HPV and Pregnancy: How the Virus Can Affect Expectant Mothers

Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) globally, with approximately 80% of sexually active people contracting it at some point in their lives. For most individuals, HPV causes no health problems and clears up on its own. However, when HPV affects women who are pregnant or planning to conceive, it raises specific concerns. The immune system changes during pregnancy, and expectant mothers might wonder about the potential risks to their health and their baby’s well-being. This article aims to answer those questions and provide comprehensive information on managing HPV during pregnancy.

What is HPV?

HPV is a group of more than 200 related viruses, with about 40 strains transmitted through sexual contact. These viruses are categorized into two main groups: low-risk and high-risk types. Low-risk types, such as HPV-6 and HPV-11, can cause genital warts, but they don’t typically lead to cancer. High-risk types, like HPV-16 and HPV-18, are more concerning as they can cause changes in cervical cells that may develop into cancer if left untreated.

For more information on the types of HPV and their impact, visit the Centers for Disease Control and Prevention (CDC) HPV resource page.

How Does HPV Affect Pregnancy?

Changes in Immune Response During Pregnancy

During pregnancy, a woman’s immune system undergoes significant changes to accommodate and protect the growing fetus. These changes can sometimes cause HPV infections to behave differently. In some cases, an HPV infection that was previously dormant or asymptomatic may become active and cause symptoms such as genital warts.

While HPV itself does not typically complicate the pregnancy, the presence of symptoms such as warts or abnormal cervical changes may require more frequent monitoring and, in some cases, treatment. Genital warts, in particular, can increase in size or number due to increased hormone levels and blood flow in the genital area during pregnancy.

Does HPV Increase the Risk of Miscarriage or Preterm Birth?

Research has shown mixed results regarding whether HPV directly increases the risk of miscarriage or preterm birth. Some studies suggest that women with persistent high-risk HPV infections may have a slightly elevated risk of preterm labor or preterm rupture of membranes. However, these findings are not conclusive, and many women with HPV have healthy, full-term pregnancies.

For more detailed research on HPV’s impact on pregnancy outcomes, see this study from the National Institutes of Health (NIH).

Cervical Health and Pregnancy

Women with a history of abnormal Pap smear results or cervical dysplasia due to HPV may have concerns about how pregnancy will affect their cervical health. During pregnancy, the cervix becomes softer and undergoes various changes. In some cases, pre-existing cervical dysplasia (precancerous changes) can worsen, requiring closer monitoring through more frequent Pap tests or colposcopy.

That said, routine treatments for cervical dysplasia, such as the loop electrosurgical excision procedure (LEEP), are generally avoided during pregnancy unless absolutely necessary. Most healthcare providers will recommend postponing treatment until after childbirth unless there is a high risk of the dysplasia progressing to cancer during the pregnancy.

To learn more about managing cervical dysplasia during pregnancy, refer to this guideline from the American College of Obstetricians and Gynecologists (ACOG).

Can HPV Be Passed to the Baby?

HPV is not commonly transmitted from mother to baby during pregnancy or delivery. However, in rare cases, a newborn can contract HPV while passing through the birth canal if the mother has an active HPV infection with visible genital warts. This condition, called recurrent respiratory papillomatosis (RRP), results in wart-like growths in the baby’s respiratory tract. While RRP is uncommon, it can cause breathing difficulties and may require surgical intervention.

To reduce the risk of RRP, some healthcare providers may recommend a cesarean delivery if large genital warts obstruct the birth canal, although this is not a routine recommendation solely due to an HPV infection.

For more on RRP and its treatment, visit the National Organization for Rare Disorders (NORD).

Diagnosing and Managing HPV During Pregnancy

HPV Testing and Cervical Cancer Screening

The primary method of detecting HPV in women is through routine Pap tests or HPV testing, which can identify changes in cervical cells or the presence of high-risk HPV strains. For pregnant women, screening guidelines do not change. The American Cancer Society (ACS) recommends:

• Women aged 21 to 29: Pap test every 3 years.
• Women aged 30 to 65: Pap test combined with an HPV test (co-testing) every 5 years or a Pap test alone every 3 years.

If a woman is diagnosed with an abnormal Pap test or HPV infection during pregnancy, her healthcare provider will determine the best course of action, often recommending repeat testing or colposcopy after childbirth.

Treating HPV-Related Conditions During Pregnancy

For expectant mothers who develop genital warts during pregnancy, treatment options are limited. Many healthcare providers prefer to delay treatment until after delivery, as the warts often regress on their own. If treatment is necessary, options such as cryotherapy (freezing the warts) or trichloroacetic acid application may be used safely during pregnancy.

However, topical treatments like imiquimod (Aldara) or podofilox (Condylox), which are often used for wart removal, are generally avoided during pregnancy due to potential risks to the fetus.

Monitoring and Follow-Up

Women with high-risk HPV or cervical dysplasia should have regular follow-up appointments to monitor any changes during pregnancy. In most cases, definitive treatment for abnormal cervical cells, such as a LEEP or cone biopsy, is postponed until postpartum, unless there is a suspicion of invasive cancer.

Prevention and Recommendations for Expectant Mothers

HPV Vaccination and Pregnancy

While the HPV vaccine is highly effective in preventing HPV infections and related cancers, it is not recommended for use during pregnancy. If a woman finds out she is pregnant after starting the HPV vaccine series, it is recommended to delay further doses until after childbirth. There is no evidence that the vaccine harms the mother or baby, but it is best to err on the side of caution and resume vaccination postpartum.

For more information on the HPV vaccine and its recommendations, refer to the CDC’s HPV Vaccination Guidelines.

Safe Practices and Regular Screenings

Pregnant women who have a history of HPV or abnormal cervical changes should maintain regular prenatal care visits and communicate openly with their healthcare provider about their concerns. Safe sexual practices, such as using condoms, can reduce the risk of transmitting HPV to partners, but it does not provide complete protection.

Maintaining a Healthy Immune System

A strong immune system can help manage HPV and reduce the likelihood of complications. Pregnant women should focus on a balanced diet, adequate rest, and regular exercise as recommended by their healthcare provider.

Final Thoughts

HPV is a common concern for many women, but being pregnant and having HPV does not mean complications are inevitable. Most women with HPV will have healthy pregnancies and healthy babies. Understanding how HPV affects pregnancy, staying informed through regular screenings, and maintaining open communication with your healthcare provider are essential steps for managing the virus effectively.

For more information on HPV and pregnancy, consult your healthcare provider or visit trusted sources like the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC). By staying informed, you can make the best decisions for yourself and your growing family.