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COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care

  • Practice Advisory PA
  • December 2020
 

Immunization Coding for Ob-GynsLast updated October 2025

This Practice Advisory update was developed by the American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group in collaboration with Mark Turrentine, MD, and Kim Fortner, MD.

Summary of Updates

This Practice Advisory provides an overview of the currently available COVID-19 vaccines and guidance for their use in individuals contemplating pregnancy and in pregnant, recently pregnant, and lactating individuals. For additional information regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and treatment, see the American College of Obstetricians and Gynecologists (ACOG)’s COVID-19 FAQs for Obstetrician–Gynecologists.

While the Centers for Disease Control and Prevention (CDC) recently removed its recommendation that pregnant and lactating individuals receive updated COVID-19 vaccines, ACOG’s recommendations have not changed. The American College of Obstetricians and Gynecologists continues to recommend the use of updated COVID-19 vaccines in individuals contemplating pregnancy and in pregnant, recently pregnant, and lactating individuals.

Key Recommendations

  • The American College of Obstetricians and Gynecologists continues to recommend that all pregnant and lactating individuals receive an updated COVID-19 vaccine or “booster.” All clinicians should provide a strong recommendation for updated COVID-19 vaccination to their pregnant and lactating patients.
  • Pregnant women have historically been at an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections. All currently available COVID-19 vaccines keep up with new coronavirus strains and remain effective at reducing rates of medically attended COVID-19 illness encounters resulting in emergency room and urgent care visits, hospitalizations, and critical illness for adults 18 years or older, with protection lasting for that season (Link-Gelles 2025). Updated COVID-19 vaccines are particularly effective at reducing morbidity from COVID-19 complications in pregnant patients and their infants (measured by emergency department/urgent care encounters) (Ciesla 2024).
  • Infants aged less than 6 months are at increased risk for severe COVID-19 disease but are not yet eligible for COVID-19 vaccination, and they depend on transplacental transfer of maternal antibodies for protection. They continue to be hospitalized for COVID-19 at higher rates than all age groups except adults 75 years and older (Havers 2024). COVID-19 vaccination in pregnancy reduces the rate of symptomatic and severe COVID-19 resulting in hospitalization in the infant in the first 6 months of life (Halasa 2022 MMWR; Cardemil 2024). During the 2023–2024 respiratory virus season, mothers of less than 5% of infants hospitalized for COVID-19 were vaccinated during pregnancy (Havers 2024). 
  • COVID-19 vaccine safety during pregnancy has been well established. There is no evidence of increased risk of negative maternal, pregnancy, or infant outcomes associated with vaccination (Ciapponi 2024). 
  • Vaccination may occur in any trimester, and emphasis should be on vaccine receipt at the earliest opportunity to maximize maternal and fetal health.
  • COVID-19 vaccines may be administered simultaneously with other vaccines. This includes vaccines routinely recommended during pregnancy, such as influenza, respiratory syncytial virus (RSV), and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap).
  • For patients who do not receive any COVID-19 vaccine, the discussion should be documented in the patient’s medical record. During subsequent office visits, obstetrician–gynecologists should address ongoing questions and concerns and offer vaccination again.
  • Obstetrician–gynecologists and other health care practitioners are at high risk for exposure to COVID-19 and should lead by example by being vaccinated and encouraging eligible patients to be vaccinated as well.
  • ACOG encourages clinicians to stock and, ideally, administer COVID-19 vaccines along with all routinely recommended maternal vaccines in their offices.

COVID-19 Vaccine Information

At the time of this publication, four COVID-19 vaccines are currently either licensed or authorized under an Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration (FDA) (Panagiotakopoulos, Moulia et al. 2024; Panagiotakopoulos, Godfrey et al. 2024):

  • Pfizer-BioNTech COVID-19 Vaccine/COMIRNATY
  • Moderna COVID-19 Vaccine/SPIKEVAX
  • Moderna COVID-19 Vaccine/mNEXSPIKE
  • Novavax COVID-19 Vaccine, Adjuvanted

There is no preferential recommendation for the use of any one COVID-19 vaccine over another. The American College of Obstetricians and Gynecologists’ recommendations regarding the COVID-19 vaccine will continue to reflect the current accurate, evidence-based information.

