Cervical Cytological Findings and Vaginal Microbiota Alterations During Pregnancy: A Retrospective Analysis.

Objective: Pregnancy induces physiological and microbiological changes in the cervicovaginal environment, which may affect the interpretation of cervical cytology. Accurate screening in this population is essential to identify both benign and pathological alterations. Methods: We conducted a retrospective monocentric study on 58 conventional Pap smears performed during pregnancy. Cytological findings were classified according to the Bethesda System, and available microbiological and HPV data were analyzed to explore potential relationships. Results: Among the 58 Pap smears, 46.6% were negative for intraepithelial lesions or malignancy (NILM), while 12.1% showed ASC-US, 10.3% LSIL, 5.2% ASC-H, and 25.9% HSIL. Candida infection and Döderlein-related cytolysis were observed in 8.6% and 8.6% of cases, respectively. HPV genotyping, available in 24 patients, identified several high-risk HPV types. Among cases with available HPV data, high-risk HPV types were more frequently observed in high-grade cytological categories, although this association did not reach statistical significance. Culture-based microbiological data were available only in a very limited subset of patients (n = 6). Conclusions: Cervical cytology during pregnancy remains a valuable screening tool, but its interpretation requires awareness of pregnancy-related changes and potential diagnostic pitfalls. The integration of HPV and microbiological data may provide additional contextual information; however, larger prospective studies with systematic testing are required to clarify the relationship between microbiota, HPV infection, and cytological abnormalities in pregnant women.