The Impact of Reproductivity and Parity on High-Risk HPV Persistence and Cytological Progression: A Systematic Review and Meta-Analysis

Background. Persistent infection with a high-risk human papillomavirus is a prerequisite for a cervical malignancy with known factors of smoking, usage of oral contraceptives and quite controversial cofactor of reproductivity history which is evaluated in the context of physiological shift of initial childbirth and the potential dose-response effect of cumulative births.
Methods. A systematic review with meta-analysis of five peer reviewed studies from 2016, spanning across Europe and Asia with two main investigations was conducted. Comparisons between nulliparous vs multiparous and between low parity vs high parity were calculated using OR and traditional Cochran’s Q test and I² statistic.
Results. Analysis between nulliparous vs multiparous cohorts reported uniform, negligible baseline risk (OR 1.06 [0.86-1.31]) with low heterogeneity I² =13.36%, p=0.283. Conversely, analysis between low and high parity revealed a significant compounding risk associated with high parity with pooled OR 2.27 [1.84-2.79], although the heterogeneity was substantial (I² =69.12%, p=0.021).
Conclusion. The physiological experience of childbirth itself doesn’t significantly alter the risk of HR-HPV persistence but the high parity may serve as context-dependent predictor of cytological progression and cervical carcinoma, likely explained by hormonal shifts and socioeconomic factors.