Patient and provider knowledge and attitudes regarding vaccination with the 9-valent HPV vaccine during pregnancy

Objective: Cervical cancer is preventable with the Human Papilloma Virus (HPV) vaccine; however, vaccination rates remain low. Pregnancy presents an opportunity to complete vaccination. Preliminary safety data are reassuring, but vaccination is currently contraindicated in pregnancy. We aimed to examine patient and provider knowledge and attitudes regarding 9-valent HPV vaccination in pregnancy. Study Design: We performed a mixed methods study utilizing patient Focus Group Discussions (FGD) and a national provider survey. FGDs with pregnant patients were conducted until thematic saturation was achieved. Surveys were sent to providers from the American College of Obstetricians and Gynecologists mailing list until the sample size (300) was achieved. Thematic analysis and descriptive statistics were performed on FGD transcripts and survey results. Findings were integrated and interpreted together. Results: We recruited 18 FGD patient participants and analyzed 321 provider surveys. Five key themes emerged from the integrated data: 1) knowledge of the HPV vaccine in pregnancy, 2) perceptions of HPV vaccine safety, 3) perceptions of HPV vaccine efficacy, 4) vaccine decision-making process, and 5) barriers and facilitators of HPV vaccination in pregnancy. Patient participant knowledge of the vaccine was variable. Physician recommendation and personal autonomy were key factors in their patient participant vaccine decision-making. Patient and provider participants expressed uncertainty about the safety and efficacy of the vaccine in pregnancy. A primary concern was fetal well-being. Both desired more research on vaccine safety and efficacy. Main provider-identified barriers to vaccination during pregnancy were professional organization recommendations against vaccination, safety concerns during pregnancy, and patient vaccine hesitancy. Most provider participants would offer vaccination during pregnancy if not contraindicated. Conclusion: Patient and providers report significant uncertainty about the safety and efficacy of the HPV vaccine in pregnancy. More research, and permissive language from professional organizations, are needed before patients and providers would feel comfortable with antepartum vaccination.