Abstract
Human Papillomavirus (HPV) infection is a significant public health concern, particularly during pregnancy. The impact of HPV infection during pregnancy on maternal and child health is a growing concern. However, research on infection rate and pregnancy outcomes of nine-valent vaccine-covered and non-covered high-risk HPV subtypes during pregnancy remains limited. A retrospective cohort study involved 7110 pregnant women who underwent HPV testing in Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University (FMCH) from January 2021 to December 2022. Multiple logistic regression analyses investigated the association between HPV infections and maternal and neonatal outcomes. The study identified that the overall HPV infection rate in pregnant women was 19.9%. The HPV types 52, 16, 58, 42, and 51 were the most common among the participants. Infections with nine-valent HPV vaccine-covered high-risk subtypes significantly increased the risk of preterm premature rupture of membranes (PPROM) (OR = 1.29; 95% CI: 1.08-1.55) and cesarean section (OR = 1.25; 95% CI: 1.06-1.49). Co-infections with both nine-valent vaccine-covered and non-covered high-risk HPV subtypes elevated the risks of cesarean section (OR = 1.59; 95% CI: 1.11-2.27) and hypertensive disorders of pregnancy (OR = 2.73; 95% CI: 1.44-5.15). Additionally, these infections significantly increased the risk of small for gestational age (SGA) infants, with the group IV (OR = 2.07; 95% CI: 1.21-3.54) having a higher risk than the group III (OR = 1.33; 95% CI: 0.17-1.65). Moreover, those neonates who were born to mothers with HPV co-infections had a significantly higher risk of ICU admission (OR = 1.58; 95% CI: 1.01-2.49). This study revealed the significant association between specific HPV infections during pregnancy and adverse maternal and neonatal outcomes. These findings underscore the importance of monitoring HPV infections during pregnancy and suggest that an enhanced rate of the nine-valent HPV vaccine and strengthen the development and application of the non-nine-valent HPV vaccine could improve maternal-fetal health outcomes.