HPV and Pregnancy: What Expectant Mothers Need to Know

HPV during pregnancy generally does not harm the baby. Genital warts may grow larger during pregnancy due to hormonal and immune changes, but they do not typically require treatment unless they obstruct the birth canal. The HPV vaccine is not recommended during pregnancy. Juvenile-onset recurrent respiratory papillomatosis (JORRP) — a rare condition where HPV is transmitted to the baby's airway during delivery — occurs in approximately 2 per 100,000 births.

HPV and pregnancy intersect in ways that generate significant anxiety for expectant mothers, and in my experience most of that anxiety exceeds the actual medical risk. The key message I share with pregnant patients is this: HPV is extremely common, it very rarely affects pregnancy outcomes, and with proper management, both mother and baby do well.

Does HPV Affect the Baby?

In the vast majority of cases, no. High-risk HPV types do not cross the placenta, do not cause birth defects, and do not affect fetal development. The CDC does not consider HPV a significant risk factor for adverse pregnancy outcomes such as miscarriage, preterm birth, or low birth weight. The rare exception is juvenile-onset recurrent respiratory papillomatosis — discussed below.

Genital Warts During Pregnancy

If you had genital warts before pregnancy or develop them during pregnancy, they may grow larger and more numerous due to increased blood flow, hormonal changes, and relative immunosuppression during pregnancy. This can be alarming but is generally not dangerous. Treatment of warts during pregnancy is usually deferred unless they are causing symptoms or are large enough to potentially obstruct vaginal delivery. If treatment is needed, cryotherapy and surgical excision are considered safe during pregnancy. Podophyllin and imiquimod are contraindicated. Our guide on early signs of genital warts helps with recognition.

Pap Smears and HPV Testing During Pregnancy

Routine Pap smears can be safely performed during pregnancy and should follow the standard screening schedule. If an abnormal Pap result is found, colposcopy (magnified cervical examination) can be performed during pregnancy, but biopsies are generally avoided unless high-grade disease or cancer is suspected. Treatment of cervical dysplasia (LEEP, cone biopsy) is typically postponed until after delivery, as most pregnancy-related cervical changes regress postpartum.

HPV Vaccine and Pregnancy

The HPV vaccine is not recommended during pregnancy — not because harm has been demonstrated, but because safety data is limited. If you discover you are pregnant after starting the series, delay remaining doses until after delivery. No intervention or pregnancy termination is recommended if a dose was inadvertently given during pregnancy. Breastfeeding is not a contraindication — the vaccine can be safely administered while nursing.

JORRP: The Rare Complication

Juvenile-onset recurrent respiratory papillomatosis is a condition where HPV types 6 or 11 are transmitted to the baby during vaginal delivery, causing wart-like growths in the child's airway. It is rare (approximately 2 per 100,000 births) and typically presents between ages 2 and 5 with hoarseness, stridor, or breathing difficulty. JORRP is not a routine indication for cesarean delivery — the risk is too low to justify surgical delivery in all women with genital warts. Cesarean delivery may be considered if warts are so extensive they physically obstruct the birth canal.

Delivery Decisions

Vaginal delivery is safe for the vast majority of women with HPV or genital warts. Cesarean delivery is recommended only when warts are large enough to obstruct the birth canal or cause significant bleeding during delivery. A history of HPV or a positive HPV test alone is not an indication for C-section.

When to Talk to Your OB-GYN

Inform your provider if you have a history of genital warts, an abnormal Pap, or a known HPV diagnosis. Discuss any new growths or changes during pregnancy. Understanding HPV clearance timelines helps set realistic expectations about your HPV status postpartum. Confidential STD testing is available if you want screening during pregnancy.

Frequently Asked Questions

Should I delay pregnancy because I have HPV?

No. HPV is not a reason to delay pregnancy. Most infections clear on their own, and those that don't are manageable during pregnancy with proper obstetric care.

Will my baby get HPV if I deliver vaginally?

The risk of clinically significant HPV transmission to the baby during vaginal delivery is extremely low. JORRP occurs in approximately 2 per 100,000 births. Vaginal delivery is recommended for most women with HPV.

Can I get vaccinated right after delivery?

Yes. The HPV vaccine can be administered immediately postpartum, including while breastfeeding. Completing or starting the vaccine series after delivery is recommended if you are under 45 and not fully vaccinated.

Do genital warts go away after pregnancy?

Often, yes. Warts that grew during pregnancy frequently shrink or resolve after delivery as immune function and hormone levels normalize.