The appearance of warts during pregnancy can cause concern, but most cases are not a serious threat to the developing baby. Warts are non-cancerous skin growths caused by infection with the human papillomavirus (HPV). Hormonal fluctuations and changes to the immune system during gestation can sometimes lead to new warts forming or existing ones growing larger or multiplying faster. These growths should always be discussed with a healthcare provider to determine the type and the safest management plan.
Understanding Wart Types and Pregnancy
Warts encountered during pregnancy fall into two primary categories: non-genital and genital. Non-genital warts, such as common warts on the hands or plantar warts on the feet, are caused by HPV strains different from those affecting the genital area. These common skin growths pose virtually no risk to the fetus or newborn and are managed as a minor dermatological issue.
Genital warts (condyloma acuminata) are caused by specific low-risk HPV types, primarily 6 and 11, and are considered a sexually transmitted infection. This type presents the only potential concern for the baby due to a low risk of transmission during vaginal delivery. Recognizing this distinction is the first step in creating a safe and appropriate treatment plan, which differs significantly based on the wart’s location.
Management of Non-Genital Warts
Non-genital warts, including common, plantar, and flat warts, are common findings during pregnancy and typically do not require immediate intervention. These lesions do not affect the developing fetus and are not associated with adverse pregnancy outcomes. Healthcare providers often recommend a conservative “wait and see” approach, especially if the warts are not causing pain or physical interference.
Many non-genital warts spontaneously shrink or disappear completely within a few months after delivery, once the immune system returns to its pre-pregnancy state. If the warts are painful, interfere with walking, or are significantly spreading, safe treatment options are available for relief. The treatment decision balances maternal comfort and minimizing systemic exposure to the fetus.
Genital Warts and Delivery Planning
Genital warts are the main focus of concern due to the risk of vertical transmission of HPV to the infant during passage through the birth canal. This rare transmission can lead to juvenile-onset recurrent respiratory papillomatosis (JORRP). JORRP involves the growth of warts in the throat and larynx, often requiring repeated surgical procedures to manage airway obstruction.
The risk of JORRP is low, estimated at about seven cases per 1,000 births to mothers with active genital warts. This represents a significant increase in risk compared to the general population. For most women with genital warts, a vaginal delivery remains the preferred and safest option because the risk of transmission is very low. A C-section is usually reserved for specific situations, such as when the warts are so large or numerous that they obstruct the birth canal or could cause significant bleeding. The obstetrician monitors the size and location of the lesions throughout the third trimester to determine the safest delivery method.
Approved Treatment Options During Gestation
Treatment for warts during pregnancy prioritizes fetal safety by using modalities with minimal systemic absorption. For non-genital warts, safe treatment options include cryotherapy (freezing the wart with liquid nitrogen) and the controlled application of low-concentration salicylic acid. Cryotherapy is a localized destructive method appropriate throughout all trimesters.
For genital warts, physical removal methods are preferred, especially if the lesions are large or numerous near delivery. These methods include cryotherapy, surgical excision, electrocautery, or laser treatment, which physically remove the lesions without systemic medications. Trichloroacetic acid (TCA) at concentrations of 80% to 90% is another topical option safely applied by a healthcare provider. Treatments strictly contraindicated during pregnancy due to potential harm to the fetus include Imiquimod, Podophyllin, Podofilox, and 5-Fluorouracil.