Can the human papillomavirus (HPV) vaccine be administered during pregnancy?

HPV Vaccine Should Not Be Given During Pregnancy

The HPV vaccine is not recommended for administration during pregnancy and should be delayed until after delivery. 1, 2, 3

Key Clinical Guidance

What to Do If Pregnancy is Discovered

• No pregnancy test is required before starting the HPV vaccine series 1, 2
• If a woman becomes pregnant after starting the series: postpone remaining doses until after delivery 1, 2, 3
• If a dose was inadvertently given during pregnancy: no intervention is needed - simply defer subsequent doses 2, 3
• Report exposures to the pregnancy registry at 1-800-986-8999 1, 2

Safety Profile of Inadvertent Exposure

While the vaccine is not recommended during pregnancy, the available evidence is reassuring if inadvertent exposure occurs:

The vaccine has not been causally associated with adverse pregnancy outcomes. Multiple large studies demonstrate no increased risk for:

• Spontaneous abortion 4, 5, 6
• Stillbirth 5, 6
• Major birth defects 4, 5, 6
• Preterm birth 4, 5, 6
• Small for gestational age 4, 5
• Low birth weight 5, 6

The most robust evidence comes from a Danish nationwide cohort study of over 1,600 exposed pregnancies showing no significant associations with any adverse outcomes 5. A U.S. Vaccine Safety Datalink study of 1,493 pregnancies similarly found no increased risks 4.

Important Caveats

One meta-analysis suggested a possible signal for spontaneous abortion when 2vHPV was given 45 days before last menstrual period (LMP) to LMP, or when 9vHPV was given 90 days before LMP to 45 days after LMP 7. However, this finding:

• Conflicts with larger individual studies showing no association
• Has not changed official guideline recommendations
• Requires further research for confirmation

Practical Algorithm

Before vaccination:

1. Ask about pregnancy status in sexually active patients
2. Do NOT require pregnancy testing
3. Proceed with vaccination if not pregnant

If pregnancy discovered after dose 1 or 2:

1. Reassure the patient - no intervention needed for doses already given
2. Defer remaining doses until postpartum period
3. Report to pregnancy registry (1-800-986-8999)
4. Resume series after delivery

Breastfeeding is NOT a contraindication - lactating women can receive HPV vaccine 2, 3

Why Delay During Pregnancy?

The recommendation to delay is based on insufficient data rather than demonstrated harm 2. The vaccine contains no viral DNA and is not infectious 1, but the precautionary principle applies given limited pregnancy exposure data at the time guidelines were established.