ACOG Updates Guidance: COVID-19, Flu, and RSV Vaccines Recommended Throughout Pregnancy
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Protecting both expectant mothers and their infants, the American College of Obstetricians and Gynecologists (ACOG) has reaffirmed the safety and efficacy of vaccination against COVID-19, influenza, and respiratory syncytial virus (RSV) during all stages of pregnancy.
The updated clinical guidance, released today, underscores the critical role maternal immunization plays in preventing severe illness and safeguarding the health of newborns. ACOG’s recommendations are based on a complete review of current scientific evidence, consistently demonstrating the benefits of vaccination outweigh any potential risks.
Protecting Mothers and Infants from COVID-19
ACOG’s updated advisory on COVID-19 vaccination encourages individuals to receive an updated vaccine or booster at any point during pregnancy, while planning to become pregnant, postpartum, or while lactating. Data indicates these vaccines are particularly effective in reducing COVID-19 complications for both pregnant patients and their infants, as measured by emergency department and urgent care visits.
Importantly,vaccination during pregnancy provides passive immunity to the infant,offering protection in the crucial first months of life before they are eligible for vaccination themselves. According to one author of the practice advisory, “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.” Furthermore, maternal vaccination results in greater antibody persistence in infants compared to those whose mothers experienced infection without vaccination. During the 2023-24 respiratory virus season,less than 5% of mothers whose infants were hospitalized with COVID-19 had been vaccinated during pregnancy,highlighting the protective impact of immunization.
Side effects remain generally mild and localized, with no evidence suggesting increased rates in pregnant individuals or negative impacts on pregnancy outcomes.
Influenza Vaccination Remains a Priority
ACOG continues to strongly recommend influenza vaccination for all individuals who are or will be pregnant during flu season, utilizing either an inactivated or recombinant vaccine as soon as it becomes available. This recommendation stems from the heightened risks influenza poses to both pregnant patients and their newborns.
While a new live-attenuated, intranasally administered influenza vaccine has recently been approved for self-governance, it is not approved for use in pregnant individuals. However, it may be considered for postpartum patients, including those who are lactating, who prefer this method of administration. A senior official noted that “decades of data have informed ACOG’s long-standing recommendation in support of vaccination against the seasonal flu during pregnancy,” but acknowledged that less than half of pregnant patients currently choose to receive the flu vaccine.
New Guidance on RSV Vaccination
In a important development, ACOG now recommends maternal vaccination against RSV with the bivalent RSV PreF vaccine during RSV season (September 1 through January 31 in most of the United States). The vaccine should be administered between 32 0/7 and 36 6/7 weeks of gestation, provided a planned delivery is not within two weeks and the patient has not previously received the vaccine during a prior pregnancy.
If a patient declines the maternal RSV vaccine,ACOG advises that their infant receive 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,” explained one of the authors of the RSV guidance.
Co-administration of Vaccines Encouraged
ACOG emphasizes that all three vaccines – COVID-19,influenza,and RSV – can be administered simultaneously. Sandra E. Brooks, MD, MBA, FACOG, chief executive officer of ACOG, stated, “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.” As respiratory illness season approaches, ACOG urges healthcare professionals to actively recommend these vaccines to their pregnant patients.