COVID-19 Vaccine Availability for Health Care Workers

In August 2025, the FDA (FDA 2025) updated eligibility criteria for the 2025–2026 COVID-19 vaccine to include adults aged 65 years or older and individuals under 65 years with at least one underlying health condition associated with increased risk for severe COVID-19 outcomes (CDC 2025a). While federal officials have stated that individuals seeking vaccination may do so in consultation with a health care practitioner, the narrower authorization may restrict access for some who previously received routine immunization. During the 2024–2025 season, 90% of COVID-19 vaccinations were administered through retail pharmacies, which offered convenient, insurance-covered access without requiring a prescription (CDC 2025b). Currently, FDA-authorized vaccines may still be administered in pharmacies where state laws permit; however, some state-level regulations prohibit pharmacists from administering vaccines not explicitly recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP), potentially limiting pharmacy-based access.

Concerns have been raised that individuals who fall outside the current FDA eligibility criteria for COVID-19 booster vaccination—including health care workers who no longer qualify under the updated guidelines— may face barriers to access. Although current infection control measures, such as the use of personal protective equipment, are effective in clinical settings, the risk of SARS-CoV-2 infection among health care workers may also stem from community and non–patient care exposures (Jacob 2021). However, a systematic review and meta-analysis of 185,712 health care workers found that high-risk occupational exposure—defined as direct care of patients likely infected with COVID-19—was associated with a significantly increased risk of infection compared to minimal or no contact (pooled OR 1.79, 95% CI 1.49–2.14; I² = 99%) (Bansal 2025). A subgroup analysis of North American data reported an even higher odds ratio of 2.03 (95% CI 1.29–3.19), underscoring the continued elevated risk faced by frontline workers.

While rigorous infection prevention practices remain essential in health care settings, vaccination continues to play a critical role in minimizing SARS-CoV-2 infection among health care workers. This population remains a priority for vaccination due to ongoing occupational exposure risks, the need to maintain health care system capacity, and the potential for transmission from infected workers to vulnerable patient populations.

 

Storage and Administration

ACOG encourages clinicians to stock and, ideally, administer all recommended vaccines in their offices. Studies show that immunization rates are higher when a trusted clinician can strongly recommend, offer and administer the vaccine during the same visit, as opposed to recommending vaccination and referring the patient elsewhere to receive the vaccine. This is particularly important for the COVID-19 vaccine as some pharmacies (depending by state) may no longer administer the vaccine to pregnant patients. Influenza and Tdap vaccines are routinely offered and administered by a majority of practices, while other vaccines are not as commonly stocked, leaving significant gaps in coverage (CDC 2024, O’Leary 2019). When clinicians make immunizations an integral part of their practice and routinely recommend and administer indicated vaccine, they help to increase vaccination rates for pregnant people.

Many obstetrician–gynecologists also perceive a lack of reimbursement as a major barrier to including immunization services in their practices (Leddy 2009). However, with proper documentation and coding, these services can be reported to third-party payers and reimbursement can be received. The practice should adhere to basic coding principles when billing for immunization services. In general, the appropriate vaccine product code should always be reported along with the appropriate Current Procedural Terminology (CPT) vaccine administration code.
Obstetrician–gynecologists have a unique opportunity to reduce the frequency of vaccine-preventable diseases. To accomplish that goal, clinicians must be aware of current vaccine recommendations, educate patients about vaccination, encourage patients to be vaccinated, and institute systems in the office to integrate vaccination into the routine running of their practice.

For more information on coding, please visit, Immunization Coding for Obstetrician-Gynecologists.

