Safety of Pap Testing During Pregnancy
Yes, it is safe to perform a Pap test during pregnancy, and pregnant women should be screened at the same frequency as non-pregnant women. 1, 2
When to Perform Pap Testing in Pregnancy
- A Pap smear should be obtained at the first prenatal visit if none has been documented during the preceding year. 1
- Pregnant women should follow the same screening frequency as non-pregnant women, making pregnancy an excellent opportunity for cervical cancer screening. 1, 2
- If a woman is menstruating, postpone the conventional cytology Pap test and advise her to have it at the earliest opportunity. 1, 2
Safe Collection Technique in Pregnancy
Use a swab and an Ayre's spatula for obtaining Pap tests in pregnant women, but do NOT use cytobrushes. 1, 2
- Cytobrushes are contraindicated in pregnancy because they may disrupt the mucous plug. 2
- The presence of mucopurulent discharge should not delay the Pap test—simply remove the discharge carefully with a saline-soaked cotton swab before obtaining the specimen. 1, 2
- Liquid-based cytology is an acceptable alternative to conventional Pap tests with similar test-performance characteristics. 1
Evidence Supporting Safety
Research demonstrates that Pap testing during pregnancy is safe, necessary, and acceptable:
- A study of 954 pregnant women found that cervical Pap smear testing is safe and acceptable for routine prenatal care, with abnormal epithelial changes detected in 9.3% of pregnant women (similar to non-pregnant controls). 3
- The prevalence of squamous intraepithelial lesions (SIL) was actually lowest in pregnant women (0.94%) compared to non-pregnant controls (2.75%) and gynecological patients (6.23%). 3
- A prospective study of 596 pregnant women showed a low prevalence (0.8%) of premalignant lesions, with only 1.5% unsatisfactory smears, demonstrating the feasibility of opportunistic screening during pregnancy. 4
Management Considerations
- Management recommendations for abnormal Pap smears differ for pregnant women compared to non-pregnant women. 1, 2
- Pregnant adolescents with minor Pap abnormalities may be followed rather than referred for immediate colposcopy due to high rates of HPV regression. 5
- Postponing colposcopy in pregnant, reproductive-age women with minor Pap changes until after delivery is now acceptable. 5
- Women with external genital warts do not need Pap tests more frequently than women without warts. 1, 2
Important Caveats
Do not skip Pap testing during pregnancy assuming it can wait until postpartum. Research shows that 4.9% of women with normal prenatal Pap smears had abnormal postpartum results, and Pap test results during pregnancy may not be accurate due to hormonal influences. 6, 7 However, this supports performing the test during pregnancy rather than avoiding it, as pregnancy provides a critical screening opportunity that should not be missed. 1, 4