The American College of Obstetricians and Gynecologists has released its first official maternal vaccination schedule, marking a significant departure from federal health guidance and underscoring tensions between medical professionals and the Trump administration's approach to immunizations.
ACOG, the nation's leading professional organization for OB-GYNs, long recommended vaccines during pregnancy but never codified them into a formal schedule until now. The move comes as the administration, led by Health and Human Services Secretary Robert F. Kennedy Jr., has dropped federal recommendations for flu and Covid shots and halted work by the Advisory Committee on Immunization Practices on additional maternal vaccine guidance.
The new schedule recommends four core vaccines for all pregnant people: influenza, Covid, tetanus/diphtheria/pertussis (Tdap), and respiratory syncytial virus (RSV). Additional vaccines such as hepatitis B and measles, mumps, rubella (MMR) may be recommended based on individual risk factors or comorbidities.
Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and an ACOG member, was blunt about the divergence during a press conference announcing the schedule. "The evidence, I think, does not support their recommendation. The evidence supports our recommendation," she said, referring to the administration's stance.
About 13 medical societies have endorsed the schedule, including the American Academy of Pediatrics and the American Academy of Family Physicians. Andrew Racine, AAP president, emphasized that maternal vaccination provides critical protection during the vulnerable first months of infancy before babies develop their own immunity.
"Babies are among the most susceptible populations for vaccine-preventable diseases, and they depend upon the adults around them to keep them safe in those first few months of life," Racine said, calling maternal vaccines a "key element" of protection.
Recent data supports the recommendations. A study published last week in Jama Network Open found that RSV vaccination during pregnancy is 68% effective against hospitalization in babies under three months old. Riley also highlighted what she called "very clear data" demonstrating that Covid vaccines in pregnancy prevent serious outcomes including hospitalization and preterm birth.
Current vaccination rates reveal gaps in implementation. About 70% of pregnant people receive Tdap and RSV vaccines, but the rate drops to roughly 30% for flu vaccines and falls even further for Covid shots. Kevin Ault, a professor of obstetrics and gynecology at Western Michigan University, noted disparities between people on public versus private insurance. "We could do better overall," he said.
The split between ACOG and federal authorities represents a historic rupture. In early 2026, ACOG withdrew from the Advisory Committee on Immunization Practices over "concerns about recent changes that undermine the committee's scientific integrity and evidence-based approach to vaccine policy," according to Christopher Zahn, ACOG's chief of clinical practice and health equity and quality.
"The relationship we had with the CDC was so incredibly important for so many years," Riley said. "But we've got to shift to a different approach." She noted that ACOG's earlier recommendations had remained synchronized with CDC guidance until 2025.
The schedule addresses a growing challenge in clinical practice. Vaccine hesitancy has reached levels higher than in the past, and misinformation circulates widely on social media. Sarah Vaillancourt, a board member of the National Association of Nurse Practitioners in Women's Health, acknowledged the difficulty clinicians face in competing with online health claims. The new schedule aims to provide accessible, evidence-based information for patients as well as providers.
Margot Savoy, chief medical officer at the American Academy of Family Physicians, noted that skepticism toward vaccines reflects a broader erosion of trust in science itself. However, she emphasized that many patients simply have genuine questions. "Clinicians can show up slightly differently in that conversation to answer those concerns," she said, "and that can help reestablish trust."
OB-GYNs occupy a unique position in this effort. Riley pointed out that obstetricians see pregnant patients roughly 10 times over nine months, plus postpartum and lactation follow-ups. That frequency creates multiple opportunities to discuss vaccine concerns and build confidence in recommendations over time.
Author James Rodriguez: "When the government walks away from evidence-based guidance, doctors have to step in, and ACOG just did."
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