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ACOG Reaffirms COVID-19 Vaccine Guidance

 Although CDC recently removed its explicit pregnancy and lactation call-out for the updated COVID-19 vaccine, ACOG is standing firm.

Conexiant

The American College of Obstetricians and Gynecologists has reaffirmed its strong recommendation that patients who are pregnant, recently pregnant, lactating, or planning pregnancy receive the seasonally updated COVID-19 vaccination.

This reaffirmation follows the Centers for Disease Control and Prevention (CDC)’s recent decision to remove its specific pregnancy/lactation call-out from routine vaccination guidance. The American College of Obstetricians and Gynecologists' (ACOG) stance remains unchanged, urging clinicians to continue strongly recommending vaccination to eligible patients.

Updated Vaccination Guidance

According to the August 2025 ACOG Practice Advisory, patients who are pregnant or planning pregnancy should:

  • Receive a seasonally updated COVID-19 vaccine (“booster”) for the 2024–2025 respiratory virus season.

  • Be vaccinated in any trimester, with administration at the earliest opportunity to maximize protection for both patient and infant.

  • Co-administer COVID-19 vaccines with other recommended maternal vaccines, including influenza, RSV, and Tdap when appropriate.

Risks and Benefits: Protecting Patients and Infants

Pregnant individuals remain at higher risk of severe illness, hospitalization, and complications from COVID-19 compared to nonpregnant peers. Maternal vaccination provides dual protection:

  • For infants:

    • 35%–52% reduction in COVID-19–related hospitalizations among infants younger than 6 months.

    • 56% lower risk of symptomatic COVID-19 during the first six months of life when a maternal booster is received during pregnancy.

  • For patients:

    • Reduced risk of severe maternal morbidity, preterm birth, and stillbirth. Protection against post-acute sequelae of SARS-CoV-2 infection (long COVID)

    • Protection against post-acute sequelae of SARS-CoV-2 infection (long COVID).

Infants under six months remain among the highest-risk groups for COVID-19 hospitalization, second only to adults aged 75 years and older—underscoring ACOG’s urgency in recommending maternal vaccination.

Vaccination Uptake Remains Low

Despite clear benefits, vaccine uptake remains low among pregnant patients:

  • As of April 2025, only 14.4% of pregnant individuals in the U.S. had received the updated 2024–2025 COVID-19 vaccine.

  • Uptake disparities persist: highest among Asian patients (23.6%); lowest among Black patients (7.2%).

ACOG warns that improving equitable vaccine access remains critical, particularly as newer, more transmissible variants continue to emerge.

Safety Profile Remains Strong

ACOG emphasizes that COVID-19 vaccines remain safe during pregnancy, lactation, and conception planning:

  • No increased risk of pregnancy loss, preterm birth, small-for-gestational-age infants, or congenital anomalies (including with first-trimester exposure).

  • No impact on fertility or assisted reproduction outcomes; routine pregnancy testing before vaccination is not recommended.

    Side effects are typically mild (injection-site pain, headache, fatigue, fever); severe allergic reactions are rare.

    Vaccination while breastfeeding is safe:

  • Antibodies against SARS-CoV-2 are consistently detected in human milk, with higher and longer-lasting levels after booster doses.

  • Vaccine mRNA is rarely present and is undetectable in most milk samples.

Clinician’s Role

ACOG calls on clinicians to proactively recommend vaccination and provide evidence-based counseling:

“All clinicians should provide a strong recommendation for updated COVID-19 vaccination to their pregnant and lactating patients,” the advisory states.

Clinicians are also encouraged to:

  • Address vaccine hesitancy with transparent, patient-centered discussions.

  • Review vaccination status at every prenatal encounter.

  • Offer vaccination whenever patients are eligible, and consider offering missed maternal vaccinations during hospital stays.

Bottom Line

Despite the CDC’s 2025 update, ACOG continues to strongly recommend COVID-19 vaccination for pregnant, recently pregnant, lactating, and planning-to-be-pregnant individuals. The seasonally updated vaccines are safe, effective, and critical for protecting both patients and their infants during the 2024–2025 respiratory virus season.

Source: The American College of Obstetricians and Gynecologists