Warts are common skin growths caused by the human papillomavirus (HPV). These growths are generally benign and localized to the skin or mucous membranes. While HPV infection is widespread, the presence of warts during gestation can cause concern. Pregnancy is a unique physiological state that can influence the appearance and behavior of existing or new warts.
How Pregnancy Hormones Affect Warts
The body undergoes significant changes during gestation, including a natural modulation of the immune system to accommodate the developing fetus. This temporary, pregnancy-induced immune suppression can reduce the body’s ability to keep the HPV infection dormant. As a result, warts may become more active and noticeable than before conception.
Elevated levels of hormones, particularly estrogen and progesterone, play a substantial role in wart changes. These hormonal fluctuations enhance viral replication and accelerate the growth of existing lesions. Warts may proliferate, grow rapidly, or become more numerous, often appearing or enlarging significantly during the second and third trimesters. These changes are often temporary, with many warts spontaneously regressing or disappearing within six months following childbirth.
Assessing the Risk to Mother and Baby
The vast majority of warts, including common warts on the hands or plantar warts on the feet, pose no risk to the mother or the developing fetus. These lesions are localized skin issues that do not typically affect the course of the pregnancy. The primary concern is associated with genital warts (condyloma acuminata), which are caused by specific, low-risk types of HPV.
Even with genital warts, the risk of transmission to the baby is considered very low, and the virus usually does not affect the baby’s health during pregnancy. The most significant, although extremely rare, risk occurs during vaginal delivery. If the infant is exposed to the virus in the birth canal, there is a minimal chance of developing a serious condition called recurrent respiratory papillomatosis (RRP). This involves warts forming on the infant’s larynx or vocal cords, requiring frequent medical intervention.
This rare complication of RRP is the main reason for caution, but most babies born to mothers with genital warts do not experience any complications. The presence of the warts does not increase the risk of miscarriage, premature delivery, or congenital abnormalities. Healthcare providers monitor the size and location of genital warts closely to determine the safest delivery plan.
Pregnancy-Safe Treatment Options
While many warts are left untreated until after delivery, treatment is sometimes necessary if they cause discomfort, bleeding, or potentially obstruct the birth canal. It is necessary to consult with an obstetrician or dermatologist before attempting any wart removal during pregnancy. Many common over-the-counter and prescription treatments are contraindicated due to the risk of systemic absorption and potential harm to the fetus.
Treatments that must be avoided carry a risk of absorption or known effects on fetal development. Instead, physical or minimally absorbed treatments are favored for their localized action. Avoid the following agents:
- Podophyllin
- Podofilox
- 5-fluorouracil
- High-concentration salicylic acid products
One of the safest and most effective options is cryotherapy, which involves freezing the wart with liquid nitrogen. This method is localized, has minimal systemic absorption, and can be repeated every few weeks. Trichloroacetic acid (TCA) at concentrations of 80% to 90% is another preferred treatment, as it is applied directly by a healthcare provider and is not absorbed into the bloodstream. For larger or more resistant lesions, surgical excision, electrocautery, or laser therapy may be used, often during the second trimester when the risk to the fetus is lower.
Wart Management During Labor and Delivery
The presence of genital warts does not automatically mean a Cesarean section is necessary; most women with HPV can safely have a vaginal delivery. The mode of delivery is typically decided in the final weeks of pregnancy based on the physical characteristics of the warts. A vaginal birth is generally recommended unless the warts present a physical obstruction.
A Cesarean delivery may be recommended only if the warts are exceptionally large, numerous, or block the birth canal. Obstruction could potentially lead to trauma, bleeding, or excessive viral exposure to the baby. The decision is made individually by the healthcare team, balancing the low risk of RRP against the standard risks associated with major abdominal surgery. If the warts are small, few, and non-obstructive, a vaginal delivery remains the standard recommendation.