What is the effect of Human Papillomavirus (HPV) in a mother on the fetus and newborn?

From the Guidelines

HPV infection in a mother typically poses minimal risk to the fetus and newborn, with vertical transmission occurring in approximately 1-5% of pregnancies where the mother has HPV. The primary concern is the potential development of laryngeal papillomatosis in the infant, a rare condition where papillomas grow in the baby's airway, causing breathing difficulties and requiring surgical intervention, as noted in studies such as 1. This occurs most commonly when the baby is exposed to active genital warts during vaginal delivery. However, cesarean section is not routinely recommended solely for maternal HPV infection unless extensive genital warts obstruct the birth canal, as indicated in 1 and 1.

Key Considerations

• Most infants exposed to HPV during birth clear the virus spontaneously without developing any symptoms or long-term complications.
• HPV does not cause birth defects, miscarriage, or other pregnancy complications.
• Pregnant women with HPV should continue regular prenatal care and discuss any concerns about genital warts with their healthcare provider.
• The HPV vaccine is not recommended during pregnancy, though inadvertent vaccination has not been associated with adverse outcomes, as mentioned in 1.
• Women who discover they have HPV during pregnancy do not require special monitoring of the baby for HPV-related complications.

Management and Prevention

• Imiquimod, sinecatechins, podophyllin, and podofilox should not be used during pregnancy, as stated in 1.
• Genital warts can proliferate and become friable during pregnancy, and although removal of warts during pregnancy can be considered, resolution might be incomplete or poor until pregnancy is complete.
• Cesarean delivery is indicated for women with genital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding, as noted in 1 and 1.

Counseling and Care

• Pregnant women with genital warts should be counseled concerning the low risk for warts on the larynx (recurrent respiratory papillomatosis) in their infants or children, as mentioned in 1.
• The route of transmission (i.e., transplacental, perinatal, or postnatal) is not completely understood, and whether cesarean section prevents respiratory papillomatosis in infants and children also is unclear, as indicated in 1.

From the Research

Effects of HPV on Fetus and Newborn

• Human Papillomavirus (HPV) infection in pregnancy has been associated with adverse outcomes such as spontaneous miscarriage, preterm birth, placental abnormalities, and fetal growth restriction 2, 3.
• Vertical transmission of HPV to the fetus/neonate can cause neonatal infections, especially juvenile-onset recurrent oral and respiratory papillomatosis (JORRP) 2, 4.
• The risk of adverse pregnancy outcomes is increased among HPV-positive women, with clinical impacts including preterm birth, miscarriage, pregnancy-induced hypertensive disorders, intrauterine growth restriction, low birth weight, premature rupture of membranes, and fetal death 3.

Transmission and Prevention

• HPV infection is the most common sexually transmitted infection, and its transmission can occur through direct contact of infected organs, either through the skin or mucosa 5, 6.
• Vaccination is the primary method of prevention, and the nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 5.
• Use of condoms and dental dams may decrease the spread of the virus, and screening for HPV infection is effective in identifying precancerous lesions and allowing for interventions that can prevent the development of cancer 5, 6.

Diagnosis and Treatment

• Diagnosis of HPV in pregnancy is mainly by viral PCR or from the clinical appearance of characteristic lesions on the vulva 2.
• Treatment is local by either surgical or laser excision or application of trichloroacetic acid, and podophyllin/podophyllotoxin is contraindicated in pregnancy 2.
• HPV infection is not an indication for cesarean delivery, as this has not been shown to prevent vertical transmission 2, 4.