Efficacy of Available COVID-19 Vaccines

Pregnant women have historically been at an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections. All currently available COVID-19 vaccines are highly effective against moderate to severe COVID-19 disease. Updated COVID-19 vaccines keep up with new coronavirus strains and remain effective at reducing rates of medically attended COVID-19 illness encounters resulting in emergency room and urgent care visits, hospitalizations, and critical illness for adults 18 years or older, with protection lasting for that season (Link-Gelles 2025). Updated COVID-19 vaccines are particularly effective at reducing morbidity from COVID-19 complications in pregnant patients and their infants as measured by emergency department or urgent care encounters (Ciesla 2024). Furthermore, the data support the benefit of vaccination in reducing pregnancy complications, such as severe maternal morbidity, preterm birth, and stillbirth (Ciapponi 2024; Lindsay 2023).

Vaccination during pregnancy provides passive immunity to the infant, protecting them from COVID-19 in the first few months of life before they can be vaccinated. Maternal COVID-19 vaccination during pregnancy results in significantly greater antibody persistence in infants when compared to infants whose mother experienced infection during pregnancy without vaccination (Shook 2022). Infants aged less than 6 months are at increased risk for severe COVID-19 disease but are not yet eligible for COVID-19 vaccination, and they depend upon transplacental transfer of maternal antibodies for protection. They continue to be hospitalized for COVID-19 at higher rates than all age groups except adults 75 years and older (Havers 2024). COVID-19 vaccination in pregnancy reduces the rate of symptomatic and severe COVID-19 resulting in hospitalization in the infant in the first 6 months of life (Halasa 2022 MMWR; Cardemil 2024). During the 2023–2024 respiratory virus season, less than 5% of mothers whose infants were hospitalized for COVID-19 were vaccinated during pregnancy (Havers 2024). Infants born to vaccinated birthing people are at 35–52% reduced risk of COVID-19-related hospitalization for up to 6 months of age (Halasa 2022 NEJM; Simeone 2023). Obtaining a COVID-19 booster vaccination during pregnancy reduces the infant’s risk of acquiring symptomatic COVID-19 in the first 6 months by 56% (95% CI, 8–79%; P=.03) relative to no boosting (Cardemil 2024). Finally, data suggest the benefit of vaccination in protecting against post-acute sequelae of SARS-CoV-2 infection (PASC; also referred to as long COVID) (Sterian 2025).

Safety of Available COVID-19 Vaccines

Side Effects

Overall, the data support that COVID-19 vaccination can safely be administered to pregnant and lactating people.

Patients can be counseled that side effects after vaccination include injection site pain, headache, fatigue, and fever, and that the rates of these side effects are not higher in pregnant individuals (Fernandez-Garcia 2024). Allergic reactions, including anaphylaxis, are rare following COVID-19 vaccination in nonpregnant individuals (Washrawirul 2022). There has been no significant association of the Pfizer-BioNTech COVID-19 vaccine and Guillain-Barré syndrome (GBS) incidence (reporting rate, 7.20 cases of GBS per million doses of the vaccine). While studies have reported cases of GBS after administration of the Moderna COVID-19 vaccine (reporting rate, 2.26 cases of GBS per million doses of the vaccine), a relative risk for GBS could not be analyzed due to limited studies reporting this outcome (Meo 2024).

Patients should be counseled about more severe side effects and when to seek medical care. For more information and details on side effects, see Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States from the CDC.

Pregnancy Surveillance Data

Post-approval surveillance is currently ongoing through CDC’s Vaccine Safety Datalink (VSD) and through the CDC and FDA’s Vaccine Adverse Event Reporting System (VAERS), a national early-warning system to detect possible safety problems in U.S.-licensed vaccines. Data from the VSD and VAERS continue to provide reassuring evidence regarding the safety of COVID-19 vaccines during pregnancy.

