At the same time, they spent 14 hours a week on child care, up from 10 hours a week in Dads, too, are spending more time on child care. Among these parents, moms spend more time than dads on caregiving activities. In fact, mothers are the primary breadwinners in four-in-ten U. While most U. All told, about 9 million mothers are living with a child younger than 18 without a spouse or partner. A relatively small but growing share of moms are living with an unmarried partner. Even in an era where women make up nearly half the U.
While annual births have decreased among U. In the past quarter century, births to foreign-born moms have boosted fertility in all but two states. And they accounted for more than one-third of all births in three states in New Jersey, New York and California. To complete the subscription process, please click the link in the email we just sent you. About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research.
Pew Research Center does not take policy positions. At the end of the study none of the infants developed oral, anogenital or cutaneous, macroscopically identifiable HPV-related lesions. Our data from both the HPV screening survey of unselected pregnant women and the prospective cohort study provide for the first time estimates for HPV prevalence, type-specific distribution, mother-to-child transmission rates as well as HPV persistence in pregnant women and in infants in Spain. Consistent with previous reports reviewed in [ 2 , 3 , 6 - 8 ] , our data confirm that the risk of transmission of any HPV type from infected mothers to the newborn is shown to be relatively low 9.
Although HPV-DNA detection rates in samples of newborns and infants vary widely in the literature, well conducted prospective studies suggest that the risk of perinatal transmission, although existent, is relatively low. Rates of detection at 6 weeks vary also widely and they are not always significantly different for infants born to HPV positive or negative mothers.
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Consistent with our high rates of HPV X detection, this study found that all positive results in the infants were positive for unclassified HPV types and all of them were preceded or followed by HPV negative specimens. This report and our data clearly show that the few HPV infections detected in infants probably represent low-level genital or non-genital HPVs or may represent horizontal transmission. Taken together the evidence from this and other prospective studies [ 9 , 10 ] strongly suggests that the risk of perinatal transmission of HPVs although existent is relatively low.
A consistent finding from our cohorts of HPV positive and negative pregnant women and their offspring is the evidence for horizontal transmission. First, we found that up to This percentage is only slightly lower, and not statistically significantly different, than that observed in infants born to HPV-positive mothers Secondly, we found an association between HPV status in the mother at the 6-week postpartum visit and the HPV status in children at the same visit or thereafter.
Thus, at the 6-week post-partum visit, children of mothers' who were HPV-positive at the post-partum visit were about 5 times more likely to test HPV-positive than children of corresponding HPV-negative mothers In contrast, no association was found between mothers' HPV status at pregnancy and children's HPV status at any of the visits combined. Mothers themselves, relatives, caregivers and fomites harbour HPVs that can be horizontally transmitted to the child, in particular in the first weeks of life when there is a close caring physical contact relationship with the infant.
Indeed, other study designs are needed to properly distinguish vertical from horizontal transmission. These studies should include accurate and repeated HPV detection and genotyping of multiple sites from parents, siblings and care givers as well as assays to distinguish between markers of inert HPV DNA detection and markers of active HPV infection.
Our results do not support a high prevalence of HPV during pregnancy: 6.
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This relatively low HPV prevalence in pregnant women correlates with the low prevalence of HPV infection in the female general population between 1. Still, our HPV prevalence estimate among pregnant women is between 3 and 5 times higher than that observed in the female general population, confirming the findings from other studies showing that pregnant women do have a higher HPV-DNA detection rate than un-pregnant women [ 6 , 16 - 18 ].
It has been argued that immunological or hormonal changes could modulate the rate of HPV positivity and clearance during pregnancy [ 18 , 19 ]. While some authors report evidence that pregnancy decreases clearance of high-risk HPV types in the first two trimesters of pregnancy [ 16 , 18 , 19 ], others question these findings [ 20 , 21 ]. These expected associations provide further internal validity to our complex study. The effect of cesarean section on HPV transmission among HPV-positive pregnant women could not be assessed due to the low number of HPV-positive children born by cesarean section.
Concerning reproductive variables, only ever use of hormonal contraception was associated with a reduced risk of HPV in the child. We do not have any biologically plausible explanation for this inverse association. Since such a relationship has never before been reported one should be cautious in its interpretation.
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Concerning HPV in the mother the only correlate found for HPV positivity in the child at any point during follow-up was the mother's HPV positivity at the post-partum visit. It is worth noting that mothers that had HPV status persistence from pregnancy to the post-partum visit had a higher percentage of HPV-positive children In interpreting these results it should be considered that our reported HPV type-specific distribution is probably biased towards an overestimated detection of HPV X, as the samples that tested positive with the generic probe were tested with only seven type-specific probes HPVs 6,11,16,18,31,33, and Thus the high percentage of samples classified as HPV X could be true rare genital HPV types, cutaneous types unlikely because of the poor efficiency of the primer system in detecting cutaneous types or still untyped HPVs.
