August 25, 2025
3 min read
Key takeaways:
- ACOG continues to recommend RSV, influenza and COVID-19 vaccination during pregnancy.
- The new guidance “underscores the safety and benefits” of choosing these vaccines, ACOG’s president told Healio.
ACOG released updated clinical guidance on vaccination for COVID-19, respiratory syncytial virus and influenza during pregnancy, emphasizing the importance of the three vaccines.
“ACOG continues to recommend COVID-19, flu and RSV vaccines as part of maternal immunizations, and the latest guidance lays out the full body of current scientific evidence that underscores the safety and benefits of choosing to be vaccinated against these respiratory conditions during pregnancy,” ACOG President Steven J. Fleischman, MD, MBA, FACOG, told Healio.
ACOG continues to recommend RSV, influenza and COVID-19 vaccination during pregnancy. Image: Adobe Stock
RSV guidance
ACOG recommends that during the RSV season, Pfizer’s bivalent Abrysvo vaccine — also known as RSVPreF — be given to patients:
- between 32 0/7 and 36 6/7 weeks of gestation;
- who do not have a planned delivery within 2 weeks;
- who did not receive the maternal RSV vaccine during a prior pregnancy; and
- who are not planning to have their infant receive a monoclonal antibody, Beyfortus (nirsevimab, Sanofi) or Enfonsia (clesrovimab, Merck).
The organization in a press release said that patients “should also understand that if they decline the maternal RSV vaccination, their infant needs a monoclonal antibody at birth.”
“The RSV vaccine provides our pregnant patients with the ability to protect their infants against severe respiratory illness before they are even born,” Brenna L. Hughes, MD, FACOG, a guideline author, said in the release. “The RSV vaccine is a powerful tool that allows us to keep infants healthier and prevent hospitalizations and even has the potential to save lives.”
Influenza guidance
ACOG recommends that all patients who are or will be pregnant during influenza season receive a recombinant or inactivated influenza vaccine as soon as it is available, during any trimester of pregnancy.
Healio previously reported that maternal influenza vaccination reduces the risk for influenza-related ED visits or hospitalizations in infants aged younger than 6 months.
The new guidance advises vaccination before the start of influenza season but encourages vaccination at any time during the season, and includes recommendations related to treatment of influenza during pregnancy.
The guidance further acknowledges that the new live-attenuated, intranasally administered influenza vaccine is not yet approved for use in pregnant individuals but “that it could be used for postpartum patients, including those who are lactating, who are averse to needle-based vaccines, or who prefer intranasal vaccine administration,” ACOG said.
“Decades of data have informed ACOG’s long-standing recommendation in support of vaccination against the seasonal flu during pregnancy. Unfortunately, data show that in recent years, less than half of pregnant patients have chosen to receive the flu vaccine,” Neil S. Silverman, MD, FACOG, a guideline author, said in the release. “All patients should know that the increased risks of influenza to pregnant women and their newborns are real, and that getting vaccinated before delivery can help them and their babies be protected against influenza and stay healthier during and after their pregnancies.”
COVID-19 guidance
Currently, there are conflicting recommendations regarding COVID-19 vaccination in pregnant women.
HHS Secretary Robert F. Kennedy Jr. in May said that the CDC would no longer recommend COVID-19 vaccines for healthy children and healthy pregnant women.
“While the CDC recently removed its recommendation that pregnant and lactating individuals receive updated COVID-19 vaccines, it’s important for clinicians and patients to know that ACOG’s recommendations have not changed,” Fleischman told Healio.
In its latest guidance, ACOG recommends that patients receive an updated COVID-19 vaccine or booster:
- at any point during pregnancy;
- in the postpartum period;
- when planning to become pregnant; or
- when lactating.
“Pregnant and recently pregnant patients with COVID-19 are at increased risk of more severe illness compared with nonpregnant peers, and ACOG continues to recommend COVID-19 vaccination so that pregnant patients can protect their health and the health of their pregnancy,” Fleischman said.
ACOG emphasized that COVID-19 vaccination is not associated with negative pregnancy outcomes. Side effects are minor and generally localized, and rates of adverse events are “not higher in pregnant individuals.”
Fleischman explained that confidence in and access to COVID-19 vaccines “are of critical importance for all communities, but willingness to consider vaccination varies by patient context.”
“Clinicians are encouraged to share the facts about the safety and efficacy of the COVID-19 vaccines with their patients to help boost vaccine confidence,” he said. “At the same time, clinicians should be aware of historical and current injustices perpetrated against certain communities and actively listen to and address any expressed fears and concerns.”
References:
For more information:
Steven J. Fleischman, MD, MBA, FACOG, can be reached through Jamila Vernon at jvernon@acog.org.
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