-up, multivariant logistic regression analysis | Sample collection from cervix at different time points |
|
[38] | Poland | Pregnant women singleton, normal cervical smear | 33–41 | Cervix | 135 | 16.3 | PCR | Large cohort, multivariant logistic regression analysis, confirmation by sequencing | Vaginal and cesarean deliveries included, potential contamination problem (HPV11 present in all positive samples) |
|
[23] | Korea | Pregnant women healthy, over 36 weeks of gestation | >36 | Cervix, placenta, umbilical cord blood | 469 | Cervix: 15.4 Placenta: 0 Umbilical cord blood: 0 | DNA chip | Large cohort, confirmation by in situ hybridization | Vaginal and cesarean deliveries included Umbilical cord blood and placenta were collected from HPV positive mothers |
|
[39] | China | Pregnant women healthy, asymptomatic | 22.5–26.7 | Cervix | 3139 | 13.4 | DNA chip | Large cohort, logistic regression analysis | Vaginal and cesarean deliveries included, women with abnormal cervical cytology included |
|
[40] | Netherlands | Pregnant women NA | 1st, 2nd, and 3rd trimester, postpartum | Cervix | 51 | 21.6 | PCR | Matched groups, detection method with high analytical sensitivity | Small sample size, self-sampling, sample collection at different time points |
|
[41] | Korea | Pregnant women healthy, over 36 weeks of gestation | >36 | Cervix | 291 | 18.9 | DNA chip | Large cohort, stratified analysis to test for confounding | Women with abnormal cervical cytology included, vaginal and cesarean deliveries included |
|
[42] | Finland | Pregnant women healthy, in third trimester | 3rd trimester, at birth | Cervix, placenta, umbilical cord blood | Cervix: 329 Placenta: 306 Umbilical cord: 311 | Cervix: 16.4 Placenta: 4.2 Umbilical cord blood: 3.5 | PCR | Large cohort, regression analysis, multimetrix assay for HPV detection, pap smear at baseline | — |
|
[43] | Poland | SA: healthy ND: healthy, delivering at term | SA: 6–16 ND: at birth | Aborted products of conception, placenta | SA: 51 ND: 78 | SA: 17.7 ND: 24.4 | PCR | — | Small sample size, comparison of SA with ND, HPV-related disease history unclear |
|
[44] | Mexico | Pregnant women healthy, in third trimester, delivering at term | 3rd trimester | Cervix, placenta | 72 | Cervix: 75 Placenta: 47.2 | PCR | PCR process was blinded | Potential contamination problem (HPV18 present in all positive placenta samples), vaginal and cesarean deliveries included |
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[45] | Lithuania | Pregnant women NA | 1st and 3rd trimester | Cervix | 1st trimester: 213 3rd trimester: 146 | 1st trimester: 17.8 3rd trimester: 10.3 | PCR | Large cohort, risk analysis, separate analysis for trimesters | Big proportion with history of gynecological diseases, exclusion of 67 women due to change of residency/miscarriage/ premature delivery, no inclusion and exclusion criteria, commercial HPV PCR kit |
|
[46] | Japan | Pregnant women NA | 1st, 2nd, or 3rd trimester or postpartum | Cervix | 151 | 35.8 | PCR | Large cohort, pap smear at study entry | Sample collection at different time points, unclear how and when women deliver |
|
[21] | USA | PD <37 weeks of gestation, available HPV-test results | NA | Cervix | 70 | 67.1 | HCA | Risk analysis (age, race), data from over 11 years | Sampling method and time point not mentioned, study including African Americans, HCA restricted to 13 HPV-types only |
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[47] | Turkey | Pregnant women NA | 18–22 | Cervix | 134 | 2.2 | PCR | Large cohort | 22 with abnormal ultrasound findings, other virus types being in focus, HPV-related disease history unclear, no inclusion and exclusion criteria, outpatient clinic (low socioeconomic group) |
|
[32] | Belgium | Pregnant women assigned for abdominal CVS, mainly due to high risk for chromosomal abnormalities | 11–13 | Placenta | 35 | 5.7 | PCR | Transabdominal sampling (no birth canal contamination), highly sensitive detection method, confirmation by sequencing | Small sample size, highly selected group of women, limited amount of placenta material (actual HPV prevalence higher?), HPV-related disease history unclear |
|
[48] | USA | Pregnant women healthy, in third trimester, 18 and above | 3rd trimester | Cervix | 333 | 28 | PCR | Large cohort, logistic regression analysis, confirmation by sequencing | Vaginal and cesarean deliveries included, unclear if deliveries are at term, 25% of women with history of HPV-related lesions |