COVID-19 mRNA vaccination is not associated with an increased risk of pregnancy loss, such as stillbirth or miscarriage (Fernandez-Garcia 2024; Kharbanda 2021).  COVID-19 vaccination during pregnancy is also not associated with preterm birth or small-for-gestational age at birth overall (Fernandez-Garcia 2024). COVID-19 mRNA vaccination during the first trimester is not associated with an increased risk of congenital anomalies (Sharma 2025; Rowe 2025; Jorgensen 2024).

A recent systematic review and meta-analysis that included 177 clinical and preclinical studies involving pregnant persons (n=631,957) found no safety concerns regarding the administration of COVID-19 vaccines to pregnant individuals (Ciapponi 2024). COVID-19 vaccine safety during pregnancy has been well established. There is no evidence of increased risk of negative maternal, pregnancy, or infant outcomes.

Health care professionals are encouraged to report any clinically significant adverse events after vaccination to VAERS, even if they are not sure if vaccination caused the event. In addition, the following adverse events will be required to be reported to VAERS for COVID-19 vaccines administered under an EUA:

  • Vaccine administration errors (whether associated with an adverse event or not)
  • Serious adverse events, irrespective of attribution to vaccination (such as death, life-threatening adverse event, inpatient hospitalization)
  • Multisystem inflammatory syndrome in children or adults
  • Cases of COVID-19 that result in hospitalization or death

Other Considerations

  • Locations administering COVID-19 vaccines, including employee health organizations, are encouraged to follow evidence-based guidelines for the implementation of vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended postvaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine (ACOG 2019; CDC 2024).
  • Vaccination should still be offered to individuals with a history of prior symptomatic or asymptomatic SARS-CoV-2 infection, including to people with PASC/long COVID and to people who experienced SARS-CoV-2 infection after vaccination.
  • Vaccination in individuals who currently have SARS-CoV-2 infection can be deferred until the person has recovered from their acute illness and until criteria to discontinue from isolation have been met.
 

Obstetric Care Recommendations and Considerations

Pregnant Individuals

COVID-19 Infection Risk in Pregnancy

Pregnant and recently pregnant patients with COVID-19 are at increased risk of more severe illness compared with nonpregnant peers (Strid 2021). Available data indicate an increased risk of intensive care unit admission, need for mechanical ventilation, and ventilatory support (extracorporeal membrane oxygenation) reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic nonpregnant women (Strid 2021; Khan 2021). The risk of death increased in the period of the SARS-CoV-2 infections with Delta variant predominance in symptomatic pregnant compared to symptomatic nonpregnant women of reproductive age (adjusted risk ratio, 2.36; 95% CI, 1.87–2.97) (Strid 2021). Pregnant and recently pregnant patients with comorbidities such as preexisting diabetes mellitus, hypertension, cardiovascular disease, and obesity are at an even higher risk of severe illness, consistent with the general population with similar comorbidities (Smith 2023).

COVID-19 Vaccination

The American College of Obstetricians and Gynecologists strongly recommends that pregnant individuals be vaccinated against COVID-19. Furthermore, ACOG strongly recommends that individuals who are or will be pregnant receive the seasonally updated COVID-19 vaccine booster at any time during pregnancy. The CDC reported pregnancy and recent pregnancy as conditions with conclusive evidence indicating an increased risk for at least one severe outcome from COVID-19. Pregnant patients should be immunized against COVID-19 because they are at higher risk of severe illness, hospitalization, and complications from COVID-19, which can also be harmful to the newborn. Initial COVID strains posed risks for severe maternal illness and death that were mitigated by receipt of COVID-19 vaccines (Strid 2022). Subsequent and less virulent COVID strains, coincident with increased natural and vaccine-driven maternal immunity, decrease risks for severe maternal illness and death; however, vaccinated individuals still have improved maternal outcomes (Fernandez-Garcia 2024). With additional years of study, no safety concerns have been identified and reported in over 700,000 pregnant women, and increasing data support a neonatal benefit to maternal vaccination in pregnancy (Fernandez-Garcia 2024). Studies in both Canada (n=85,670) (Jorgensen 2023) and Sweden and Norway (n=94,303) (Norman 2024) examined receipt of COVID-19 vaccine in pregnancy and found no safety concerns and reduced severe neonatal morbidity and mortality. Given the potential for mitigation of severe maternal and neonatal illness through vaccination during pregnancy, the increased risk for infection-related adverse pregnancy outcomes, and the significant number of vaccinations in pregnancy without safety concerns, vaccination against COVID remains an important strategy for improving the overall health and well-being of the pregnant person and their infant.

