Warts are non-cancerous skin growths caused by the Human Papillomavirus (HPV). The appearance of these lesions during pregnancy can cause concern because many standard over-the-counter and prescription treatments carry risks for the developing fetus. Since systemic absorption of chemicals is a primary safety concern, treatment prioritizes the health of both the pregnant individual and the baby. This often favors conservative management or localized physical removal techniques performed by a physician.
Why Warts May Develop During Pregnancy
Physiological changes during gestation can create an environment conducive to wart growth. Pregnancy naturally induces a state of slight immunosuppression to prevent the mother’s body from rejecting the developing fetus. This immunological shift compromises the body’s cell-mediated immune response, which normally keeps dormant HPV in check.
Hormonal fluctuations also contribute to wart growth. Elevated levels of hormones like estrogen and progesterone can enhance HPV replication and accelerate the growth of existing lesions. Women with a pre-existing HPV infection often notice that their warts multiply or become larger during the second and third trimesters. These changes often spontaneously regress or disappear completely within six months after delivery, once the immune system returns to its non-pregnant state.
Safe At-Home and Over-the-Counter Options
Conservative at-home methods are often the first line of management for common warts on the hands or feet, but they must be approached with caution and medical consultation. Over-the-counter products containing salicylic acid are widely available, but a pregnant individual must use only low-concentration formulations and limit the area and duration of application. High-concentration salicylic acid, typically above 17%, is discouraged due to the theoretical risk of systemic absorption posing a risk to the fetus.
Another non-chemical option is duct tape occlusion therapy, which involves covering the wart for several days at a time to irritate the skin and encourage the body’s immune response. While the evidence for its effectiveness is mixed, it presents no chemical risk during pregnancy. At-home freezing kits, which utilize freezing agents less potent than medical-grade liquid nitrogen, can also be used for small warts, but their safety must be confirmed with a healthcare provider before use.
Professional Treatments and Medications to Avoid
When at-home methods are unsuccessful or for larger, more symptomatic lesions, several in-office physical destruction methods are considered safe. Cryotherapy, which involves the targeted application of liquid nitrogen to freeze the wart tissue, is a preferred method because the treatment is localized and carries minimal risk of systemic absorption. The freezing causes the lesion to blister and eventually fall off, often requiring multiple short sessions.
Other safe physical removal techniques include electrocautery, which uses heat to burn off the wart, and laser removal, which precisely targets the blood vessels feeding the growth. These procedures are typically reserved for persistent, large, or painful warts that have not responded to less invasive treatments. Physicians usually prefer to perform these procedures during the second trimester, which is generally considered the safest period for minor medical interventions.
Conversely, many common topical prescription medications must be strictly avoided due to potential risks to the developing baby.
Medications to Avoid
- Podophyllin and podofilox are strictly contraindicated throughout all trimesters because they are known to have embryotoxic and teratogenic effects, with a risk of systemic absorption even with topical use.
- Imiquimod cream, an immune response modifier, is discouraged because its safety profile during pregnancy has not been established and its potential effects on the fetus are unknown.
- 5-fluorouracil, a chemotherapeutic agent used for some resistant warts, is avoided due to its mutagenic properties and significant risk of birth defects.
Managing Genital Warts During Pregnancy
Genital warts (Condyloma acuminata) are caused by specific low-risk HPV types and require a distinct management strategy during pregnancy. These lesions may grow rapidly due to hormonal changes and increased blood flow, sometimes becoming large enough to cause discomfort or bleeding. The primary concern is the rare possibility of transmitting HPV to the infant during a vaginal delivery, which can lead to recurrent respiratory papillomatosis (RRP) in the child’s larynx or vocal cords.
For treatment, a healthcare provider can safely apply Trichloroacetic acid (TCA) at concentrations of 80% to 90% directly to the external warts, which acts as a chemical caustic agent. Cryotherapy with liquid nitrogen is also a safe and effective clinician-applied treatment for genital warts during pregnancy. Surgical excision or laser removal may be used for very large lesions that could obstruct the birth canal or cause significant bleeding during delivery.
A Cesarean section is not routinely performed solely to prevent HPV transmission to the newborn, as the risk of RRP is very low. A C-section is typically only considered if the warts are extensive, obstructive, or located in a way that would make a vaginal delivery difficult or traumatic. Most experts advocate for the removal of visible genital warts in the late third trimester to reduce the viral load and minimize the already low risk of transmission.