Washington, D.C.—Today, the American College of Obstetricians and Gynecologists (ACOG) released updated clinical guidance regarding vaccination during pregnancy against COVID-19, influenza, and RSV. The three guidance documents, all of which recommend maternal immunization, lay out the full body of current scientific evidence that underscores the safety and benefits of choosing to be vaccinated against these respiratory conditions during pregnancy.
“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,” said Steven J. Fleischman, MD, MBA, FACOG, president of ACOG. “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.”
The updated recommendations in support of vaccination are consistent with ACOG’s previous recommendations and also reflect a large and growing body of research and data regarding the safety and benefits of maternal immunization.
COVID-19
The updated Practice Advisory COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care recommends that patients receive an updated COVID-19 vaccine or “booster” at any point during pregnancy, when planning to become pregnant, in the postpartum period, or when lactating.
The guidance notes that data show that the COVID-19 vaccines are particularly effective at reducing morbidity from COVID-19 complications in pregnant patients and their infants as measured by emergency department or urgent care encounters. Data also support the benefit of vaccination in reducing pregnancy complications, such as severe maternal morbidity, preterm birth, and stillbirth.
Importantly, vaccination during pregnancy provides passive immunity to the infant after birth, protecting them from COVID-19 in the first few months of life before they can be vaccinated. Maternal COVID-19 vaccination during pregnancy also results in significantly greater antibody persistence in infants when compared to infants whose mother experienced infection during pregnancy without vaccination. Infants continue to be hospitalized for COVID-19 at higher rates than all age groups except adults 75 years and older, but vaccination during pregnancy can help protect infants against requiring hospitalization: during the 2023–24 respiratory virus season, less than 5% of mothers whose infants were hospitalized for COVID-19 were vaccinated during pregnancy.
Side effects of the COVID-19 vaccine are generally localized and minor, and the rates of side effects are not higher in pregnant individuals. Data strongly show that COVID-19 vaccination is not associated with a negative effect on pregnancy outcomes.
“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,” said Mark Turrentine, MD, FACOG, one of the named authors of the practice advisory. “I know that my patients do all that they can to make decisions that will help them have a healthy baby, and choosing to get vaccinated against COVID-19 is one decision that I encourage them all to make.”
Influenza
In the new practice advisory Influenza in Pregnancy: Prevention and Treatment, ACOG continues to strongly recommend that all individuals who are or will be pregnant during influenza season receive an inactivated or recombinant influenza vaccine as soon as it is available, during any trimester of pregnancy. This recommendation reflects the increased risks associated with influenza infection for both pregnant patients and their newborns. Specifically, ACOG recommends influenza vaccination before the start of the influenza season but encourages vaccination at any time during the influenza season to ensure protection as long as the virus is circulating in the community. The new guidance notes that the new live-attenuated, intranasally administered influenza vaccine, which has recently been approved for home self-administration after having been exclusively prescribed and administered in a medical setting or a pharmacy, is not approved for use in pregnant individuals, but that it could be used for postpartum patients, including those who are lactating, who are averse to needle-based vaccines, or who prefer intranasal vaccine administration. The guidance also includes recommendations related to treatment of influenza during pregnancy, including with antiviral medications.
“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,” said Neil S. Silverman, MD, FACOG, one of the named authors of the practice advisory. “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.”
RSV
In the updated practice advisory on RSV, Maternal Respiratory Syncytial Virus Vaccination, ACOG recommends that during RSV season patients receive the bivalent RSV PreF vaccine in order to protect their infants after birth. Specifically, patients should receive the vaccine when they are between 32 0/7 and 36 6/7 weeks of gestation; if they do not have a planned delivery within two weeks; if they did not receive the maternal RSV vaccine during a previous pregnancy; and if they are not planning to have their infant receive a monoclonal antibody, nirsevimab or clesrovimab. Patients should also understand that if they decline the maternal RSV vaccination, their infant needs a monoclonal antibody at birth.
“The RSV vaccine provides our pregnant patients with the ability to protect their infants against severe respiratory illness before they are even born,” said Brenna Hughes, MD, FACOG, one of the named authors of the RSV guidance. “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 of the guidance documents note that all three maternal vaccines for respiratory conditions—COVID-19, influenza, and RSV—can be administered at the same time.
“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,” said Sandra E. Brooks, MD, MBA, FACOG, chief executive officer of ACOG. “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.”
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