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The leading professional organization for obstetricians and gynecologists in the US has launched its first maternal vaccination schedule and diverged for the first time from federal recommendations.

The American College of Obstetricians and Gynecologists (ACOG) has long recommended giving the shots during pregnancy, but this is the first time releasing them as an official schedule.

The Trump administration, under the leadership of Robert F Kennedy Jr, the secretary of the US Department of Health and Human Services (HHS) and a longtime vaccine critic, dropped its recommendations for flu and Covid shots. The Advisory Committee on Immunization Practices (ACIP), which offers recommendations to the US Centers for Disease Control and Prevention (CDC), was planning to focus next on vaccines for pregnant people before the committee was halted by a judge’s order.

Tracy Beth Høeg, a sports medicine physician who oversaw an investigation into vaccines at the US Food and Drug Administration (FDA) until she was fired in May, claimed without rigorous data that the RSV vaccine was deadly for babies. The first study using real-world data in the US, published last week in Jama Network Open, found that RSV vaccination during pregnancy is 68% effective against hospitalization in babies under the age of three months.

The administration’s recommendations are not based in science, Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and a member of ACOG, said in a press conference about the announcement: “The evidence, I think, does not support their recommendation. The evidence supports our recommendation.”

The recently announced new ACOG schedule recommends four shots for all pregnant people: influenza; Covid; tetanus, diphtheria and pertussis (Tdap); and respiratory syncytial virus (RSV). For some people with comorbidities or who are at risk of contracting certain diseases, vaccines such as hepatitis B and measles, mumps, rubella (MMR) may also be recommended.

The guidance is intended to be an accessible resource for providers, patients and pharmacists in an effort to “communicate clear, evidence-based guidance and to address the growing vaccine misinformation that is circulating”, said Christopher Zahn, chief of clinical practice and health equity and quality at ACOG.

About 13 medical societies endorsed the schedule, including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

“At the same time that we are putting out this information, we have the HHS secretary saying that Covid vaccines are not necessary in children and in pregnant women. So, we needed to get rid of some of that confusion, as well,” Riley said. She highlighted the “very clear data” that Covid vaccines in pregnancy still help prevent serious outcomes, like hospitalization and preterm birth.

“As pediatricians, when we talk about protecting children, we often focus on what happens after they’re born, but the protections really start well before that during pregnancy,” said Andrew Racine, AAP president. “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 before they’ve had the opportunity to develop their own immunity,” he said, and maternal vaccines are a “key element” of protection.

“The science is clear,” said Margot Savoy, chief medical officer at AAFP. Vaccines in pregnancy provide “critical protection”, she said.

Immunizations protect the pregnant person, the infant and the wider public, Zahn pointed out.

About 70% of pregnant people get their Tdap and RSV shots in the US, but the rate has fallen to about 30% for flu and even less for Covid, said Kevin Ault, professor of obstetrics and gynecology at Western Michigan University and member of ACOG. But there are disparities between people on public versus private insurance – both in vaccination rate and in outcomes for babies, he said. “We could do better overall.”

Obstetricians and gynecologists used to be in the rooms where federal recommendations were made; several members of ACOG, including Riley and Ault, were in ACIP working groups until those groups stopped meeting under Kennedy.

In early 2026, ACOG withdrew from the ACIP due to “concerns about recent changes that undermine the committee’s scientific Integrity and evidence-based approach to vaccine policy”, Zahn said. “The relationship we had with the CDC was so incredibly important for so many years. But … we’ve got to shift to a different approach.”

ACOG’s recommendations, previously released as toolkits on each vaccine, were “in sync” with the CDC until 2025, Riley said. But now, “we’re going to have to do things differently now that the CDC is not exactly what we had hoped,” she said. The recommendations were informed by a comprehensive review of data from the Vaccines Integrity Project.

Increasingly, patients say they are “doing their own research” about vaccines – frequently on social media. “Social media is not going away,” said Sarah Vaillancourt, a board member of the National Association of Nurse Practitioners in Women’s Health (NPWH). “So how, as active working clinicians, do we help patients navigate that landscape to find evidence and information that’s accurate?” The schedule will help, she said, because it’s accessible not just to providers but to patients as well.

The vast majority of parents want to have their kids vaccinated, but hesitancy is significantly higher than it has been in the past, Racine said, and that is “taking a significant toll” on pediatric practices. There’s evidence that delaying vaccination makes it more likely that children will never get the shots.

Providers aren’t just seeing an increase in vaccine hesitancy, Savoy said. Patients are increasingly skeptical of science in general. But often, patients just have questions and need to talk them through. Clinicians can “show up slightly differently in that conversation” to answer those concerns, and that can help reestablish trust, she said.

Doctors are the most trusted source of information on these topics – and OB-GYNs occupy a special place. “We do have a unique opportunity in pregnancy, because we see people 10 times in 9 months,” plus follow-up postpartum and lactation visits, Riley said. “it does give you the opportunity to answer those questions over time” and talk about vaccines – in pregnancy and for infants later down the road, she said.