{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T23:25:50Z","timestamp":1787354750450,"version":"build-2736575974"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UIC Building Interdisciplinary Research Careers in Women's Health (BIRCWH)from the National Institutes of Health (NIH) Office of Research on Women's Health","award":["2K12AR084225-07"],"award-info":[{"award-number":["2K12AR084225-07"]}]},{"name":"Investigator-Initiated Studies Program of Merck Sharp & Dohme LLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cervical cancer is preventable with the human papillomavirus (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.<\/jats:p>\n                  <jats:p>We performed a mixed-methods study utilizing patient focus group discussions (FGDs) 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 (ACOG) 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.<\/jats:p>\n                  <jats:p>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 participants' 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.<\/jats:p>\n                  <jats:p>Patients 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.<\/jats:p>","DOI":"10.1055\/a-2936-5812","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T23:14:43Z","timestamp":1786749283000},"source":"Crossref","is-referenced-by-count":0,"title":["Patient and Provider Knowledge and Attitudes Regarding Vaccination with the 9-Valent HPV Vaccine during Pregnancy"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9706-1461","authenticated-orcid":false,"given":"Sarah","family":"Boudova","sequence":"additional","affiliation":[{"name":"University of Illinois Chicago, Illinois, United States","place":["Chicago"],"department":["Department of Obstetrics and Gynecology, Division of Maternal\u2014Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Gannon","sequence":"additional","affiliation":[{"name":"College of Nursing, Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Zhan","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Frusone","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aichatou","family":"Haidara","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agustina","family":"Arce","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"McGuigan","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth I.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Chambers","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3705-6943","authenticated-orcid":false,"given":"Rupsa C.","family":"Boelig","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Obstetrics and Gynecology, Division of Maternal\u2014Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S0140-6736(18)32470-X","article-title":"Cervical cancer","volume":"393","author":"P A Cohen","year":"2019","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/S0140-6736(17)31821-4","article-title":"Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial","volume":"390","author":"W K Huh","year":"2017","journal-title":"Lancet"},{"issue":"33","key":"ref3","doi-asserted-by":"crossref","first-page":"708","DOI":"10.15585\/mmwr.mm7333a1","article-title":"National vaccination coverage among adolescents aged 13-17 years - National Immunization Survey-Teen, United States, 2023","volume":"73","author":"C Pingali","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.acap.2017.09.014","article-title":"Ten years of human papillomavirus vaccination in the United States","volume":"18","author":"L E Markowitz","year":"2018","journal-title":"Acad Pediatr"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"100298","DOI":"10.1016\/j.jvacx.2023.100298","article-title":"Parental perceptions of the HPV vaccine for prevention of anogenital and oropharyngeal cancers","volume":"14","author":"B I Schwartz","year":"2023","journal-title":"Vaccine X"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1097\/AOG.0000000000004000","article-title":"Human papillomavirus vaccination: ACOG Committee Opinion, Number 809","volume":"136","author":"American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists' Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"28","key":"ref7","doi-asserted-by":"crossref","first-page":"4618","DOI":"10.1016\/j.vaccine.2011.04.062","article-title":"Willingness of pregnant women to vaccinate themselves and their newborns with the HPV vaccine","volume":"29","author":"K P Heyman","year":"2011","journal-title":"Vaccine"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"213.e1","DOI":"10.1016\/j.ajog.2013.11.036","article-title":"Assessing the need for and acceptability of a free-of-charge postpartum HPV vaccination program","volume":"210","author":"A B Berenson","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1586\/14760584.2014.867236","article-title":"Is administration of the HPV vaccine during pregnancy feasible in the future?","volume":"13","author":"A B Berenson","year":"2014","journal-title":"Expert Rev Vaccines"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.36922\/MI025310073","article-title":"Safety of the 9-valent human papillomavirus vaccine in pregnancy based on the vaccine adverse event reporting system","volume":"3","author":"S Boudova","year":"2026","journal-title":"Microbes Immun"},{"issue":"11","key":"ref11","first-page":"300","article-title":"Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices","volume":"64","author":"E Petrosky","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"13","key":"ref13","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1056\/NEJMoa1612296","article-title":"Quadrivalent HPV vaccination and the risk of adverse pregnancy