Obstetrician–gynecologists and other obstetric care professionals should routinely assess their pregnant patients' vaccination status. On the basis of this assessment, they should recommend the needed vaccines to their pregnant patients.

 

COVID-19 Vaccine Counseling

Individuals should have access to available and unbiased information regarding the safety and efficacy of the vaccine. Conversations between the patient and their clinical team often aid in identifying reliable sources of data and assist with informed decisions regarding COVID-19 vaccination during pregnancy.

When recommending the COVID-19 vaccine, clinicians should review the available data on the risks and benefits of vaccination with pregnant patients, including the risks of not getting vaccinated in the context of the individual patient’s current health status and risk of exposure, including the possibility for exposure at work or home and the possibility for exposing high-risk household members. Conversations about risk should take into account the individual patient’s values and perceived risk of various outcomes and should respect and support autonomous decision making (ACOG 2021).

COVID vaccines have been associated with vaccine hesitancy and misinformation. Primary concerns reported among vaccine-hesitant individuals include the short time that COVID-19 vaccines have been available and the perceived lack of data on their safety in pregnancy. Content-specific counseling and knowledge of the extensive research regarding safety and benefits of vaccination can help tailor patient counseling (Cox 2023; Gianfredi 2023). Misinformation and mistrust remain key barriers to vaccine receipt, especially in lower-resource settings. Individuals who accepted Tdap or influenza vaccines were often more likely to accept COVID-19 vaccination (Ha 2023). Any of the currently authorized COVID-19 vaccines can be administered to pregnant, recently pregnant, or lactating people.

Additional Vaccination Considerations for Pregnant Individuals

  • Similar to their nonpregnant peers, vaccination of pregnant individuals with a COVID-19 vaccine may occur in any setting authorized to administer these vaccines. This includes any clinical setting and nonclinical community-based vaccination sites (eg, pharmacy).
  • Pregnant individuals who experience fever after vaccination should be counseled to take acetaminophen. Acetaminophen has been proven to be safe for use in pregnancy and does not appear to impact antibody response to COVID-19 vaccines. COVID-19 vaccines may be administered simultaneously with other vaccines, such as influenza, RSV, and Tdap, or immunization products, such as anti-D immunoglobulin (eg, RhoGAM). It is critically important that pregnant patients receive all recommended vaccines. It is recommended that clinicians discuss all vaccines recommended during pregnancy (COVID-19, influenza, Tdap, RSV) with their patients at the first prenatal encounter to plan for when patients are eligible to receive them and to reduce vaccine burden. For pregnant patients who have been admitted to the hospital, clinicians should review the patients’ vaccination status and consider offering missed maternal vaccinations at that time.
  • For patients who do not receive a COVID-19 vaccine, the discussion should be documented in the patient’s medical record. During subsequent office visits, obstetrician–gynecologists should address ongoing questions and concerns and offer vaccination again. Clinicians should reinforce the importance of other prevention measures, such as hand washing, physical distancing, and wearing a mask in large public spaces, to reduce the risk of exposure.
  • In counseling patients regarding vaccination or booster vaccination of COVID-19, clinicians should strive to have accurate, informed, and transparent discussions weighing benefits and potential risks. Included in the benefits of maternal COVID vaccine receipt are reducing the risk of maternal infection and severe disease, with improved neonatal and infant outcomes, including lower rates of neonatal morbidity and mortality and reduced hospitalization rates for those less than 6 months of age. At present, no COVID-19 vaccine products are approved for infants aged less than 6 months, and any protection must come from transfer of maternal antibodies, either from vaccination during pregnancy or prior infection (Halasa 2022 MMWR).

