Objective To explore the impact of HR-HPV infection on pregnancy outcomes and vaginal microbiota. Methods 128 pregnant women who underwent prenatal examinations at Mingshan Branch of the First Affiliated Hospital of Chengdu Medical College were selected as the research subjects. Both vaginal microbiota and HR-HPV testing were conducted， and single factor analysis and multiple linear regression analysis were used to identify the relevant factors of HR-HPV infection in pregnant women. The impact of HR-HPV infection on pregnancy outcomes and vaginal microbiota was studied. Results Among the 49 cases in the infection group， 30 cases contracted with type 16 HPV， accounting for 61.22%， 13 type 18 HPV， accounting for 26.53%， and 1 type 31， 33， 51， 52， 53， and 58， respectively. Univariate analysis showed that HR-HPV infections were significantly correlated with age of first sexual activity， condom use， number of sexual partners， reproductive tract inflammation， and smoking history （P < 0.05）. Multivariate analysis showed that age of first sexual activity ≤ 20 years， concurrent reproductive tract inflammation， multiple sexual partners， and smoking history were independent risk factors for HR-HPV infection， while condom use was an independent protective factor for HR-HPV infection. There were significant differences in the number of lactobacilli， candida infections， and vaginal cleanliness between the two groups （P < 0.05）. The incidence of spontaneous abortion and fetal growth restriction in the HR-HPV-infected group was significantly higher than that in the HR-HPV-uninfected group （P < 0.05）. Conclusions Pregnant women with HR-HPV infections are closely related to factors such as premature sexual conduct， number of sexual partners， reproductive tract inflammation， and smoking. Infections with HR-HPV during pregnancy can cause changes in the vaginal microenvironment and lead to adverse pregnancy outcomes.