The American College of Obstetricians and Gynecologists on Tuesday released its first comprehensive maternal vaccination schedule, a formal document recommending four routine immunizations for all pregnant people and marking a sharp departure from the federal approach under the Trump administration.
The schedule recommends influenza, Covid-19, tetanus-diphtheria-pertussis (Tdap), and respiratory syncytial virus (RSV) vaccines for all pregnant individuals. For those with certain comorbidities or elevated disease risk, hepatitis B and measles-mumps-rubella (MMR) vaccines may also be indicated, according to the guidance.
The announcement came as the administration of President Donald Trump, led by Health and Human Services Secretary Robert F. Kennedy Jr. — a longtime vaccine skeptic — has dropped federal recommendations for flu and Covid-19 shots during pregnancy. The Advisory Committee on Immunization Practices (ACIP), which normally provides recommendations to the CDC, stopped meeting after a federal judge halted its work, according to the report.
Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and an ACOG member, said in a press conference that the administration’s recommendations are not supported by science. “The evidence, I think, does not support their recommendation. The evidence supports our recommendation,” Riley said.
Christopher Zahn, chief of clinical practice and health equity and quality at ACOG, said the schedule is intended to “communicate clear, evidence-based guidance and to address the growing vaccine misinformation that is circulating.” He told the Guardian that immunizations protect the pregnant person, the infant and the wider public.
The new schedule was endorsed by approximately 13 medical societies, including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
Andrew Racine, president of the AAP, said that “protections really start well before that during pregnancy” and that maternal vaccines are a “key element” of protection for infants, who are among the most vulnerable populations for vaccine-preventable diseases in their first months of life.
Margot Savoy, chief medical officer of the AAFP, said the science is “clear” and that vaccines in pregnancy provide “critical protection.”
ACOG has long recommended giving vaccines during pregnancy but had previously released its advice as individual toolkits rather than a consolidated schedule. The organization had historically aligned with the CDC — until 2025, according to Riley. “But now, we’re going to have to do things differently now that the CDC is not exactly what we had hoped,” she said.
In early 2026, ACOG withdrew from ACIP due to “concerns about recent changes that undermine the committee’s scientific integrity and evidence-based approach to vaccine policy,” Zahn said. The recommendations were informed by a comprehensive review of data from the Vaccines Integrity Project, an internal effort to evaluate vaccine evidence.
Kevin Ault, a professor of obstetrics and gynecology at Western Michigan University and an ACOG member, said that about 70% of pregnant people currently receive Tdap and RSV vaccines, but rates have fallen to about 30% for flu and even lower for Covid. Disparities exist between those on public versus private insurance, he said. “We could do better overall.”
The report noted that several ACOG members, including Riley and Ault, had served on ACIP working groups until the groups stopped meeting under Kennedy.
The Guardian also reported that Tracy Beth Høeg, a sports medicine physician who oversaw an investigation into vaccines at the FDA until she was fired in May, claimed without rigorous data that the RSV vaccine was deadly for babies. A study published last week in JAMA Network Open, using real-world U.S. data, found RSV vaccination during pregnancy is 68% effective against hospitalization in infants under three months.
Clinicians are increasingly encountering patients who say they are “doing their own research” on vaccines, often through social media. Sarah Vaillancourt, a board member of the National Association of Nurse Practitioners in Women’s Health (NPWH), said the new schedule can help because it is accessible to both providers and patients. Racine noted that the vast majority of parents still want to vaccinate their children, but hesitancy is “significantly higher” than in the past and is “taking a significant toll” on pediatric practices. Delaying vaccination makes it less likely children will ever receive the shots, he said.
Savoy added that clinicians can “show up slightly differently” in conversations with patients to help address concerns and reestablish trust. Riley noted that OB-GYNs see patients about 10 times over 9 months of pregnancy, plus postpartum and lactation visits, providing a “unique opportunity” to answer vaccine questions over time.