Is the Human Papillomavirus (HPV) vaccine safe to receive during pregnancy?

HPV Vaccine and Pregnancy

Primary Recommendation

The HPV vaccine should be delayed until after pregnancy is completed, but if inadvertently administered during pregnancy, no specific intervention is needed as available data show no causal association with adverse pregnancy outcomes. 1, 2

Key Management Points

If Pregnancy is Discovered After Vaccination

• If a woman becomes pregnant after starting the vaccine series, postpone the remaining doses until after delivery 1, 2
• No intervention is required if a dose was already given during pregnancy 2
• The woman should be reassured that inadvertent vaccination during pregnancy has not been causally linked to adverse fetal outcomes 1, 2

Pre-Vaccination Considerations

• Pregnancy testing is NOT required before administering the HPV vaccine 1
• This practical approach recognizes that routine pregnancy testing would create unnecessary barriers to vaccination 1

Safety Data Overview

The evidence regarding inadvertent pregnancy exposure is reassuring but limited:

• No increased risk of spontaneous abortion or stillbirth with the quadrivalent vaccine (4vHPV) when given during periconceptional or gestational periods 3, 4
• Registry data from over 1,000 exposed pregnancies show no particular pattern of congenital malformations with the quadrivalent vaccine 5
• The bivalent vaccine (2vHPV) has less robust data, with fewer than 400 studied pregnancies, though rates of malformations were similar to controls 5

Important caveat: Some evidence suggests a possible increased risk of spontaneous abortion with bivalent (2vHPV) and nonavalent (9vHPV) vaccines when given during the periconceptional period, though this finding requires further investigation 4

Postpartum Vaccination

Women who delayed vaccination due to pregnancy should receive the vaccine immediately postpartum, even before hospital discharge 2

• Breastfeeding is NOT a contraindication to HPV vaccination 1, 2
• Women ≤26 years who have not completed the series should start or continue vaccination during the postpartum period 2
• The standard 3-dose schedule (0,1-2, and 6 months) should be followed 2

Reporting Requirements

• Any exposure to HPV vaccine during pregnancy should be reported to the pregnancy registry at 800-986-8999 2
• This ongoing surveillance helps strengthen the safety database for inadvertent exposures 2

Clinical Pitfalls to Avoid

• Do not withhold vaccination from postpartum women due to breastfeeding concerns - the vaccine is a non-live recombinant protein vaccine and is safe during lactation 1, 2
• Do not perform pregnancy testing as a routine barrier to vaccination - this creates unnecessary delays and reduces vaccine uptake 1
• Do not assume that inadvertent pregnancy exposure requires pregnancy termination or intensive monitoring - reassure patients based on available safety data 1, 2, 6

Special Populations

• Immunocompromised women can receive the HPV vaccine as it is non-infectious, though immune response may be reduced 2
• Women with abnormal Pap smears or known HPV infection can still receive the vaccine postpartum, as it protects against other vaccine-type strains 2