IMPACT OF HIGH-RISK HPV INFECTION AND MATERNAL THYROID FUNCTION ON ADVERSE OBSTETRIC OUTCOMES.

Background: High-risk-HPV, metabolic disorders, and prior cesarean scar have been linked with adverse obstetric outcomes, but their combined effects are unclear. Methods: Retrospective cohort of 185 pregnancies at a Romanian tertiary center (2021-2024) with high-risk HPV DNA testing ≤24 weeks and thyroid profiling. Exposures: HPV status and comorbidities (gestational hypertension, gestational diabetes, prior cesarean scar). Primary outcome: cesarean delivery; secondary: preterm birth <37 weeks, major placental pathology, NICU admission. Multilevel logistic regression adjusted for age, BMI, parity, smoking, and twin gestation; interaction terms assessed HPV×comorbidity. Results: 41/185 (22.2%) HPV-positive. Cesarean odds were higher for HPV-negative with any comorbidity (aOR 2.9, 95% CI 1.5-5.6) and highest for HPV-positive with comorbidity (aOR 4.3, 1.8-10.2) versus HPV-negative without comorbidity. HPV-positive status was associated with a modest TSH increase (max Δ+0.25 mIU/L in T3, 95% CI 0.05-0.44; p = 0.013), with similar FT4/FT3 and values largely within pregnancy-specific ranges. A significant interaction was observed for HPV × prior cesarean scar on preterm birth (p_interaction = 0.008; aOR 2.9, 1.2-7.2); interactions with gestational hypertension or diabetes were non-significant. Conclusions: High-risk HPV combined with maternal comorbidity was associated with increased cesarean and preterm-birth risk. Findings support incorporating HPV status into antenatal risk assessment and warrant larger prospective studies.