AUTHOR=Yan Xiaoli , Li Hongyu , Song Bin , Huang Ge , Chang Qing , Wang Dan , Yan Ping 

TITLE=Association of periconceptional or pregnancy exposure of HPV vaccination and adverse pregnancy outcomes: a systematic review and meta-analysis with trial sequential analysis

JOURNAL=Frontiers in Pharmacology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1181919

DOI=10.3389/fphar.2023.1181919

ISSN=1663-9812

ABSTRACT=<p><bold>Objective:</bold> To evaluate whether periconceptional or pregnancy exposure of human papillomavirus (HPV) vaccination would increase the risk of adverse pregnancy outcomes.</p><p><bold>Methods:</bold> The PubMed, Web of Science, Embase, the Cochrane Library of clinical trials were searched from inception to March 2023. We computed relative risk (RR) and 95% confidence intervals (CIs) and prediction intervals (PIs) regarding the association between HPV vaccination in periconceptional period or during pregnancy and the risks of adverse pregnancy outcomes by using R software Version 4.1.2 and STATA Version 12.0. A trial sequential analysis (TSA) was performed with TSA v0.9.5.10 Beta software.</p><p><bold>Results:</bold> Four randomized controlled trials (RCTs) and eight cohort studies were included in this meta-analysis. Analysis of RCTs showed that HPV vaccination in periconceptional period or during pregnancy did not increase the risks of spontaneous abortion (RR = 1.152, 95% CI: 0.909–1.460, 95% PI: 0.442–3.000), birth defects (RR = 1.171, 95% CI: 0.802–1.709, 95% PI: 0.320–4.342), stillbirth (RR = 1.053, 95% CI: 0.616–1.800, 95% PI: 0.318–3.540), preterm birth (RR = 0.940, 95% CI: 0.670–1.318) and ectopic pregnancy (RR = 0.807, 95% CI: 0.353–1.842, 95% PI: 0.128–5.335). In cohort studies, periconceptional or pregnancy exposures of HPV vaccine were not associated with the increased risk of spontaneous abortion (RR = 0.987, 95% CI: 0.854–1.140, 95% PI: 0.652–1.493), birth defects (RR = 0.960, 95% CI: 0.697–1.322, 95% PI: 0.371–2.480), stillbirth (RR = 1.033, 95% CI: 0.651–1.639, 95% PI: 0.052–21.064), small size for gestational age (SGA) (RR = 0.971, 95% CI: 0.873–1.081, 95% PI: 0.657–1.462) and preterm birth (RR = 0.977, 95% CI: 0.874–1.092, 95% PI: 0.651–1.444).</p><p><bold>Conclusion:</bold> HPV vaccine exposures in periconceptional period or during pregnancy did not increase the risks of adverse pregnancy outcomes, including spontaneous abortion, birth defects, stillbirth, SGA, preterm birth and ectopic pregnancy.</p><p><bold>Systematic Review Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>, identifier CRD42023399777.</p>