On October 3, 2023, the American College of Obstetricians and Gynecologists (ACOG) unveiled updated clinical guidance concerning the vaccination of pregnant women against COVID-19, influenza, and respiratory syncytial virus (RSV). These three crucial guidance documents collectively advocate for maternal immunization, presenting a comprehensive overview of the latest scientific evidence that highlights the safety and benefits of vaccinations for pregnant individuals. ACOG emphasizes that immunization is vital to protect both mothers and infants from severe respiratory illnesses.
“It is well documented that respiratory conditions can lead to poor outcomes during pregnancy, exposing pregnant women to severe illness and jeopardizing the health of their pregnancy,” stated Steven J. Fleischman, MD, MBA, FACOG, president of ACOG. “Thanks to vaccines, severe outcomes from respiratory infections are largely preventable.” The updated guidance reiterates ACOG’s long-standing position that vaccines remain the most effective tool for safeguarding pregnant patients and their infants from these viruses.
The updated Practice Advisory on COVID-19 vaccination for obstetric and gynecologic care recommends that patients receive an updated COVID-19 vaccine or "booster" at any stage during pregnancy, whether planning to conceive, during the postpartum period, or while lactating. The guidance emphasizes that research indicates COVID-19 vaccines significantly reduce complications associated with COVID-19 for both pregnant individuals and their infants, as evidenced by lower rates of emergency department visits.
Moreover, vaccination during pregnancy is linked to a decrease in pregnancy complications, including severe maternal morbidity, preterm birth, and stillbirth. A significant benefit of maternal COVID-19 vaccination is the passive immunity it provides to infants after birth, shielding them from COVID-19 during their initial months of life. Data shows that infants of vaccinated mothers exhibit greater antibody persistence compared to those whose mothers contracted COVID-19 without vaccination.
Despite the ongoing threat of COVID-19, fewer than 5% of mothers whose infants were hospitalized for COVID-19 during the 2023–24 respiratory virus season had been vaccinated during pregnancy. Side effects from the COVID-19 vaccine are generally localized and mild, with no increased rates of adverse effects in pregnant individuals. “The full body of data clearly shows that the COVID-19 vaccines are safe for use during pregnancy and provide protection for both mother and infant,” stated Mark Turrentine, MD, FACOG, one of the advisory's authors.
In the newly released practice advisory on influenza, ACOG strongly recommends that anyone who is or will be pregnant during the influenza season receive an inactivated or recombinant influenza vaccine as soon as it becomes available, regardless of the trimester. This recommendation is grounded in the heightened risks associated with influenza for both pregnant individuals and their newborns.
ACOG encourages vaccination before the onset of the influenza season but acknowledges that any time during the season is suitable for receiving the vaccine. Importantly, the newly approved live-attenuated, intranasally administered influenza vaccine is not recommended for use in pregnant individuals but can be utilized by postpartum patients who may prefer this method of administration.
Additionally, the guidance addresses treatment options for influenza during pregnancy, including antiviral medications. “Decades of data have informed ACOG’s consistent recommendation for seasonal flu vaccination during pregnancy. Unfortunately, less than half of pregnant patients have opted for the flu vaccine in recent years,” remarked Neil S. Silverman, MD, FACOG, another author of the advisory. “It’s critical for all patients to understand the real risks that influenza poses to both themselves and their newborns.”
The updated practice advisory on RSV vaccination advises that during RSV season, patients should receive the bivalent RSV PreF vaccine between 32 0/7 and 36 6/7 weeks of gestation, provided they do not have a planned delivery within two weeks and have not received the maternal RSV vaccine in previous pregnancies. If patients choose to decline the maternal RSV vaccination, it is essential for their infants to receive a monoclonal antibody at birth.
“The RSV vaccine empowers our pregnant patients to protect their infants from severe respiratory illness even before birth,” explained Brenna Hughes, MD, FACOG, one of the authors of the RSV guidance. “This vaccine is a powerful tool that helps keep infants healthier and prevents hospitalizations, potentially saving lives.”
All three guidance documents affirm that COVID-19, influenza, and RSV vaccines can be administered concurrently. “In light of misinformation and vaccine hesitancy, a robust, evidence-based recommendation from trusted clinicians is crucial in encouraging patients to safeguard themselves and their pregnancies,” concluded Sandra E. Brooks, MD, MBA, FACOG, CEO of ACOG. As the respiratory illness season approaches, it is imperative for healthcare professionals to actively advocate for COVID-19, flu, and RSV vaccinations for pregnant patients.
For more information about these updated recommendations and the importance of maternal vaccination, visit ACOG’s official website.