|
[49] | Brazil | Pregnant women NA | 2–37 | Cervix | 371 | 35.3 | HCA | Large cohort, multivariant logistic regression analysis | Inclusion at ambulatories for patients suspected to infectious diseases, no inclusion and exclusion criteria, sample collection at different time points, women with genital warts included |
|
[50] | Brazil | Pregnant women NA | NA | Cervix | 40 | 25 | PCR | — | Small sample size, inclusion at outpatient clinic (low socioeconomic group), no inclusion and exclusion criteria, HPV-related disease history unclear, sampling time point not mentioned |
|
[51] | Spain | Pregnant women unselected | 29–33 | Cervix | 828 | 6.5 | PCR | Large cohort, multivariant logistic regression analysis | Goal to find HPV positive women for prospective cohort study on mother-to-child transmission, HPV-related disease history unclear, no inclusion and exclusion criteria, vaginal and cesarean deliveries |
|
[27] | Finland | Pregnant women third trimester | 31.6–42.5 | Placenta, Umbilical cord blood | Placenta: 306 Umbilical cord blood: 311 | Placenta: 4.2 Umbilical cord blood: 3.5 | PCR | Large cohort, multivariant regression analysis, pap smear at study entry, confirmation by sequencing | Included women delivering before week 37, part of women showing genital warts or cervical lesions, no HPV status examination before recruitment |
|
[20] | USA | PD: spontaneous, <37 weeks of gestation ND: delivering at term | PD: 21–36 ND: 37–42 | Placenta | PD: 30 ND: 30 | PD: 50 ND: 20 | PCR | Comparison of PD to ND (best possible control), confirmation by sequencing | Small sample size, study including mostly African Americans, HPV-related disease history unclear, type-specific PCR only |
|
[29] | USA | SA: singleton, in second trimester IA: singleton, for congenital anomalies or maternal medical indications | 16.7–23.6 | Placenta | SA: 84 IA: 16 | SA: 57 IA: 31 | PCR | Multivariable logistic regression analysis, comparison of SA to IA (best possible control), confirmation by sequencing | Small sample size, imbalance between cases and controls, study including African Americans, HPV-related disease history unclear, gestational age of controls being greater |
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[52] | Japan | Pregnant women healthy, unselected | 1st, 2nd, or 3rd trimester | Cervix | 1183 | 12.5 | PCR | Large cohort | HPV-related disease history unclear, sample collection at different time points |
|
[53] | USA | Pregnant women clinically indicating amniocentesis, intact membranes | NA | Amniotic fluid | 142 | 0 | PCR | Large cohort, transabdominal sampling (no birth canal contamination) | HPV-related disease history unclear, sampling time point not mentioned, highly selected group of women, unclear how/when they deliver |
|
[54] | Mexico | Pregnant women healthy | 1st, 2nd, or 3rd trimester | Cervix | 274 | 37.1 | HCA | Large cohort, unconditional/conditional logistic regression | Self-sampling, HPV-related disease history unclear, sample collection at different time points, HCA restricted to 13 HR-types |
|
[55] | China | Pregnant women asymptomatic (cervical) | 1st, 2nd, or 3rd trimester | Cervix, amniotic fluid, umbilical cord blood | 116 | Cervix: 36.2 | PCR | Large cohort | Sample collection at different time points |
|
[13] | Austria | Pregnant women healthy, uncomplicated pregnancy, undergoing cesarean section | 37.1–40.2 | Cervix, placenta, amniotic fluid, umbilical cord blood | 153 | Cervix: 36.6 Placenta: 5.2 Amniotic fluid: 0 Umbilical cord blood: 0 | HCA, PCR | Large cohort, univariant/multivariant logistic regression analysis | Highly selected group of women, placenta swabs (quality of material) |
|
[56] | USA | Pregnant women unselected | 35 and 39 | Cervix | 577 | 29 | PCR | Large cohort, logistic regression analysis, confirmation by sequencing, pap smear at study entry | No inclusion and exclusion criteria, women with history of HPV-related lesions included |
|
[28] | Croatia | SA normal cervix | 4–19 | Placenta | 108 | 7.4 | PCR | Large cohort, only women with normal cervix | 49.1% having a miscarriage before, 35.2% having abnormal karyotype, possible contamination due to curettage, positive results only with HPV16 and 18 specific primers |
|
