The American College of Obstetricians and Gynecologists released its 2026 maternal immunization schedule, presenting guidance for US-based pregnant, postpartum, and lactating patients and their infants. ACOG notes that the schedule differs from the CDC’s immunization schedule.
Adapted from ACOG Committee Statement No. 26, Maternal Immunizations, the schedule lists 4 routinely recommended maternal vaccines: inactivated or recombinant influenza; COVID-19; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); and maternal respiratory syncytial virus (RSV) vaccine. Thirteen medical and health organizations endorsed the document, including the American Academy of Pediatrics, the Infectious Diseases Society of America, and the Society for Maternal-Fetal Medicine.
“Immunizations are an essential part of prepregnancy, prenatal, and postpartum care,” said Christopher Zahn, MD, FACOG, ACOG chief of clinical practice in a press release. “ACOG’s maternal immunization schedule is a tool that ob-gyns can use to start a dialogue with their patients about the importance of protecting themselves and their infants from vaccine-preventable diseases that can lead to poor health outcomes.”
Influenza and COVID-19 vaccines may be given at any gestational age, according to the schedule. Only inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) products should be used during pregnancy. ACOG advised influenza vaccination before the end of October, while also encouraging vaccination at any time during influenza season, while the virus is circulating. COVID-19 vaccination may occur in any trimester, with emphasis on receipt as soon as possible.
A Tdap dose is recommended during each pregnancy at 27 through 36 weeks of gestation, preferably early in that window, regardless of the patient’s prior Tdap vaccination history.
For RSV, only Pfizer’s Abrysvo is recommended for maternal vaccination. ACOG recommends a one-time dose between 32 weeks 0 days and 36 weeks 6 days of gestation during September through January in most of the continental United States for patients who have not previously been vaccinated. In subsequent pregnancies after prior Abrysvo vaccination, repeat maternal vaccination is not indicated, and infants should receive a monoclonal antibody. Infant monoclonal antibody may also be administered as an alternative to maternal RSV vaccination. Jurisdictions with differing seasonality, such as Alaska and tropical regions, should follow state, local, or territorial guidance.
The schedule also lists pneumococcal; meningococcal conjugate (MenACWY or MenABCWY) and serogroup B; hepatitis A; and hepatitis B vaccines for patients with specific comorbidities or disease risk factors. Human papillomavirus (HPV) vaccination is recommended for initiation while postpartum or breastfeeding, rather than during pregnancy.
Measles-mumps-rubella (MMR) and varicella vaccines are contraindicated during pregnancy but may be initiated postpartum or while breastfeeding.
ACOG noted that the schedule is intended as an educational resource and should not be considered inclusive of all proper treatments or methods of care or as a statement of the standard of care. The organization also stated that its publications are reviewed regularly but may not reflect the most recent evidence.
Source: ACOG