Immunological dysregulation and adverse perinatal outcomes in pregnant women with human papillomavirus infection
Keywords:
Human papillomavirus, pregnancy, persistent HPV infection, placental abnormalities, immune dysregulation, cytokines, Neonatal outcomes, placental dysfunction.Abstract
Background and Aim: Human papillomavirus (HPV) infection during pregnancy has increasingly been associated with placental dysfunction, immune dysregulation, and adverse perinatal outcomes. However, prospective studies simultaneously evaluating immunological alterations, placental abnormalities, and neonatal outcomes in HPV-positive pregnant women remain limited. The aim of the present study was to evaluate pregnancy and perinatal outcomes in women with HPV infection and to assess the association between maternal HPV infection, placental abnormalities, immunological alterations, and adverse neonatal outcomes.
Methods: This prospective observational study included 206 pregnant women examined between 2015 and 2022 at Azerbaijan Medical University and affiliated maternity centers. According to HPV persistence status, women were divided into three groups: transient HPV infection (n=88), persistent HPV infection (n=64), and HPV-negative controls (n=54). A subgroup of 77 pregnant women underwent immunological evaluation of cervical mucus, including assessment of immunoglobulins and cytokine profiles. Placental ultrasound findings, placental morphology, obstetric complications, and neonatal outcomes were analyzed.
Results: Persistent HPV infection was associated with significant local immune dysregulation characterized by increased levels of IFN-α, IFN-γ, IL-1β, IL-2, IL-4, and IL-8, as well as elevated cervical IgG concentrations. HPV-positive women demonstrated a higher frequency of placental abnormalities, including vascular dilatation, enlargement of the intervillous space, placental calcification, and increased placental thickness. Threatened miscarriage, premature rupture of membranes, preterm delivery, and congenital fetal malformations occurred more frequently in HPV-positive pregnancies. Newborns from HPV-positive mothers additionally demonstrated lower Apgar scores.
Conclusions: Persistent HPV infection during pregnancy is associated with local immune imbalance, placental dysfunction, and adverse neonatal outcomes. Careful antenatal monitoring of HPV-positive pregnant women may improve early identification of placental abnormalities and perinatal complications.
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