The American College of Obstetricians and Gynecologists (ACOG) has released updated clinical guidance recommending vaccination against COVID-19, influenza, and respiratory syncytial virus (RSV) during pregnancy. The three practice advisories present the current evidence base and emphasize both maternal and infant protection.
ACOG President Steven J. Fleischman, MD, MBA
Courtesy of ACOG
“It is well documented that respiratory conditions can cause poor outcomes during pregnancy, with pregnant women facing both severe illness and threats to the health of their pregnancy. Thanks to vaccines, severe outcomes from respiratory infections are largely preventable,” Steven J. Fleischman, MD, MBA, FACOG, president of ACOG. “ACOG’s updated respiratory guidance documents repeat what we have long known: that vaccines continue to be the best tool available for pregnant patients to protect themselves and their infants from these viruses.”
The updated COVID-19 advisory recommends that patients receive an updated COVID-19 vaccine or booster at any point during pregnancy, when planning pregnancy, postpartum, or while lactating. Data show that vaccination reduces maternal morbidity, preterm birth, stillbirth, and severe maternal morbidity. Infants of vaccinated mothers had greater antibody persistence compared with those whose mothers had infection without vaccination. During the 2023–24 season, fewer than 5% of mothers whose infants were hospitalized for COVID-19 had received the vaccine during pregnancy. Adverse effects are mostly mild and localized, with no higher rates observed in pregnant individuals. “Looking closely at the full body of data clearly shows that the COVID-19 vaccines are not only completely safe for use during pregnancy but also protective both during pregnancy and after the infant is born,” said Mark Turrentine, MD, FACOG, one of the advisory’s authors.
In its influenza advisory, ACOG continues to recommend inactivated or recombinant influenza vaccination during any trimester of pregnancy, ideally before the start of influenza season but at any time while influenza is circulating. The advisory specifies that the newly approved live-attenuated intranasal influenza vaccine is not indicated in pregnancy, though it may be used postpartum, including among lactating patients who prefer intranasal administration. Antiviral treatment guidance for influenza during pregnancy is also included. “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,” said Neil S. Silverman, MD, FACOG. “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.”
The RSV advisory recommends administration of the bivalent RSV PreF vaccine between 32 0/7 and 36 6/7 weeks of gestation for patients without a planned delivery within two weeks, who did not receive the RSV vaccine in a prior pregnancy, and who do not plan for their newborn to receive nirsevimab or clesrovimab. Infants of mothers who decline maternal RSV vaccination should receive monoclonal antibody protection 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,” said Brenna Hughes, MD, FACOG. “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.”
All three maternal respiratory vaccines may be administered simultaneously. “In the face of misinformation and vaccine hesitancy, a strong, evidence-based recommendation in support of vaccination from a trusted clinician can go a long way toward encouraging our patients to protect themselves and their pregnancies,” said Sandra E. Brooks, MD, MBA, FACOG, chief executive officer of ACOG. “As respiratory illness season begins, it is crucial that my fellow health care professionals actively support and recommend COVID-19, flu, and RSV vaccines for pregnant patients.”