The Human Papillomavirus (HPV) is the most common sexually transmitted infection globally. Most sexually active people encounter the virus, which has over 200 different types categorized by their potential to cause cancer or genital warts. A majority of HPV infections are transient, causing no noticeable symptoms, and often clear on their own due to the body’s immune system. When HPV is present during pregnancy, it raises concerns about the developing fetus and the birthing process. However, its presence rarely leads to severe complications for the mother or the baby.
Overall Impact on Mother and Fetus
Maternal HPV infection generally does not pose a substantial threat to the health of the developing fetus. The virus is not associated with an increased risk of adverse pregnancy outcomes like miscarriage, stillbirth, or major birth defects. Some research suggests a potential link between HPV infection and an increased incidence of premature rupture of membranes or preterm birth, possibly due to cervical tissue inflammation. However, this association is not definitively established as a direct cause.
The possibility of the virus passing from the mother to the baby, known as vertical transmission, is relatively low. Even when the virus is detected in a newborn, the infection is usually temporary. For example, one study found that while about 7% of newborns born to HPV-positive mothers had the virus at birth, all had cleared the infection within six months. Most infants who acquire HPV clear the virus rapidly, often within a few months, with little to no lasting symptoms.
Recurrent Respiratory Papillomatosis (RRP) is a rare but serious condition involving non-cancerous, wart-like growths developing in the child’s throat or airways. Low-risk HPV types, particularly 6 and 11, are responsible for RRP, which is a rare complication requiring repeated surgical procedures to manage airway obstruction. Although the risk of a baby developing RRP is extremely small, it is the most significant potential complication of HPV transmission during birth. A higher viral load of HPV in the first trimester may increase the odds of vertical transmission, suggesting viral activity is a factor.
Managing Genital Warts During Pregnancy
The hormonal and immunological changes during pregnancy can cause existing genital warts to grow larger, multiply, or bleed more easily. This increased growth is often caused by elevated estrogen levels, increased blood flow, and vaginal discharge, which provide a moist environment for the virus to thrive. While the presence of warts may be concerning, they do not threaten the health of the mother or the fetus.
Treatment for visible genital warts is often delayed until after delivery. Treatment is only necessary if the lesions cause significant discomfort, bleeding, or are large enough to obstruct the birth canal. When treatment is required during pregnancy, physical removal methods are preferred to avoid fetal exposure to chemicals. Safe options include cryotherapy (freezing the warts with liquid nitrogen), surgical excision, or laser removal.
Some common topical treatments for genital warts, such as podophyllin, podofilox, and imiquimod, are avoided during pregnancy. This is because their safety profile for the fetus has not been established or they may be contraindicated. Trichloroacetic acid (TCA) is sometimes used for small lesions since it is not absorbed systemically, though its effectiveness varies. The primary goal of intervention during pregnancy is to manage symptoms and reduce the bulk of the lesions at birth, minimizing the risk of transmission or delivery complications.
Clinical Screening and Delivery Considerations
Routine cervical cancer screening, involving a Pap test and sometimes an HPV DNA test, is frequently modified during pregnancy. If a pregnant woman has a history of abnormal Pap smears or receives an abnormal result early in pregnancy, a visual examination called a colposcopy may be performed. If the colposcopy reveals abnormal cell changes but no evidence of invasive cancer, further diagnostic or treatment procedures, such as biopsies, are postponed until after the baby is born.
This delay in treatment occurs because many low-grade cellular changes are likely to regress spontaneously after delivery. It also prevents unnecessary procedures that could cause bleeding or complicate the pregnancy. HPV testing itself is not routinely performed on all pregnant women, as a positive result would not change pregnancy management unless visible warts or abnormal cytology are present.
The presence of HPV, even with a history of genital warts or abnormal cervical cells, rarely necessitates a cesarean section (C-section). A C-section is considered only in specific circumstances. These include when very large or widespread genital warts physically block the birth canal, preventing a safe vaginal delivery. It may also be considered if the warts are so extensive that they risk excessive bleeding or tearing during a vaginal birth. For the majority of pregnant women with HPV, a vaginal delivery is considered safe for both the mother and the baby.
Infant Follow-up and Maternal Vaccination
For newborns whose mothers have HPV, a specific follow-up plan is usually not required unless the baby develops symptoms, such as the rare signs of RRP. Since most infants who acquire the virus during birth clear the infection on their own, the typical approach is watchful waiting. If an infant shows signs of respiratory distress, a specialized evaluation is immediately performed to check for growths on the vocal cords or larynx.
The HPV vaccine is not recommended during pregnancy due to limited safety data. However, it is strongly advised for mothers who have not completed the series or were not previously vaccinated. Postpartum vaccination is considered safe and provides protection against the HPV types responsible for most genital warts and cervical cancers. This period is an ideal time to complete the vaccination series, as women are often engaged in the healthcare system for their postpartum check-ups.