ACOG Breaks from CDC, Issues Independent Maternal Immunization Schedule Amid Federal Policy Shift
Key Insights
The American College of Obstetricians and Gynecologists (search) (ACOG) released its first independent maternal vaccination schedule, diverging from CDC (search) recommendations for the first time.
ACOG continues to recommend routine COVID-19 (search) and influenza (search) vaccination for all pregnant people, directly contradicting the Trump administration's rollback of these recommendations under HHS Secretary Robert F. Kennedy Jr.
The new schedule, endorsed by 13 medical societies including the AAP and AAFP, recommends four routine vaccines: influenza (search), COVID-19 (search), Tdap, and RSV for all pregnant patients.
The American College of Obstetricians and Gynecologists (search) (ACOG) has published its first-ever independent maternal immunization schedule, marking a historic break from federal health agency recommendations and igniting a public disagreement over vaccine guidance for pregnant patients.
The move comes after the Department of Health and Human Services (HHS), under the leadership of Secretary Robert F. Kennedy Jr., dropped its recommendations for routine COVID-19 (search) and influenza (search) vaccination during pregnancy. In response, ACOG partnered with 13 other major medical organizations—including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP)—to reinforce recommendations grounded in peer-reviewed science.
"The evidence, I think, does not support their recommendation. The evidence supports our recommendation," said Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and a member of ACOG, at a press conference announcing the schedule.
A Schedule Built on Scientific Independence
The new ACOG schedule recommends four routine vaccines for all pregnant people regardless of prior immunization history: influenza (search), COVID-19 (search), Tdap (tetanus, diphtheria, and pertussis (search)), and respiratory syncytial virus (search) (RSV). For individuals with comorbidities or specific risk factors, additional vaccines such as hepatitis B and MMR may also be recommended.
Christopher Zahn, chief of clinical practice and health equity and quality at ACOG, described the guidance as an effort to "communicate clear, evidence-based guidance and to address the growing vaccine misinformation that is circulating."
The influenza (search) vaccine, inactivated or recombinant, is recommended in any trimester, ideally by the end of October. For COVID-19 (search), ACOG recommends routine vaccination for all pregnant, postpartum, and lactating individuals using updated formulations, with physicians stressing administration as soon as possible during pregnancy. The Tdap vaccine should be given during each pregnancy, ideally between 27 and 36 weeks' gestation to maximize antibody transfer. For RSV, ACOG recommends Pfizer's Abrysvo vaccine once between 32 and 36 weeks, seasonally from September through January in most of the continental United States.
The Science of Maternal Immunization
Maternal immunization leverages transplacental antibody transfer, a biological mechanism by which protective IgG antibodies pass from the mother across the umbilical cord into the fetal bloodstream. This process provides newborns with passive immunity during their first vulnerable months of life, before they can receive their own childhood immunizations.
"Babies are among the most susceptible populations for vaccine-preventable diseases, and they depend upon the adults around them to keep them safe in those first few months of life before they've had the opportunity to develop their own immunity," said Andrew Racine, AAP president. He emphasized that maternal vaccines are a "key element" of that protection.
The clinical stakes are significant. During pregnancy, natural changes in cardiovascular, respiratory, and immune systems place extra stress on the lungs and heart. Influenza (search) and COVID-19 (search) carry substantial risks for severe maternal morbidity, ICU admission, and respiratory failure if contracted during pregnancy.
Divergence from Federal Guidance
ACOG's recommendations were historically "in sync" with the CDC (search) until 2025, Riley noted. In early 2026, ACOG withdrew from the Advisory Committee on Immunization Practices (ACIP) due to "concerns about recent changes that undermine the committee's scientific integrity and evidence-based approach to vaccine policy," Zahn said.
"The relationship we had with the CDC (search) was so incredibly important for so many years. But we've got to shift to a different approach," Zahn added.
The ACIP had been planning to focus on vaccines for pregnant people before the committee was halted by a judge's order. Several ACOG members, including Riley and Kevin Ault, professor of obstetrics and gynecology at Western Michigan University, had served in ACIP working groups until those groups stopped meeting under the current administration.
Vaccination Rates and Disparities
Approximately 70% of pregnant people in the US receive Tdap and RSV vaccines, but rates have fallen to about 30% for influenza (search) and even lower for COVID-19 (search), according to Ault. He noted disparities between patients on public versus private insurance, both in vaccination rates and in outcomes for babies. "We could do better overall," he said.
Addressing Vaccine Hesitancy
The schedule arrives amid what providers describe as increasing vaccine hesitancy and broader skepticism of science among patients. Sarah Vaillancourt, a board member of the National Association of Nurse Practitioners in Women's Health, noted that patients increasingly report "doing their own research" on social media. The new schedule is designed to be accessible not only to providers but to patients as well.
"Changing national recommendations coupled with rampant vaccine misinformation are resulting in confusion for both patients and health care professionals," said Dr. Camille Clare, MD, MPH, CPE, president of ACOG. "It is incredibly important for the public to have access to reliable, evidence-based information on maternal immunizations from a trusted source."
Margot Savoy, chief medical officer at AAFP, underscored the evidence base: "The science is clear." Vaccines in pregnancy provide "critical protection" for the pregnant person, the infant, and the wider public, Zahn added.
Safety and Contraindications
The Mayo Clinic reports that side effects from maternal vaccines are temporary and safe for the baby, typically resolving within 24 to 48 hours. The most common side effect is localized pain, mild swelling, or a firm knot at the injection site. Some pregnant individuals may experience low-grade systemic effects such as mild headaches, muscle aches, low-grade fevers, or fatigue.
Live-attenuated vaccines—including those for varicella, HPV, and MMR—should be avoided during pregnancy. ACOG's expert committee also reiterates that thimerosal-containing influenza (search) vaccines are safe and should not be postponed if thimerosal-free formulations are unavailable.
For RSV protection, the gold standard is maternal vaccination with Abrysvo during pregnancy. If a mother declines or has previously received the RSV vaccine, the infant can receive the monoclonal antibody injection nirsevimab shortly after birth as an alternative.
Riley highlighted the unique position of OB-GYNs in addressing vaccine concerns: "We do have a unique opportunity in pregnancy, because we see people 10 times in nine months," plus follow-up postpartum and lactation visits. "It does give you the opportunity to answer those questions over time."