HPV in Pregnancy: Can It Pass to the Baby, and Can I Have a Normal Birth?
What does a positive HPV result mean in pregnancy? Risk to the baby, vaginal birth or cesarean, smear and colposcopy in pregnancy, genital warts and the HPV vaccine.
Getting a "positive HPV" result during or before pregnancy is one of the situations that worry expectant mothers most: "Can it pass to my baby?", "Can I have a normal birth?", "Does it need treatment in pregnancy?" This article answers these questions in plain language, based on international gynecology and obstetrics guidelines. For what HPV is and general information, see our page on HPV (human papillomavirus); for how follow-up is done after a positive result, see our article on a positive HPV result.
Is HPV Common in Pregnancy?
Yes. In studies, HPV is found in roughly 15% to 40% of pregnant women, which is a little higher than in women who are not pregnant. The reasons are the rising hormones of pregnancy, increased blood flow in the pelvis and a mild, temporary dampening of immunity. This can make it easier for the virus to multiply.
Pregnancy does not make HPV "more dangerous"; but clearing of the virus from the body may be somewhat slower, and existing genital warts may grow and multiply during pregnancy and bleed more easily. The good news is that after birth, once hormones and immunity return to normal, most genital warts and HPV-related cell changes go away on their own.
Are Smear and HPV Tests Done in Pregnancy?
Yes. At the first antenatal visit, age-appropriate cervical screening (a smear and, if needed, an HPV test) can be done safely. In pregnancy the cervix (the neck of the womb) has more blood supply and looks a little different; but the screening rules are the same as for women who are not pregnant. We explained the difference between a smear and an HPV test in a separate article, and the test itself on our page on the smear test and HPV test in Antalya.
What Happens If the Smear Is Abnormal in Pregnancy?
The approach depends on how serious the result is:
- Mild changes (such as ASC-US or LSIL): Colposcopy (looking at the cervix with a special lighted magnifier) can be done in pregnancy, but because the risk is low it can also be safely postponed until after birth (about the 6th week). You can read how colposcopy is done in our colposcopy article.
- Suspicion of a serious change (such as ASC-H, HSIL or AGC): Colposcopy is recommended in pregnancy. The aim is to rule out invasive cancer (cancer with a tendency to spread).
- Biopsy: If an area that raises suspicion of cancer or an advanced cell change is seen at colposcopy, a specialist doctor can take a biopsy; a biopsy alone does not put the pregnancy at risk.
- Scraping the inside of the cervical canal for a sample (endocervical curettage): It is not done in pregnancy because of the risk of bleeding, infection and pregnancy loss.
- Treatment (LEEP, cone biopsy): In pregnancy, the risk of moderate-to-advanced cell changes progressing to cancer is very low (below 0.5%), and a good part of them go away after birth. For this reason, these procedures, which carry a risk of bleeding, pregnancy loss and preterm birth, are postponed in pregnancy and reassessed at least 6-12 weeks after birth. A diagnostic cone biopsy (usually in the 2nd trimester) is considered only in selected cases that cannot be proven by biopsy but in which cancer is seriously suspected clinically.
Results may vary from person to person in interventional procedures. It is advisable to obtain detailed information from your doctor before a procedure.
Can HPV Pass to the Baby?
Passing from mother to baby (vertical transmission) is theoretically possible; it can happen while passing through the birth canal or in the womb. However, it is very rare for this to cause a clinically significant disease.
The only serious condition known is recurrent respiratory papillomatosis, in which low-risk HPV types (6 and 11) cause wart-like growths in the larynx and vocal cords in childhood. Its signs are hoarseness and shortness of breath. This is very rare: about 5 cases are reported per 10,000 live births in the general population; even in babies of mothers with active genital warts the figure is around 7 per 1,000 births. In other words, a mother having HPV or genital warts does not mean that the baby will catch this disease.
Vaginal Birth or Cesarean?
The shared view of the guidelines is this: HPV positivity, a cell change in the cervix or genital warts is not on its own a reason for a cesarean. The mode of birth is decided by the usual birth-related reasons, and vaginal birth is preferred.
One reason is that it has not been shown that a cesarean prevents the virus from passing to the baby or prevents recurrent respiratory papillomatosis in the baby. A cesarean comes up only in these rare situations:
- When genital warts cover the vaginal opening or the perineum and block the birth canal
- When tearing of the tissues during vaginal birth creates a risk of uncontrolled bleeding
Are Genital Warts Treated in Pregnancy?
Treating warts in pregnancy is not a must. If the warts are very large, bothersome or bleeding, they can be reduced with methods considered safe in pregnancy, in which the medicine does not pass into the bloodstream:
- Chemical burning with local acid-containing solutions
- Freezing with liquid nitrogen (cryotherapy)
- Surgical removal with local numbing, or burning with electricity or laser
Some creams and solutions that stop cell division, and some medicines that stimulate immunity, are not used in pregnancy because of the risk of harm to the baby or because there is not enough safety data. Do not use a product for warts on your own in pregnancy. For the causes of warts and general treatment options, see our genital warts article and our genital warts page.
Is the HPV Vaccine Given in Pregnancy?
The HPV vaccine is not recommended in pregnancy because there is not enough safety data; vaccination is left until after pregnancy. However, if it turns out that you became pregnant during the vaccine series, do not worry: the vaccine contains no live virus, and in large registry studies no harm to the baby or increase in miscarriage was found. The pregnancy does not need to be ended; only the remaining doses are completed after birth. While breastfeeding, the vaccine can be given; it has no negative effect on breast milk or the baby. We explained who should have the vaccine and when in our HPV vaccine article.
Does HPV Affect Getting Pregnant or the Course of Pregnancy?
- Chance of getting pregnant: An HPV infection of the cervix does not harm natural pregnancy rates or the pregnancy rates obtained with assisted reproduction such as IVF.
- Miscarriage and preterm birth: The evidence that HPV alone causes miscarriage or preterm birth is limited; no marked increase has been shown.
- An important distinction: If you had LEEP or a cone biopsy of the cervix before pregnancy for an advanced HPV-related cell change, the cervix becomes shorter, so in later pregnancies the risk of cervical weakness, early rupture of the membranes and preterm birth may rise a little. This risk comes from the procedure, not from the virus; it is taken into account in pregnancy follow-up. For the procedure itself, see our LEEP page.
When Should You See a Doctor?
- When you notice a wart or lump on the outer genital area or in the vagina that is growing fast, painful, itchy or bleeding when rubbed
- When there is bleeding after intercourse or spotting of unclear cause in pregnancy
- When you become pregnant and have had an abnormal smear or HPV result before
- When foul-smelling, coloured discharge or groin pain develops
For information about pregnancy care, see our page on pregnancy follow-up.
Frequently Asked Questions
I am HPV positive. Can I get pregnant?
Yes. Having HPV does not reduce your chance of getting pregnant. It is recommended that your cervical screening is up to date before pregnancy and that follow-up is completed if needed.
Do I have to have a cesarean because I am HPV positive?
No. HPV positivity is not on its own a reason for a cesarean. The mode of birth is decided by birth-related reasons.
If HPV is not treated in pregnancy, will it harm my baby?
The chance of the virus harming the baby is very low. There is no medicine for HPV in pregnancy; follow-up is done, warts are reduced with safe methods if needed, and treatment of cell changes is often left until after birth.