Prevalence, risk factors and pregnancy outcomes of cervical cell abnormalities in the puerperium in a hyperendemic HIV setting.

Abstract

Objective We investigated the impact of cervical cell abnormalities detected in the puerperium in association with HIV-1 infection on pregnancy outcomes. Methods A behavioural intervention RCT enrolled 1480 pregnant women (>18years) at a peri-urban primary health clinic in South Africa during May 2008-June 2010. A pap smear was performed 14weeks postpartum and sent to the local laboratory services for cytology. We performed a secondary data analysis of pregnancy outcomes, Pap smear results (cytology), HIV results and participant demography. Results 564 women (38.1%; 95%CI35.7-40.1) were HIV-1 positive and 78(8.0%; 95%CI6.4-9.9) women tested positive for cervical cell abnormalities at the postpartum visit. Forty two (4.2%; 95%CI 3.1-5.6) women presented with LGSIL, and 7 (0.7%; 95%CI 0.3-1.4) with HGSIL. In an adjusted analysis, HIV-infected women were significantly more likely to test positive for LGSIL (p<0.001) and HGSIL (p=0.011). Premature birth, low-birth weight and non-live birth rates were similar among HIV-infected and uninfected women with abnormal cervical cytology. Low-birth weight was also significantly more common among HIV infected women with normal cervical cytology. Conclusion HIV-infected pregnant women are more likely to be diagnosed with higher grades of squamous cell abnormalities. There is no evidence of an association between squamous cell abnormalities/HIV comorbidity and adverse pregnancy outcomes. Synopsis HIV-infected pregnant women are likely to present with higher grades of cervical cell abnormalities in the puerperium but without any evidence of adverse pregnancy outcomes.