The association between placental human papillomavirus detection and pre-eclampsia in adult women giving birth in two academic hospitals in Johannesburg

Retief, Pieter Francois
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Background and objectives Evidence supporting an association between HPV infection and pre-eclampsia has recently been published. Pre-eclampsia is a common, serious complication of pregnancy of complex aetiology that to date has not been fully described. Human papillomavirus (HPV) is a ubiquitous, DNA-virus with tropism for human mucosal commonly found in the female genital tract. Association between placental HPV infection and preterm labour and pregnancy loss has previously been described. This study tested the hypothesis that an association exists between HPV in the placenta or the cervix and clinical pre-eclampsia, or levels of its associated biomarkers, soluble fms-like tyrosine kinase (sFLT1) and placental growth factor (PlGF). Methods Women with pre-eclampsia were matched to healthy controls. All subjects were delivered by caesarean section, and cervical and placental samples were collected at the time of delivery. These samples were tested for HPV using a polymerase chain reaction (PCR) assay. Serum levels of soluble fms-like tyrosine kinase (sFLT1) and placental growth factor (PlGF) at the time of delivery were tested. Placental and cervical HPV was compared to the outcomes of clinical pre-eclampsia and serum sFLT1 and PlGF levels. Results and conclusion While clinically apparent disease was associated with increased levels of sFLT1 and decreased levels of PlGF, HPV was not detected in any of the placental specimens using the PCR assay. As a result, no association was found between placental HPV detection and clinically apparent pre-eclampsia or deranged serum levels of sFLT1 or PlGF. HPV was very common in cervical samples and showed a non-significant trend towards negative association with clinical pre-eclampsia and sFLT1, and a positive association with PlGF. This may be an effect of cervical HPV infection on the vascular endothelial growth factor (VEGF) signalling system that may explain its association with miscarriage.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics & Gynaecology. Johannesburg, 2017.