ACOG Publishes Revised Guidance on Maternal Immunization for COVID-19, Influenza, and RSV

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, president of ACOG, said in a statement. “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.”

COVID-19 Advisory

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 respiratory virus season, fewer than 5% of mothers whose infants were hospitalized for COVID-19 had received the vaccine during pregnancy. "Infants continue to be hospitalized for COVID-19 at higher rates than all age groups except adults 75 years and older," according to the ACOG statement.

“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,” Mark Turrentine, MD, one of the advisory’s authors said in the statement.

Influenza Advisory

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 (FluMist; AztraZeneca) is not indicated in pregnancy. However, it is safe to use postpartum, including among women who are lactating and prefer intranasal administration. The advisory also includes guidance on antiviral treatment for influenza during pregnancy.

"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, said in the ACOG statement.

“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.”

Respiratory Syncytial Virus Advisory

Recommendations for administration of the bivalent RSV PreF vaccine call for vaccination between 32 0/7 and 36 6/7 weeks of gestation for women:

• without without a planned delivery within 2 weeks
• who did not receive the RSV vaccine in a prior pregnancy
• 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 advisory recommends.

“The RSV vaccine provides our pregnant patients with the ability to protect their infants against severe respiratory illness before they are even born,” Brenna Hughes, MD, said.

“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 3 maternal respiratory vaccines may be administered simultaneously, the statement advises. “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,” Sandra E. Brooks, MD, MBA, chief executive officer of ACOG, stated. “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.”

Take-Homes for Patients

Vaccines in pregnancy: What you need to know

• COVID-19 vaccine: Safe in pregnancy at any stage. Protects you from severe illness and lowers the risk of preterm birth and stillbirth. It also protects your baby for the first few months of life.

• Flu shot: Safe in any trimester. Pregnant women and newborns are at higher risk of flu complications, so vaccination during pregnancy helps keep both of you healthy. Only the standard flu shot (not the nasal spray) is used during pregnancy.

• RSV vaccine: Recommended between 32 and 36 weeks of pregnancy to protect your baby from RSV, a virus that can cause severe breathing problems in infants. If you decline the RSV shot, your baby should receive antibody protection at birth.

• All three vaccines can be given at the same visit.

Bottom line: Vaccination during pregnancy is a safe and effective way to protect both you and your baby from serious respiratory illnesses.

1. ACOG releases updated maternal immunization guidance for COVID-19, influenza, and RSV. News release. American College of Obstetricians and Gynecologists. August 22, 2025. Accessed August 26, 2025. https://www.acog.org/news/news-releases/2025/08/acog-releases-updated-maternal-immunization-guidance-covid-influenza-rsv

For More Information

• COVID-19 Vaccination considerations for obstetric–gynecologic care

• COVID-19 Vaccination for women who are pregnant or breastfeeding

• Influenza in pregnancy: Prevention and treatment

• Maternal respiratory syncytial virus vaccination