Which vaccine is contraindicated in pregnancy: A. Influenza (flu) vaccine, B. Covid-19 vaccine, C. Tetanus, diphtheria, and pertussis (Tdap) (whooping cough) vaccine, or D. Human Papillomavirus (HPV) vaccine?

HPV Vaccine is Contraindicated in Pregnancy

The HPV vaccine (Option D) is the only vaccine among the choices that is contraindicated during pregnancy and should be deferred until after delivery. 1, 2

Vaccines Safe and Recommended During Pregnancy

The following vaccines from your question are not contraindicated and are actually recommended:

Influenza (Flu) Vaccine - Option A: SAFE

• The inactivated influenza vaccine is strongly recommended during any trimester of pregnancy by the CDC, WHO, and ACOG 3, 1, 2
• Pregnant women face 7.2% higher hospitalization rates and disproportionately high mortality risk from influenza compared to non-pregnant women 3
• Important caveat: Only the inactivated influenza vaccine (IIV) or recombinant vaccine (RIV) should be used—the live attenuated nasal spray (LAIV) is contraindicated 1, 2, 4

COVID-19 Vaccine - Option B: SAFE

• The CDC strongly recommends COVID-19 vaccination for all pregnant women, as pregnancy increases risk of ICU admission, invasive ventilation, and mortality 2-3 fold 1
• Initial safety data supports the safe use of mRNA vaccines in pregnant women 3

Tdap (Whooping Cough) Vaccine - Option C: SAFE

• Tdap is routinely recommended during each pregnancy between 27-36 weeks gestation by ACIP, ACOG, and AAP 3, 1, 2
• This timing maximizes transplacental antibody transfer to protect newborns during their most vulnerable period before they can receive their own vaccinations 1
• If not given during pregnancy, it should be administered immediately postpartum 3, 1

Why HPV Vaccine is Contraindicated

Official Guideline Recommendations

• The Advisory Committee on Immunization Practices (ACIP) and ACOG explicitly contraindicate HPV vaccination during pregnancy 1
• The vaccine should be deferred until after pregnancy completion 1
• If a woman becomes pregnant mid-series, the remaining doses should be given after delivery 5

Safety Profile Context

• HPV vaccine is FDA pregnancy category B (not expected to cause harm theoretically, as it is not a live vaccine) 6
• Clinical trial data from over 3,600 pregnancies showed no increased risk of spontaneous abortion, fetal malformations, or adverse pregnancy outcomes 7, 5
• Despite reassuring safety data, vaccination is not recommended during pregnancy because there is no urgent need for protection during the pregnancy period itself 6, 5

Preconception Planning

• The HPV vaccine series (3 doses through age 26 years) should ideally be completed before pregnancy 1
• The series can be resumed or completed immediately after delivery 1

Key Clinical Pitfall to Avoid

Do not confuse "contraindicated" with "known to cause harm." HPV vaccine is contraindicated during pregnancy as a precautionary measure and because there is no benefit to administering it during pregnancy, not because it has been proven harmful. 6, 5 If inadvertent exposure occurs (woman receives vaccine before knowing she is pregnant), reassure the patient that available data do not indicate increased risk. 6, 7