Lactating Individuals

The American College of Obstetricians and Gynecologists strongly recommends that lactating individuals be vaccinated against COVID-19. Lactating individuals were initially excluded from most clinical trials; however, subsequent observational studies demonstrated no negative impacts on breastfeeding among COVID-19-vaccinated lactating individuals. Safety profiles among lactating individuals receiving the COVID-19 vaccine were no different when compared to other populations. From European survey-based data (N=2,192), receipt of vaccine while breastfeeding was associated with higher rates of systemic reactions like headache, fatigue, and myalgias (Terezia 2023). This could be attributed to pregnancy-induced changes in cytokine signaling or coincident with sleep deprivation in the postpartum period.

Data consistently demonstrate that COVID-19 antibodies (IgG and IgA) are present in human milk following vaccination in pregnancy or postpartum during lactation. Notably, antibody levels were higher and more sustained with additional COVID booster doses (Young 2022; Deese 2025; Dimitroglou 2023). Furthermore, booster doses of COVID vaccine were found to prolong the durability of IgG and secretory IgA antibodies in human milk. There is no need to avoid initiation or discontinue breastfeeding in patients who receive a COVID-19 vaccine (Academy of Breastfeeding Medicine 2020). Very low levels of vaccine mRNA are found on rare occasions within the first week after a dose of vaccine, with 90% of breastmilk samples having undetectable levels (Muyldermans 2022).

Information for pregnant and lactating patients can be found on ACOG’s patient website: COVID-19.

Gynecologic Care Recommendations and Considerations

Individuals Contemplating Pregnancy

COVID-19 vaccination is strongly recommended for all individuals aged 6 months and older. Furthermore, ACOG recommends vaccination for individuals who are actively trying to become pregnant or are contemplating pregnancy. Additionally, it is not necessary to delay pregnancy after the COVID-19 vaccine series or booster doses.

Growing bodies of domestic and international data demonstrate that COVID-19 vaccines are unrelated to fecundability (Aharon 2022; Wesselink 2022; Chamani 2024). A recent systematic review and meta-analysis (21 cohorts, n=19,687 cycles) confirmed that COVID-19 vaccination had no effect on fertility among individuals with assisted reproductive treatment (Huang 2023). In contrast, evidence demonstrates the short-term decline in male fertility following infection with COVID-19 (Kharbanda 2023).

Neither receipt of COVID-19 initial doses (n=1,815) (Yland 2023) nor booster doses (n=112,718) (Kharbanda 2023) have been shown to increase spontaneous pregnancy losses or miscarriage rate. Given the mechanism of action and the safety profile of the mRNA vaccines in nonpregnant individuals, COVID-19 mRNA vaccines are not a cause of infertility. Because it does not replicate in the cells, the vaccine cannot cause infection or alter the DNA of a vaccine recipient and is also not a cause of infertility (Yildiz 2023; Avraham 2022).

Therefore, ACOG recommends vaccination for all eligible people who may consider future pregnancy. Finally, routine pregnancy testing is not recommended and should not be required before receiving any EUA-authorized or FDA-approved COVID-19 vaccine.

Routine Mammography

Reports of some patients developing temporary contralateral or ipsilateral lymphadenopathy after a COVID-19 vaccination have raised concerns about the possible effect on the interpretation of mammogram screening results. It is recommended that mammograms be conducted before COVID-19 vaccination or postponed, if possible, for 4–6 weeks after the second vaccine dose to avoid uncertainty in the interpretation of mammogram results (Becker 2021).

Screening mammograms are an essential part of preventive care, so postponing screening should only be considered when it does not unduly delay care. If a mammogram is performed fewer than 4–6 weeks after COVID-19 vaccination, patients should inform the mammogram technologist or radiologist when the vaccine was administered, which vaccine was received, and in which arm, to aid in the interpretation of screening results.

