The American College of Obstetricians and Gynecologists (ACOG) has released its 2026 maternal immunization schedule, formalizing recommendations for COVID-19, influenza, RSV, and Tdap vaccinations during pregnancy. The guidance, developed by ACOG’s Immunization, Infectious Disease and Public Health Preparedness Expert Work Group, provides a unified clinical framework endorsed by 13 medical organizations, including the American Academy of Pediatrics and the Infectious Diseases Society of America.
Recommended Vaccinations During Pregnancy
ACOG’s updated schedule aims to simplify clinical decision-making for obstetric providers by prioritizing evidence-based protection for both the pregnant patient and the newborn.
- Tdap: Clinicians should administer a single dose of the Tdap vaccine during every pregnancy. The optimal window for administration is between 27 and 36 weeks of gestation to maximize the transfer of maternal antibodies to the fetus.
- COVID-19: ACOG continues to recommend maternal COVID-19 vaccination. The organization advises that any authorized vaccine product is acceptable and may be administered during any trimester to reduce the risk of severe disease for both the mother and the infant.
- Influenza: Patients should receive an inactivated or recombinant influenza vaccine at any stage of pregnancy. ACOG recommends vaccination before the influenza season begins, ideally by the end of October, though vaccination remains appropriate throughout the duration of the season.
- RSV: The RSV vaccine, specifically Pfizer’s Abrysvo, is recommended as a single dose for pregnant individuals between 32 weeks 0 days and 36 weeks 6 days of gestation. This recommendation is seasonal, applying from September through January for most of the continental United States.
Distinctions from Federal Guidance
The 2026 ACOG schedule diverges from specific recommendations issued by federal health agencies, most notably regarding COVID-19 and influenza.
While the Department of Health and Human Services (HHS) shifted toward a shared decision-making model for COVID-19 vaccination in pregnant populations, ACOG maintains a direct clinical recommendation for the vaccine. Similarly, whereas some federal guidance has moved toward a shared decision-making framework for influenza, ACOG’s 2026 schedule provides a clear, affirmative recommendation for annual maternal flu vaccination. According to Dr. Flor M. Munoz-Rivas, a member of the FDA’s Vaccines and Related Biological Products Advisory Committee, ACOG’s position is based on clear clinical data demonstrating that maternal immunization effectively reduces neonatal infection risks.
Why Clinical Consistency Matters
The release of this independent schedule follows ACOG’s decision in February 2025 to withdraw as a liaison to the CDC’s Advisory Committee on Immunization Practices (ACIP). ACOG leadership cited concerns regarding the scientific integrity of the committee’s processes.
By issuing this guidance, ACOG intends to mitigate the confusion that has surfaced among clinicians due to conflicting or evolving federal messaging. The guidance is supported by a broad coalition of professional societies, including the American Academy of Family Physicians and the American College of Nurse-Midwives. According to ACOG Chief of Clinical Practice Dr. Christopher Zahn, the document serves as a trusted resource for practitioners who need clear, peer-reviewed data to guide their patients.
Additional Immunization Considerations
Beyond the core respiratory and Tdap recommendations, ACOG advises that other vaccines may be indicated based on a patient’s specific risk factors or comorbidities. These include vaccines for:
- Hepatitis A and B
- Pneumococcal disease
- Human papillomavirus (HPV)
- Varicella
- Meningococcal disease (conjugate and serogroup B)
- Measles, mumps, and rubella (MMR)
Clinicians are encouraged to review the full ACOG schedule to determine appropriate timing for these vaccines based on individual patient health histories. For RSV specifically, the guidance notes that in regions with non-traditional seasonality, such as tropical climates or parts of Alaska, practitioners should defer to local or state health department protocols.