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Condyloma in Pregnancy Is Strongly Predictive of Juvenile-Onset Recurrent Respiratory Papillomatosis

From the Departments of Epidemiology and Molecular Microbiology & Immunology, Johns Hopkins University, Baltimore, Maryland; and Department of Epidemiology and Social Medicine, Aarhus University, and Oral Pathology Laboratory, Royal Dental College, Aarhus, Denmark.

Address reprint requests to: Michael Silverberg, PhD, MPH, Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe Street, Room E-7137, Baltimore, MD 21205-2179; E-mail: msilverb{at}jhsph.edu.

OBJECTIVE: To assess the risk of juvenile-onset recurrent respiratory papillomatosis conferred by a maternal history of genital warts in pregnancy, and to identify additional cofactors such as the method of delivery (cesarean versus vaginal) and procedures or complications during pregnancy.

METHODS: A retrospective cohort design was used to evaluate maternal and infant characteristics associated with respiratory papillomatosis among Danish births between 1974 and 1993. Using data from Danish registries, we identified 3033 births with a maternal history of genital warts during pregnancy. Fifty-seven respiratory papillomatosis cases were identified by review of medical records from ear, nose, and throat departments.

RESULTS: Seven of every 1000 births with a maternal history of genital warts resulted in disease in the offspring, corresponding to a 231.4 (95% confidence interval 135.3, 395.9) times higher risk of disease relative to births without a maternal history of genital warts. In women with genital warts, delivery times of more than 10 hours were associated with a two-fold greater risk of disease. Cesarean delivery was not found to be protective against respiratory papillomatosis, and no other procedures or complications during pregnancy were observed to increase the risk of respiratory papillomatosis.

CONCLUSION: A maternal history of genital warts in pregnancy is the strongest risk factor for respiratory papillomatosis in the child. Future studies should examine the efficacy of genital wart treatment for the prevention of disease.

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