Reports of Post-Vaccination Menstrual Changes

There have been prevalence reports of temporary changes in menstruation patterns, eg, abnormal cycle duration, dysmenorrhea, irregular cycles, and abnormal cycle flow (heavy and light flow) ranging from 5.5% to 27.3% in individuals recently vaccinated for COVID-19 (Al Shahrani 2024). Changes in menstrual cycles unrelated to contraception are influenced by a variety of factors, including stress, environmental factors, and hormonal imbalances. However, the mechanisms and pathophysiological pathways underlying these changes are often not fully understood. Recent systematic reviews indicate that COVID-19 vaccination is associated with only minimal and self-limited alterations in menstrual parameters, with no clinically significant effect when compared to unvaccinated control groups (Bushi 2025; Dorjee 2025). These findings do not warrant deferral or avoidance of vaccination on the basis of menstrual health concerns. Additionally, there is no physiological rationale or empirical evidence to support timing vaccination according to menstrual cycle phase; vaccination can be safely administered at any point, including during active menstruation..

Health Equity Considerations and Communities of Color

Certain communities were disproportionately affected during the COVID-19 pandemic. Individuals in these communities are more likely to have severe illness and even die from COVID-19, likely because of a range of social and structural factors, including disparities in socioeconomic status, access to care, rates of chronic conditions, occupational exposures, and historic and continued inequities in the health care system. Access to and confidence in COVID-19 vaccines are of critical importance for all communities, but the willingness to consider vaccination varies by patient context, in part because of historic challenges that have eroded trust in some communities. With time, greater proportions of Black Americans have expressed a desire for vaccination, such that the majority surveyed affirm their intent for vaccination (Pew Research Center 2021). Despite the intent to obtain vaccination, inequities in vaccine distribution persist. Currently, information for COVID-19 vaccination coverage in pregnant women in the United States is based on electronic health record data from the CDC’s Vaccine Safety Datalink (CDC 2025c). Continuous, real-time data on vaccine coverage are not currently available, with the last posted information through April 26, 2025, which indicates 14.4% of pregnant women had received the 2024─2025 COVID-19 vaccine. Vaccination coverage was highest among non-Hispanic Asian (23.6%) pregnant women and lowest among non-Hispanic Black (7.2%) pregnant women (CDC 2025c). With the spread of the more transmissible variants, which most profoundly affect unvaccinated people, equitable vaccine access remains essential.

Obstetrician–gynecologists have the unique responsibility of counseling their patients, including people who are pregnant and lactating, through their COVID-19 vaccination decisions.

Vaccine Confidence

Low vaccine confidence, particularly around COVID-19 vaccines, exists among all populations. Clinician recommendation for vaccination and knowledge of reported vaccine safety are associated with the highest likelihood of patient vaccine receipt (Zhang 2025). When communicating with patients, it is extremely important to provide a strong recommendation for vaccines as well as to underscore the general safety of vaccines and emphasize the fact that no steps were skipped in the development and evaluation of COVID-19 vaccines. Furthermore, the vaccines were administered to hundreds of millions of people worldwide, including pregnant individuals, since the pandemic, allowing the evaluation of safety and effectiveness in real-world settings. High-volume, rigorous data support the safety and efficacy of COVID vaccines and booster doses during pregnancy, lactation, and prior to pregnancy. Patients may be told that ACOG continues to recommend that pregnant and lactating individuals receive the COVID-19 vaccine based on current, accurate, evidence-based information.

For more information:

  • For tools on discussing COVID-19 vaccines with your patients, COVID-19 Vaccine Confidence Training, and additional resources, please visit ACOG’s COVID-19 Topic Page.
  • Information for patients can be found on ACOG’s patient website: COVID-19.
 

References

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COVID-19 Coronavirus Vaccine-preventable diseases Immunization Lactation
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