COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care | ACOG

COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care | ACOG
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COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care
COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care
Practice Advisory
PA
December 2020
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This Practice Advisory update was developed by the American College of Obstetricians & 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. The American College of Obstetricians & Gynecologists (ACOG) is committed to providing recommendations based on a rigorous review of scientific evidence. When substantive new scientific information is received, recommendations will be revised. This document is designed to give clinicians the critical information needed to support a fair and balanced risk–benefit discussion and effectively counsel patients in order to optimize care. For additional information regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and treatment, refer to ACOG’s
COVID-19 FAQs for Obstetrician–Gynecologists
Despite the change in vaccine recommendations from the U.S. Department of Health and Human Services, the science has not changed (
ACOG 2025
). The American College of Obstetricians & Gynecologists continues to
recommend
the use of updated COVID-19 vaccines for individuals contemplating pregnancy and for pregnant, recently pregnant, and lactating individuals.
Key Recommendations
The American College of Obstetricians & 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 2025
Halasa 2022
Cardemil 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 MMW
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.
The American College of Obstetricians & Gynecologists 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
CDC 2025a
):
2025–2026 Pfizer‑BioNTech COVID‑19 Vaccine: COMIRNATY
2025–2026 Moderna COVID‑19 Vaccine: SPIKEVAX
2025–2026 Moderna COVID‑19 Vaccine: mNEXSPIKE
2025–2026 Novavax COVID‑19 Vaccine: NUVAXOVID
There is no preferential recommendation for the use of any one COVID-19 vaccine over another. The American College of Obstetricians & Gynecologists’ recommendations regarding the COVID-19 vaccine will continue to reflect the current accurate, evidence-based information.
COVID-19 Vaccine Availability and Recommendation in Pregnancy
The Centers for Disease Control and Prevention (CDC) recommends the 2025–2026 COVID-19 vaccine for individuals aged 6 months or older using shared, individual-based clinical decision-making (
CDC 2025a
). Pregnancy and recent pregnancy are classified by the CDC as higher-risk conditions for severe COVID-19 outcomes, as well as hospitalization, intensive care unit admission, mechanical ventilation, and death (
CDC 2025b
). For individuals with high-risk conditions, including pregnancy, the risk–benefit profile of vaccination is most favorable (
CDC 2025c
).
Although federal language has shifted toward shared clinical decision-making, the underlying scientific evidence has not changed. Robust data continue to demonstrate that pregnant and recently pregnant individuals are at increased risk for severe COVID-19–associated morbidity and adverse pregnancy outcomes. Accumulated safety data from millions of administered doses show no increased risk of adverse maternal, fetal, or neonatal outcomes associated with COVID-19 vaccination in pregnancy.
Accordingly, the American College of Obstetricians & Gynecologists continues to recommend routine administration of updated COVID-19 vaccines for individuals who are pregnant, contemplating pregnancy, recently pregnant, or lactating. For this high-risk population, vaccination should be recommended as standard preventive care rather than deferred solely to neutral shared decision-making.
Despite broad vaccine availability—including pharmacy-based access without prescription—uptake has declined. As of January 10, 2026, most COVID-19 vaccinations (90.5%) were administered through retail pharmacies, offering convenient, insurance-covered access without a prescription. However, vaccine uptake has waned, with a 25.7% year-to-date decrease in the 2025–2026 season compared with 2024–2025 (
CDC 2025d
). As of February 21, 2026, 11.1% of pregnant women overall have received a COVID-19 vaccine (
CDC 2026
). Clear, strong clinician recommendation remains one of the most influential factors in maternal vaccination acceptance and is essential to reducing preventable morbidity.
Storage and Administration
The American College of Obstetricians & Gynecologists encourages clinicians to stock and, ideally, administer all recommended vaccines in their offices (
ACOG 2026
). Studies show that immunization rates are higher when a trusted clinician can strongly recommend, offer, and administer the vaccine during the same visit, rather than recommend vaccination and refer the patient elsewhere to receive it. Influenza and Tdap vaccines are routinely offered and administered by a majority of practices, whereas 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 vaccines, 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
As SARS-CoV-2 continues to circulate and future respiratory virus pandemics are inevitable, it is critical to understand its effect on individuals at high risk of severe illness, including pregnant individuals, and the role of vaccination in risk mitigation. 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 through that season (
Link-Gelles 2025
). Updated COVID-19 vaccines are associated with reduced COVID-19–related morbidity in pregnant patients, including emergency department or urgent care visits, hospitalizations, and critical care admissions (
Ciesla 2025
McClymont 2026
). Among individuals who developed COVID-19, vaccination during pregnancy, relative to vaccination prior to pregnancy, showed a trend toward lower rates of preterm birth (P=.05) (
McClymont 2026
). Available evidence also suggests that COVID-19 vaccination during pregnancy may reduce the risk of 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 with infants whose mothers 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 have a 35–52% lower 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
).