outcomes","volume":"376","author":"N M Scheller","year":"2017","journal-title":"N Engl J Med"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.vaccine.2014.11.047","article-title":"Safety of quadrivalent human papillomavirus vaccine (Gardasil) in pregnancy: adverse events among non-manufacturer reports in the Vaccine Adverse Event Reporting System, 2006-2013","volume":"33","author":"P L Moro","year":"2015","journal-title":"Vaccine"},{"issue":"29","key":"ref15","doi-asserted-by":"crossref","first-page":"3422","DOI":"10.1016\/j.vaccine.2015.04.014","article-title":"Final report on exposure during pregnancy from a pregnancy registry for quadrivalent human papillomavirus vaccine","volume":"33","author":"M A Goss","year":"2015","journal-title":"Vaccine"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1097\/AOG.0b013e3181c2ca21","article-title":"Pregnancy and infant outcomes in the clinical trials of a human papillomavirus type 6\/11\/16\/18 vaccine: a combined analysis of five randomized controlled trials","volume":"114","author":"S M Garland","year":"2009","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1111\/aogs.14881","article-title":"Does HPV vaccination during periconceptional or gestational period increase the risk of adverse pregnancy outcomes?-An updated systematic review and meta-analysis based on timing of vaccination","volume":"103","author":"J Zhang","year":"2024","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"e20154387","DOI":"10.1542\/peds.2015-4387","article-title":"Safety profile of the 9-valent HPV vaccine: a combined analysis of 7 phase III clinical trials","volume":"138","author":"E D Moreira Jr","year":"2016","journal-title":"Pediatrics"},{"key":"ref19","volume-title":"Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 4th ed","author":"J Corbin","year":"2015"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1177\/1049732318821692","article-title":"What influences saturation? Estimating sample sizes in focus group research","volume":"29","author":"M M Hennink","year":"2019","journal-title":"Qual Health Res"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.socscimed.2019.05.010","article-title":"A reproductive justice approach to understanding women's experiences with HPV and cervical cancer prevention","volume":"232","author":"B Sundstrom","year":"2019","journal-title":"Soc Sci Med"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1080\/01443615.2022.2114327","article-title":"A systematic review to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated","volume":"42","author":"R Demir","year":"2022","journal-title":"J Obstet Gynaecol"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"e0282525","DOI":"10.1371\/journal.pone.0282525","article-title":"Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review","volume":"18","author":"B Nichol","year":"2023","journal-title":"PLoS ONE"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.whi.2021.02.002","article-title":"Inpatient immunization with HPV vaccine: a qualitative study with postpartum women","volume":"31","author":"L Avni-Singer","year":"2021","journal-title":"Womens Health Issues"},{"issue":"S 01","key":"ref25","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s10995-016-2030-0","article-title":"Implementation of a postpartum HPV vaccination program in a Southeast Texas Hospital: a qualitative study evaluating health care provider acceptance","volume":"20","author":"T T Gross","year":"2016","journal-title":"Matern Child Health J"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"106554","DOI":"10.1016\/j.ypmed.2021.106554","article-title":"Provider communication and HPV vaccine uptake: A meta-analysis and systematic review","volume":"148","author":"N L Oh","year":"2021","journal-title":"Prev Med"},{"key":"ref27","first-page":"301","article-title":"Awareness, perceptions and knowledge of recommended adult vaccines among a nationwide sample of adult primary care providers","volume":"56","author":"T Q Tan","year":"2011","journal-title":"J Reprod Med"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1016\/S1473-3099(25)00284-1","article-title":"Human papillomavirus (HPV) type 16 and type 18 antibody concentrations after a single dose of bivalent HPV vaccine in girls aged 9-14 years compared with three doses of quadrivalent HPV vaccine in women aged 18-25 years in Costa Rica (PRIMAVERA): a non-randomised, open-label, immunobridging, non-inferiority trial","volume":"25","author":"B Cort\u00e9s","year":"2025","journal-title":"Lancet Infect Dis"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/1471-0528.17349","article-title":"Spontaneous preterm birth risk among HPV-vaccinated and -unvaccinated women: a nationwide retrospective cohort study of over 240\u2009000 singleton births","volume":"130","author":"E McClymont","year":"2023","journal-title":"BJOG"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/infdis\/jiaa106","article-title":"Has human papillomavirus (HPV) vaccination prevented adverse pregnancy outcomes? Population-level analysis after 8 years of a national HPV vaccination program in Australia","volume":"222","author":"S Yuill","year":"2020","journal-title":"J Infect Dis"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2936-5812.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T23:10:28Z","timestamp":1787353828000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2936-5812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":29,"URL":"https:\/\/doi.org\/10.1055\/a-2936-5812","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8,14]]},"published":{"date-parts":[[2026,8,14]]}}}