HPV Vaccine is Contraindicated in Pregnancy
The HPV vaccine is contraindicated during pregnancy and should be deferred until after delivery, making it the correct answer (D). 1, 2
Vaccines Safe During Pregnancy
The following vaccines are not contraindicated and can be safely administered during pregnancy:
Influenza Vaccine (Option A)
- Recommended for all pregnant women during any trimester 1
- The inactivated influenza vaccine (IIV) is specifically indicated during pregnancy, though the live-attenuated intranasal formulation is contraindicated 1, 3
- Provides both maternal protection and passive immunity to the newborn through transplacental antibody transfer 1
COVID-19 Vaccine (Option B)
- Strongly recommended for all pregnant women by the CDC and WHO 4
- Real-world safety data from 90,000 pregnant women showed no safety signals 4
- Particularly important given that pregnant women face 2-3 fold higher rates of ICU admission, invasive ventilation, and mortality from COVID-19 compared to non-pregnant women 4
Tdap/Whooping Cough Vaccine (Option C)
- Routinely recommended during each pregnancy between 27-36 weeks gestation 1
- Combined tetanus-diphtheria-pertussis vaccine is safe and specifically indicated during pregnancy 1
- Provides crucial protection to newborns during their most vulnerable period before they can receive their own vaccinations 1
Why HPV Vaccine is Contraindicated
Guideline Recommendations
- HPV vaccination is explicitly contraindicated during pregnancy according to ACIP guidelines 1, 2
- The vaccine should be deferred until after pregnancy completion 2, 5
- If a woman becomes pregnant mid-series, the remaining doses should be postponed until after delivery 6
Safety Evidence
- While the HPV vaccine is not a live vaccine and theoretically poses minimal risk, it is still contraindicated as a precautionary measure 5, 3, 7
- Available data from manufacturer pregnancy registries and clinical trials (approximately 2,085-2,786 exposures) show no clear evidence of increased fetal malformations or adverse pregnancy outcomes 8, 6
- However, these studies have significant limitations including small sample sizes and retrospective design 6
- A meta-analysis found no increased risk of miscarriage (RR=2.01; 95% CI: 0.66-6.13) or stillbirth (RR=2.02; 95% CI: 0.65-6.27), but concluded vaccination is better postponed until after pregnancy 8
Clinical Algorithm
- Preconception: Administer HPV vaccine series (3 doses through age 26 years) before pregnancy 1, 2
- During pregnancy: Do not initiate or continue HPV vaccination 2, 5
- Postpartum: Resume or complete the HPV vaccine series immediately after delivery 5
- Inadvertent exposure: If vaccine is given during early pregnancy, reassure the patient that available data do not suggest increased risk, but report to manufacturer's pregnancy registry 7, 6
Common Pitfall to Avoid
Do not confuse the theoretical safety profile of HPV vaccine (being a non-live vaccine) with actual clinical recommendations—despite being theoretically safe, it remains contraindicated during pregnancy per current guidelines 1, 2, 5. The distinction is that while inadvertent exposure does not warrant pregnancy termination or excessive concern 7, intentional administration during pregnancy is not recommended 2, 5.