How Common is High-Risk HPV?
Approximately 45% of women ages 20 – 24 are infected with high-risk human papillomavirus (HPV). About 30% of women between the ages of 25 and 40 have high-risk HPV, with the percentage slightly declining among women in their forties. Indeed, high-risk HPV is a very common disease – especially among women in their child-bearing years. Women infected with high-risk HPV early in pregnancy are more than twice as likely to develop preeclampsia, according to a retrospective cohort study reported at the Pregnancy Meeting, the annual meeting of the Society for Maternal-Fetal Medicine.
“This study supports an association between high-risk human papillomavirus and preeclampsia, which is consistent with the association that was previously seen between high-risk HPV and cardiovascular disease,” lead investigator Dr. Mollie McDonnold commented. “If this is confirmed in future prospective studies or larger cohorts, it may suggest a potential role for HPV vaccination in preeclampsia prevention,” she added. Using research data and data on the population prevalence of high-risk HPV infection, the researchers estimated that if all women received the quadrivalent vaccine (which prevents about two-thirds of such infections), the rate of preeclampsia would fall from 5,189 to 5,020 cases per 100,000 women.
Preeclampsia and Hypoxia
Preeclampsia is a serious condition characterized by a rapid rise in blood pressure, leakage of protein in the urine and swelling of the legs after the 20th week of pregnancy. While the exact cause of preeclampsia is not fully understood, there is increasing evidence to suggest widespread abnormalities in the small blood vessels before the onset of preeclampsia. When capillaries are blocked or reduced in number, normal blood flow is obstructed and affected body tissues can suffer from lack of enough oxygen. This lack of oxygen (hypoxia) is thought to be the trigger of the abnormalities that cause preeclampsia.
HPV’s Effects on Pregnancy
Dr. McDonnold noted that high-risk HPV has been previously implicated in both adverse pregnancy outcomes and adverse cardiovascular outcomes. “This association between HPV and cardiovascular disease is relevant in pregnancy, as preeclampsia and cardiovascular disease share a similar pathophysiology,” including endothelial dysfunction and inflammation, as well as vascular risk factors such as obesity, hypertension, diabetes, and dyslipidemia, Dr. McDonnold elaborated. High-risk HPV causes changes in the placenta that accelerate unfavorable vascular changes. “So we believe there is a biologic plausibility to support a role of high-risk HPV and preeclampsia,” Dr. McDonnold said.
In the study, women infected with high-risk HPV had a higher rate of preeclampsia than their noninfected counterparts did. They also tended to have a higher rate of severe preeclampsia.
After adjustment for age, nulliparity, blood pressure at entry to care, and smoking, the difference corresponded to a more than doubling of the odds of preeclampsia for the high-risk HPV group, according to data reported. The women with high-risk HPV also were significantly more likely to have a spontaneous preterm birth before 37 weeks, any preterm birth before 35 weeks, and spontaneous preterm birth before 35 weeks.
Preeclampsia is the second leading cause of death during pregnancy. The condition can damage blood vessels and, if untreated, increase the risk of developing eclampsia, which can result in dangerous seizures, stroke and multiple organ failure. Preeclampsia can also cut off blood supply to the fetus and result in premature birth or even death.
The complications associated with preeclampsia include the following:
- Lack of blood flow to the placenta. Because preeclampsia can cause blood vessels to constrict, the baby may be deprived of oxygen and nutrients, which can result in slow growth, low birth weight, preterm birth and breathing difficulties for the baby. In fact, pregnancy-related hypertension is one of the leading causes of premature births, and the complications that can follow, including cerebral palsy, learning disabilities, seizures, hearing and vision problems.
- Placental abruption. Preeclampsia increases the risk of placental abruption. This is where the placenta separates from the inner wall of the uterus before delivery, causing heavy bleeding and damage to the placenta, which can be life-threatening for both the mother and the baby. An emergency C-section is the safest and quickest way to deliver the baby to prevent severe oxygen deprivation and resultant hypoxic ischemic encephalopathy.
- HELLP syndrome. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it can occur before signs or symptoms of preeclampsia appear.
- Eclampsia. When preeclampsia isn’t controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. Eclampsia can permanently damage vital organs, including the brain, liver and kidneys. Left untreated, it can cause coma, brain damage and death to the mother and baby.
- Cardiovascular disease. Having preeclampsia may increase the risk of future cardiovascular disease.
Given the serious complications associated with preeclampsia, this research is very important. It is essential for physicians to be aware of whether their pregnant patients have HPV. Since high risk HPV more than doubles the risk of developing preeclampsia, patients with high-risk HPV should be monitored very closely for the condition so that if preeclampsia occurs, treatment can be promptly initiated.
Medical Negligence and Preeclampsia
If a patient has any of the risk factors for preeclampsia, including HPV, she must be carefully monitored, and if preeclampsia develops, it is crucial that treatment begins immediately. Failure to do this is negligence. If this negligence causes injury to the mother or baby, it is medical malpractice.
Reiter and Walsh ABC Law Centers have been helping families with birth injuries for many years. Call our highly skilled attorneys for a free case review, 888-419-2229, live chat us (using the ‘chat’ button to the left of your screen), or use our contact form.