Unfortunately, very few samples remained available for re-testing with the newer PGMY system. This limitation may also have resulted in an underestimation of the true underlying type-specific concordance. In conclusion, our study, conducted in a population at low risk for HPV and cervical cancer, confirms that high-risk HPV genotypes can be vertically transmitted to the child, although the risk of vertical transmission is relatively low.
In this study, if we exclude untyped HPV X infections, HPV 16 has been found to be the most frequent type detected both in mothers and infants. Given the substantial HPV positivity observed in children born to HPV-negative mothers, these data suggest that vertical transmission may not be the sole source of HPV infections in children and that horizontal mother-to-child transmission may play also a role. It remains to be seen whether this alternative mode of HPV transmission and acquisition may have an impact in several areas, including vaccination strategies, epidemiological studies, and the clinical management of children with HPV-associated diseases.
XC, TD, FXB, SdS were the principal epidemiological investigators in the various phases of this long study, conceived the study, wrote the protocols, assured funding, identified clinical investigators and study personnel, supervised statistical analyses and performance of laboratory assays, and wrote the manuscript.
AG, RR, JMP were the clinical investigators two ObGyn and one pediatrician , trained and supervised study clinical staff nurses, gynecologists and pediatricians and sample collection throughout the study, and made substantial contributions to the manuscript. MJQ, JM, GA coordinated the field work in terms of study implementation and data collection, designed the study data collection forms, created clinical and laboratory databases, implemented quality assurance procedures, made the statistical analyses, produced the working and final tables and made substantial comments to the manuscript.
National Center for Biotechnology Information , U. BMC Infect Dis. Published online May Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Sep 1; Accepted May This article has been cited by other articles in PMC. Methods To estimate mother-to-child HPV transmission we carried out a prospective cohort study that included 66 HPV-positive and 77 HPV-negative pregnant women and their offspring attending a maternity hospital in Barcelona.
Conclusion This study confirms that the risk of vertical transmission of HPV genotypes is relatively low. Background Despite the overwhelming evidence for a sexual transmission of high-risk HPVs, other routes of transmission have been proposed.
References
Methods Recruitment of subjects The project was initiated in by carrying out a prospective cohort study of pregnant women attending a public maternity hospital for prenatal care in urban Barcelona, Spain. HPV screening survey among unselected pregnant women Subjects for this HPV screening survey included pregnant women consecutively attending the prenatal care clinic of the maternity hospital between and Statistical analyses HPV prevalence was estimated among women at the pregnancy visit and at the 6-week postpartum visit.
Results HPV detection among pregnant women Of the initial recruited pregnant women from the initial cohort and 54 from the HPV screening survey , 82 28 from the initial cohort and 54 from the HPV screening survey were HPV positive at the pregnancy visit. Baseline characteristics of subjects in the cohort Of the initial recruited women with a known HPV-DNA status, 26 mother-infant pairs 16 from the initial cohort and 10 from the HPV screening survey were excluded from the prospective cohort study because no adequate sample from the child could be obtained for HPV testing neither at birth nor at any of the subsequent follow-up visits.
Table 1 Baseline characteristics of the women included in the prospective cohort study. Open in a separate window. Table 2 HPV results in mothers and infants included in the prospective cohort study.
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Table 3 Selected determinants of HPV infection in pregnant women recruited in the prospective cohort study. HPV positivity in infants At infant visits and a mean follow-up time of 14 months, overall prevalence of HPV in infants at any visit was HPV persistence in mothers and infants A total of women had valid PCR results both at pregnancy and at the post-partum visit. Discussion and Conclsusion Our data from both the HPV screening survey of unselected pregnant women and the prospective cohort study provide for the first time estimates for HPV prevalence, type-specific distribution, mother-to-child transmission rates as well as HPV persistence in pregnant women and in infants in Spain.
Authors' contributions XC, TD, FXB, SdS were the principal epidemiological investigators in the various phases of this long study, conceived the study, wrote the protocols, assured funding, identified clinical investigators and study personnel, supervised statistical analyses and performance of laboratory assays, and wrote the manuscript.
High-risk human papillomavirus is sexually transmitted: evidence from a follow-up study of virgins starting sexual activity intercourse Cancer Epidemiol Biomarkers Prev. Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. J Clin Virol. Epidemiology and partial nucleotide sequence of four novel genital human papillomaviruses. J Infect Dis. J Med Virol. Vertical transmission of the human papillomavirus: a systematic quantitative review.
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