Risk Factors and Delivery Outcomes Among Women Diagnosed With Human Papillomavirus Prior to Pregnancy Comparing High-Risk and Low-Risk Strains: A Retrospective Chart Review

Introduction: Human papillomavirus (HPV) vaccination has reduced infection, but the virus remains widespread, with over 20 million new cases in the U.S. each year, with known effects on pregnancy outcomes. While prior studies have focused on infections acquired during pregnancy, less is known about how a history of HPV infection, cervical procedures, or treatment before conception may influence delivery and neonatal outcomes. Understanding these relationships could improve prenatal risk assessment and care planning. Methods: A single-center retrospective cohort study was conducted on patients with a prior diagnosis of HPV who delivered between 2018 and 2023. The deliveries occurred among a diverse patient population at a Midwestern US hospital with approximately 3,000 births per year. Results: Of 588 screened pregnancies, 372 met the inclusion criteria. Patients with high-risk HPV were, on average, older but otherwise demographically similar to those with other HPV strains. High-risk HPV was associated with increased delivery complications overall, including higher rates of premature rupture of membranes (OR: 0.16, 95% CI: 0.03-0.94; p=0.043), lower birth weight (p=0.006), and increased neonatal intensive care unit (NICU) admission (OR: 0.23, 95% CI: 0.05-0.97; p=0.045). A nonsignificant trend toward preterm delivery was observed (p=0.072). No differences were seen in Apgar scores or most other maternal and neonatal outcomes. Conclusions: HPV history and strain type before conception were associated with differences in pregnancy and delivery outcomes. These findings suggest HPV history should be incorporated into prenatal risk assessment to better anticipate potential complications, though further research is needed to guide specific management strategies.