HPV vaccination before pregnancy: the importance of outcomes before birth

Agreement: I Agree Body: Dear Editor, As an HPV-vaccinated woman of reproductive age and an internist, I welcome the findings of Zhang and colleagues. In 624,713 first singleton births, vaccination before pregnancy was associated with slightly lower odds of preterm birth (adjusted odds ratio 0.95, 95% confidence interval 0.91 to 0.99).¹ For preconception counselling, however, the key question is whether an association observed among women who give birth translates into improved reproductive outcomes for women planning pregnancy. The analysis conditions on reaching a first singleton birth…