Running head: LITERATURE REVIEW 1

Literature Review

Alexis Gibson

Grand Canyon University: NSG-324

March 29, 2020

LITERATURE REVIEW 2

Literature Review on Human Papillomavirus (HPV) Vaccines Before and During Pregnancy

The “Human papillomavirus (HPV) is the most common sexually transmitted infection in

the United States” (Lipkind et al., 2017, para.5). The HPV vaccine can help protect individuals

contracting HPV. HPV can also lead to cancer or genital warts, so it is important to receive the

vaccine at a young age. It is recommended to receive the vaccine around 11 or 12 years old

because at this age, it is less likely that an individual has been exposed to this sort of virus. HPV

can be contracted through intercourse, so that is why it is important to receive the vaccine at a

younger age. By finding ways to prevent the contraction of HPV, it can reduce the number of

cases and decrease the chances of individuals developing cancer. It is not known whether

receiving the HPV vaccine during pregnancy leads to birth defects. The PICOT question is “In

pregnant women, does receiving the HPV vaccine before pregnancy compared to receiving the

vaccine during the pregnancy increase the risk of birth defect in the neonate at birth?” In this

paper, there will be discussion about the criteria that was used for choosing the articles,

comparing and contrasting each article and how this supports the PICOT question, and

discussing areas of further study.

Methods

Each article had to meet certain criteria in order to correlate with the PICOT question.

The articles had to be a quantitative study. There had to be two groups of women. One group had

to be women who were pregnant and had been vaccinated during pregnancy with the HPV

vaccine. The other group had to be women who were pregnant but received the HPV vaccine

before pregnancy. All of the articles had to be published recently so within the last five years,

and the articles had to be peer-reviewed. It shows that the articles are more reliable if they are

peer-reviewed. All three of the articles met the criteria that was needed.
LITERATURE REVIEW 3

Synthesize of Literature

In the first article (Final report on exposure during pregnancy from a pregnancy registry

for quadrivalent human papillomavirus vaccine), the subjects were women who were exposed to

the HPV vaccine sometime before the onset of their last menstrual period. The patient’s studied

were from the United States, France, or Canada (Gross et al., 2015). In the second article

(Maternal and infant outcomes after human papillomavirus vaccination in the periconceptional

period or during pregnancy), the subjects being studied were living in the United States, had to

have a live birth between 2007 and 2013, the mother had to be between the ages of 13 and 27,

have continuous insurance coverage from six months before her last menstrual period through

six weeks postpartum, and at least one outpatient visit during the study period (Lipkind et al.,

2017). In the third article (Results on exposure during pregnancy from a pregnancy registry for

AS04-HPV-16/18 vaccine), the subjects had to be women who received the HPV vaccine within

60 days before pregnancy, had to be a resident in the country that the registry was active at the

time, and had to have a follow up appointment upon the pregnancy outcome (López-Fauqued,

Zima, Angelo, & Stegmann, 2017). All of the articles had two groups of participants. One group

of women received the HPV vaccine before pregnancy, and one group received the HPV vaccine

during pregnancy. All of the age ranges were different in the participants but were relatively

close in age. In all three articles, the key findings suggest that receiving the HPV vaccine at the

onset of the pregnancy or during the pregnancy did not increase the risk of congenital anomalies

or other abnormal outcomes (Gross et al., 2015; Lipkind et al., 2017; Lopez-Fauqued et al.,

2017). Everything in these articles supported the PICOT question including the sample sizes, key

findings, certain criteria, and methods.

Areas of Further Study

LITERATURE REVIEW 4

There were some limitations throughout the studies. One study (Maternal and infant

outcomes after human papillomavirus vaccination in the periconceptional period or during

pregnancy) was only focusing on women who were continuously insured with live births. The

researchers did not take into consideration women who were uninsured, and women who had

abortions or stillbirth after being exposed to HPV vaccines (Lipkind et al., 2017). In the other

article (Results on exposure during pregnancy from a pregnancy registry for AS04-HPV-16/18

vaccine), there were limitations in the data because reporting was voluntary, reported

pregnancies. This could have led to reporting a bias towards more of the high-risk pregnancies.

Researchers were also saying that women were more likely to report pregnancies with normal

outcomes than with abnormal pregnancy outcomes (López-Fauqued et al., 2017). The last article

(Final report on exposure during pregnancy from a pregnancy registry for quadrivalent human

papillomavirus vaccine), did not state any limitations in that particular study. In future studies,

these limitations should be addressed in order to decrease bias and to include more research on

different patient populations.

Conclusion

All three articles met the requirements for the time frame, subject matter, and were all

peer-reviewed. The information from the articles indicated that it did not matter when the women

received the HPV vaccine whether it was before her pregnancy or during. The three articles

supported the PICOT question “In pregnant women, does receiving the HPV vaccine before

pregnancy compared to receiving the vaccine during the pregnancy increase the risk of birth

defect in the neonate at birth?” Overall in all three articles that were chosen the key findings

suggested that receiving the HPV vaccine at the onset of the pregnancy or during the pregnancy

does not increase the risk of congenital anomalies or other abnormal outcomes.
LITERATURE REVIEW 5

References

Goss, M., Lievano, F., Buchanan, K., Seminack, M., Cunningham, M., & Dana, A. (2015). Final

report on exposure during pregnancy from a pregnancy registry for quadrivalent human

papillomavirus vaccine. Vaccine, 33(29), 3422-3428.

https://doi.org/10.1016/j.vaccine.2015.04.014

Lipkind, H. S., Vazquez-Benitez, G., Nordin, J. D., Romitti, P. A., Naleway, A. L., Klein, N. P.,

Hechter, R. C., Jackson, M. L., Hambidge, S. J., Lee, G. M., Sukumaran, L., &

Kharbanda, E. O. (2017). Maternal and infant outcomes after human papillomavirus

vaccination in the periconceptional period or during pregnancy. Obstetrics and

Gynecology, 130(3), 599–608. https://doi.org/10.1097/AOG.0000000000002191

López-Fauqued, M., Zima, J., Angelo, M., Stegmann, J. (2017). Results on exposure during

pregnancy from a pregnancy registry for AS04-HPV-16/18 vaccine. Vaccine, 35(40),

5325-5330. Retrieved from

https://www.sciencedirect.com/science/article/pii/S0264410X17311301.