[57] | China | Pregnant women unselected, regardless of sexual history or cervical disease | 1st, 2nd, or 3rd trimester | Cervix | 308 | 10.1 | PCR | Large cohort, confirmation by sequencing, age-matched controls | Sample collection at different time points, inclusion of women regardless of sexual history or cervical diseases |
|
[22] | Austria | Pregnant women assigned for CVS or placental biopsy | 9.6–31.3 | Cervix, placenta | Cervix: 179 Placenta: 147 | Cervix: 24.6 Placenta: 0 | HCA, PCR | Large cohort, univariant/multivariant logistic regression analysis, transabdominal sampling (no birth canal contamination) | Highly selected group of women, unusual PCR primers (E6), unclear how/when they delivered, analysis of placenta by PCR, cervix by HCA |
|
[58] | France, Switzerland, Germany | Pregnant women assigned for amniocentesis due to maternal or fetal abnormalities | 14–25 | Amniotic fluid | 238 | 12 | PCR, Southern blot | Large cohort, transabdominal sampling (no birth canal contamination), confirmation by Study strength | Highly selected group of women, HPV-related disease history unclear, samples collected in three countries, unclear how/when they deliver |
|
[59] | Italy | Pregnant women healthy, negative pap smear at first trimester | 36–39 | Cervix | 711 | 5.2 | PCR | Large cohort, pap smear at study entry, no history of HPV-related lesions | Sampling method not mentioned, vaginal and cesarean deliveries |
|
[60] | Greece | SA <20 weeks of gestation | 6–20 | Aborted product of conception | 102 | 0 | PCR | Large cohort | 11 women have had previous SA, 3 cases with other diseases, GP5/6 primer (low sensitivity?), HPV-related disease history unclear |
|
[61] | China | Pregnant women singleton | 36–40 | Cervix | 301 | 22.6 | PCR | Large cohort, confirmation by Study strength | Study including vaginal and cesarean deliveries, women with abnormal pap smear included, used specific E6 PCR primers only |
|
[62] | France, Germany | SA: NA IA: for social indication | NA | Aborted product of conception | SA: 27 IA: 1 | SA: 70.4 IA: 100 | PCR | — | Small sample size, HPV-related disease history unclear, sampling time point not mentioned, no inclusion and exclusion criteria, PCR primer with low sensitivity |
|
[63] | Italy | Pregnant women healthy, negative pap smear at entry | 36–39 | Cervix | 752 | 5.4 | PCR | Large cohort, control for confounders, logistic regression analysis, confirmation by Study strength | Sampling method not mentioned |
|
[64] | Finland | Pregnant women healthy | At birth | Cervix | 86 | 30.2 | PCR | Confirmation by Study strength and sequencing | Possible sampling error, contamination, multiple HPV infection, inclusion of women with signs of cervical HPV infection, vaginal and cesarean deliveries |
|
[18] | USA | SA and IA first trimester | 1st trimester | Aborted product of conception | SA: 25 IA: 15 | SA: 60 IA: 20 | PCR | Comparison of SA to IA (best possible control), confirmation by dot blot hybridization | Small sample size, possible contamination from cervix and vagina, HPV-related disease history unclear |
|
[65] | USA | Pregnant women healthy | NA | Cervix | 114 | 34.2 | Southern blot | Large cohort, logistic regression analysis | History of CIN not used as exclusion criteria, sampling time point not mentioned, study mostly including African Americans and Hispanics, Bronx → low socioeconomic group, Southern Blot (HPV11, 16, 18 only), unclear how/when they deliver |
|
[66] | Germany | Pregnant women uncomplicated pregnancies | 1st, 2nd, and 3rd trimester, postpartum | Cervix | 108 | 13.9 | HCA | Large cohort, logistic regression analysis, age-frequency matched controls | Specimens instead of patients, sample collection at different time points, commercial HPV detection kit (6 HPV-types only) |
|
[67] | Hungary | Pregnant women cytologically and colposcopically healthy | 1st, 3rd trimester, postpartum | Cervix | 39 | 31 | PCR | Cytologically and colposcopically healthy women | Small sample size, 8 deliveries being preterm, HPV-related disease history unclear, sample collection at different time points, outpatient clinic → low socioeconomic group |
|
[68] | USA | Pregnant women healthy, in first trimester, ≥18 years of age | 1st trimester | Cervix | 245 | 31 | HCA | Large cohort, univariant risk analysis/multiple logistic regression analysis, confirmation by Study strength | Study including African-Americans, HCA sensitivity limited to 14 HPV-types |
|