Ob/gyn group recommends Covid-19 vaccines during pregnancy, another major group to break from CDC

The American College of Obstetricians and Gynecologists on Friday reaffirmed support for Covid-19 vaccination during pregnancy, becoming the second major professional medical association to break from current US Centers for Disease Control and Prevention recommendations this week.

“While the Centers for Disease Control and Prevention (CDC) recently removed its recommendation that pregnant and lactating individuals receive updated COVID-19 vaccines, ACOG’s recommendations have not changed,” according to the updated practice advisory. “The American College of Obstetricians and Gynecologists continues to recommend the use of updated COVID-19 vaccines in individuals contemplating pregnancy and in pregnant, recently pregnant, and lactating individuals.”

In May, US Health and Human Services Secretary Robert F. Kennedy Jr. announced that Covid-19 vaccines will no longer be among the recommended vaccines for pregnant women and healthy children in CDC immunization schedules. The abrupt decision bypassed the government’s normal process for evaluating and recommending vaccines, and Kennedy did not offer scientific evidence to justify the change to the recommendations.

The latest recommendations from ACOG say that “all clinicians should provide a strong recommendation for updated COVID-19 vaccination to their pregnant and lactating patients.” Vaccinations can occur in any trimester, with an emphasis on the “earliest opportunity to maximize maternal and fetal health,” and any of the available Covid-19 vaccines can be delivered simultaneously with other vaccines recommended during pregnancy, including those against influenza and respiratory syncytial virus (RSV).

Dozens of references in ACOG’s advisory, including multiple CDC sources, emphasize the safety and efficacy of Covid-19 vaccination during pregnancy – and the increased risk that pregnant women and infants face from a Covid-19 infection.

On Tuesday, the American Academy of Pediatrics released its updated recommendations for vaccines with explicit support for Covid-19 vaccines for children and a direct criticism of a federal vaccine advisory committee, the CDC’s Advisory Committee on Immunization Practices, that AAP says is made up of “individuals who have a history of spreading vaccine misinformation” after it was recently overhauled by Kennedy.

There has also been tension between ACOG and those driving federal health policy.

The organization said it is no longer accepting federal funding due to recent changes that “significantly impact ACOG’s program goals, policy positions, and ability to provide timely and evidence-based guidance and recommendations for care.”

And ACOG announced in July that it was partnering with an independent group of experts called the Vaccine Integrity Project to develop maternal immunization guidance in the absence of “historically robust government-led annual review of data and subsequent evidence-based recommendations.”

“The meeting of the newly reconstructed Advisory Committee on Immunization Practices (ACIP) demonstrated that the committee did not follow the longstanding tradition of robust, unbiased review of reputable scientific evidence by medical and public health experts,” ACOG President Dr. Steven Fleischman said in June. “The data presented to ACIP affirm why ACOG continues to recommend safe, effective maternal vaccination. If ACIP responded to the data as presented in a way that values medical evidence and public health, the government’s recommendation for COVID-19 vaccination during pregnancy would be restored and support for maternal vaccination would be unwavering.”

After the abrupt federal changes to the Covid-19 vaccination schedule, dozens of health and medical organizations – including ACOG and AAP – pushed for continued access and insurance coverage for the vaccines in an open letter.

Pregnancy is still listed as a risk factor for severe illness from Covid-19 on the CDC’s website, with multiple sources of evidence offering “conclusive increase in risk.”

Pregnant women who have Covid-19 are more likely to require care in the ICU or on a ventilator, or to die, the medical organizations’ letter said, and they’re at higher risk of complications such as cesarean birth, preeclampsia or eclampsia, and blood clots. Infants born after a Covid-19 infection also face increased risks.

“It is vital that we ensure that pregnant women continue to have access to this prevention tool so that they can protect themselves and their young infants, a vulnerable group who is not yet eligible for vaccination,” the letter said.

HHS did not respond directly on ACOG’s recommendations or the evidence behind them. Instead, an agency spokesperson said in a statement that “HHS and CDC will continue to be the official resource for any guidance.”