Studies evaluating the association between maternal SARS-CoV-2 infection during pregnancy and offspring neurodevelopmental outcomes have shown mixed results. A retrospective cohort study (n=18,124) found increased odds of neurodevelopmental disorders by 36 months among exposed offspring (adjusted odds ratio [aOR] 1.29; 95% CI, 1.05–1.57), with stronger associations following third-trimester exposure (aOR 1.36; 95% CI, 1.07–1.72) and among male offspring (aOR 1.43; 95% CI, 1.05–1.91) (
Shook 2026
). In contrast, a larger longitudinal cohort (n=69,987) found no overall association by 48 months (aOR 1.01; 95% CI, 0.92–1.11), although an increased risk of autism spectrum disorder was observed among female offspring in sensitivity analyses (adjusted hazard ratio 1.44; 95% CI, 1.05–1.97) (
Croen 2026
). Maternal vaccination may reduce the risk of post-acute sequelae of SARS-CoV-2 infection (PASC, or 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 V
accine 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. (
Sheth 2025
Denoble 2024
Madni 2026
COVID-19 mRNA vaccination during pregnancy is not associated with increased risks of pregnancy loss (miscarriage or stillbirth), preterm birth, small-for-gestational-age birth, or congenital anomalies, including when administered in the first trimester (
Kharbanda 2021
Fernandez-Garcia 2024
Jorgensen 2024
Rowe 2025
Sharma 2025
Madni 2026
). A 2024 systematic review and meta-analysis of 177 studies involving 631,957 pregnant individuals found no safety concerns related to COVID-19 vaccination in pregnancy (
Ciapponi 2024
), although conclusions are limited by the quality and consistency of included studies.
A 2021 retrospective cohort analysis of the CDC’s v-safe Pregnancy Registry reported a modestly higher self-reported rate of hypertensive disorders of pregnancy (HDP) among vaccinated nulliparous individuals compared with unvaccinated participants in the Pregnancy Risk Assessment Monitoring System (PRAMS) (15.0% versus 12.0%; adjusted risk ratio [aRR] 1.24; 95% CI, 1.08–1.43) (
Sharma 2026
). However, this study relied on self-reported outcomes and is subject to potential misclassification bias and limited generalizability. Notably, reported HDP rates in this analysis (13.5% overall) exceed contemporaneous national estimates from the CDC National Vital Statistics System (9.4% in 2021) and the Vaccine Safety Datalink (9.8%) (
Osterman 2023
Vesco 2024
). In contrast, Vaccine Safety Datalink analyses using clinically verified diagnoses found no increased risk of gestational hypertension (aRR 1.08; 95% CI, 0.96–1.22) or preeclampsia/eclampsia/HELLP syndrome (aRR 1.10; 95% CI, 0.97–1.24) following mRNA COVID-19 vaccination in pregnancy (
Vesco 2024
).
Overall, COVID-19 vaccination during pregnancy is well established as safe, with no evidence of increased risk of adverse 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 unsure whether 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 (
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 2022
). 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 2022
Khan 2021
). The risk of death increased in the period of the SARS-CoV-2 infections with Delta variant predominance in symptomatic pregnant women compared to symptomatic nonpregnant women of reproductive age (aRR 2.36; 95% CI, 1.87–2.97) (
Strid 2022
). 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 & 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 the 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 of exposure at work or home and the possibility of 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. Among the benefits of maternal COVID-19 vaccine receipt are reduced 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 & 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 a vaccine while breastfeeding was associated with higher rates of systemic reactions, such as 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 showing undetectable levels (M
uyldermans 2022
).
Clear evidence supports the safety and efficacy of COVID-19 vaccination during lactation, with no demonstrated harm to mother or infant. Therefore, recommendations to avoid vaccination while breastfeeding or to withhold breast milk after vaccination are not supported by current evidence (
Shook 2023
). 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 SARS-CoV-2 (
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 (B
ushi 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. COVID-19 vaccine acceptance among pregnant women ranged from 7% to 78.3% (
Patel 2024
), with lower acceptance among Hispanics (OR 0.72; 95% CI, 0.58–0.91) and Blacks (OR 0.44; 95% CI, 0.30–0.63) and higher acceptance among Asians (OR 1.78; 95% CI, 1.10–2.88) compared with Whites. Despite the intent to obtain vaccination, inequities in vaccine distribution persist. 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. Continuous, real-time data on COVID-19 vaccine coverage was paused on April 26, 2025, but has recently become available again (
CDC 2026
). Prolonged pauses may compromise evidence supporting clinical and policy decisions (
Jacobs 2026
). 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
Ethical issues with vaccination in obstetrics and gynecology. Committee Opinion No. 829. American College of Obstetricians and Gynecologists.
Obstet Gynecol
. 2021;138:e16–23. doi:
10.1097/AOG.0000000000004390
American College of Obstetricians and Gynecologists. ACOG statement on HHS recommendations regarding the COVID vaccine during pregnancy. News release; May 27, 2025. Accessed March 5, 2026.
Immunization implementation strategies for obstetrician–gynecologists. ACOG Committee Opinion No. 772.
Obstet Gynecol
. 2019;133:e254–9. doi:
10.1097/AOG.0000000000003130
Academy of Breastfeeding Medicine. Considerations for COVID-19 vaccination in lactation. ABM; 2020. Accessed August 18, 2025.
Aharon D, Lederman M, Ghofranian A, Hernandez-Nieto C, Canon C, Hanley W, et al. In vitro fertilization and early pregnancy outcomes after coronavirus disease 2019 (COVID-19) vaccination.
Obstet Gynecol
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Topics
COVID-19
Coronavirus
Vaccine-preventable diseases
Immunization
Lactation
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