New pregnancy vaccine guidance backs COVID shot, despite CDC shift

Clinical Takeaway: Counsel pregnant patients early in prenatal care that ACOG continues to recommend four routine maternal immunizations: influenza, COVID-19, Tdap, and RSV when eligible.

Amid shifting federal guidance and rising vaccine misinformation, ACOG’s first independent schedule reasserts evidence-based recommendations that directly affect maternal and neonatal outcomes.

ACOG released its 2026 Maternal Immunization Schedule on June 10, marking the first time the organization has issued its own immunization schedule for pregnant, postpartum, and breastfeeding patients. The schedule reaffirms four routine maternal immunizations: influenza, COVID-19, Tdap, and RSV for eligible patients.

The most notable difference from current CDC guidance is COVID-19 vaccination. ACOG recommends routine administration of updated COVID-19 vaccines for people who are pregnant, recently pregnant, considering pregnancy, or lactating. CDC’s current COVID-19 vaccination guidance for people ages 6 months and older, including pregnant and breastfeeding patients, is based on individual decision-making that weighs benefits and risks.

That distinction matters for point-of-care counseling. CDC acknowledges that pregnancy increases the risk of severe COVID-19 disease and says vaccination during pregnancy has not been linked to increased health risks for pregnant patients or babies. ACOG goes further, framing COVID-19 vaccination as standard preventive care for pregnant patients and emphasizing vaccination at the earliest opportunity.

ACOG’s schedule also continues to support influenza vaccination during any trimester, Tdap during each pregnancy—preferably early in the 27- to 36-week window—and RSV vaccination at 32 to 36 weeks during the seasonal window for eligible patients. Additional vaccines may be appropriate based on age, comorbidities, exposure risk, travel, or immunization history.

The new schedule is intended as a practical clinical tool, helping ob-gyns “start a dialogue with their patients about the importance of protecting themselves and their infants from vaccine-preventable diseases,” said ACOG Chief of Clinical Practice Christopher Zahn, MD.

Key points for clinicians

• Review immunization status at the first prenatal visit and revisit it throughout pregnancy and postpartum care.
• Recommend influenza vaccination for patients who are or will be pregnant during influenza season; it can be given in any trimester.
• Recommend updated COVID-19 vaccination during pregnancy, with emphasis on vaccination at the earliest opportunity.
• Administer Tdap during every pregnancy, preferably as early as possible from 27 through 36 weeks’ gestation.
• Offer Pfizer’s RSVpreF vaccine to eligible pregnant patients at 32–36 weeks during the seasonal administration window.
• Consider risk-based vaccines for patients with relevant comorbidities, exposure risks, travel needs, or incomplete immunization histories.
• Plan postpartum vaccination when vaccines are contraindicated during pregnancy, including MMR and varicella when indicated.
• Use a strong clinician recommendation; ACOG notes that direct recommendations from obstetric care professionals are associated with substantially higher vaccine acceptance.

Source: American College of Obstetricians and Gynecologists (ACOG). (2026, June 10). 2026 Maternal Immunization Schedule