What ACOG’s 2026 maternal vaccine schedule means in pregnancy

ACOG released a new standalone maternal immunization schedule on June 10, 2026, aimed specifically at U.S. patients who are pregnant, postpartum, or lactating. For many readers, the practical checklist will look familiar: flu, Tdap, RSV in the right window, and discussion of COVID-19. What is new is that obstetric vaccine guidance is now gathered in one pregnancy-focused schedule rather than spread across multiple documents. ([acog.org](https://www.acog.org/clinical-information/maternal-immunization-schedule?utm_source=openai))

That matters because vaccine advice in pregnancy is not only about which shots exist. Timing matters. A vaccine may be recommended in every pregnancy, recommended only for some patients based on risk, delayed until after delivery, or avoided during pregnancy altogether. ACOG’s schedule is meant to make those categories easier to understand. ([acog.org](https://www.acog.org/clinical-information/maternal-immunization-schedule?utm_source=openai))

What changed in 2026

ACOG says its schedule differs from CDC’s immunization schedule and has been endorsed by 13 other medical and health organizations. In broad terms, though, it does not create an entirely new maternal vaccine strategy. It mainly gives obstetric clinicians and patients one clearer roadmap for pregnancy, postpartum, and breastfeeding care. ([acog.org](https://www.acog.org/clinical-information/maternal-immunization-schedule?utm_source=openai))

The place where readers are most likely to notice a mismatch is COVID-19. ACOG continues to recommend updated COVID-19 vaccination during pregnancy. As of June 23, 2026, CDC’s public pregnancy vaccine page still says pregnant patients should stay up to date on COVID-19 vaccination, while a CDC clinician summary table lists COVID-19 as “No guidance/not applicable.” HHS also still says pregnant people need COVID-19 vaccination. So if the wording has seemed inconsistent, that is not your imagination. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html))

What is routinely recommended during pregnancy

Flu vaccine: CDC recommends a seasonal flu shot during pregnancy because pregnant patients are at higher risk for severe flu illness. It can be given in any trimester. The preferred products in pregnancy are the inactivated or recombinant flu vaccines, not the live nasal spray vaccine. CDC says getting vaccinated by the end of October is ideal in most years, though later vaccination can still help if flu viruses are circulating. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html))

Tdap: This vaccine is recommended during every pregnancy, ideally in the earlier part of the 27- through 36-week window so protective antibodies have more time to reach the baby before birth. CDC notes Tdap may be given at any time in pregnancy if needed, but 27 to 36 weeks is the preferred timing for routine use. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html))

COVID-19 vaccine: ACOG continues to treat updated COVID-19 vaccination as part of routine maternal care. CDC’s public pregnancy page and HHS both still say pregnancy raises the risk of severe COVID-19 illness and pregnancy complications, and both continue to tell pregnant patients to stay current. That said, the mixed wording across federal pages means some readers may hear different phrasing depending on which government page or clinician handout they see. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html))

RSV vaccine: CDC recommends maternal RSV vaccination during 32 weeks and 0 days through 36 weeks and 6 days of pregnancy, using seasonal administration in most of the continental United States from September through January. In places where RSV season differs, including Alaska, Puerto Rico, Guam, the U.S. Virgin Islands, and some southern areas, local or territorial guidance may set different timing. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html))

Other vaccines may be recommended only for certain pregnant patients. CDC says hepatitis B vaccination is recommended in pregnancy if you have not already been vaccinated, and hepatitis A may be recommended for people at higher risk of infection or severe outcomes. Travel-related vaccines and other risk-based vaccines depend on your itinerary, medical history, job exposures, and underlying conditions. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html))

RSV is the easiest place to get tripped up

RSV protection for a newborn can come through two different paths: vaccination during pregnancy or an infant antibody product after birth called nirsevimab. In most cases, the plan is one route or the other, based on timing and clinical circumstances. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html))

If you choose maternal vaccination, the product matters. CDC says only Pfizer’s Abrysvo should be used during pregnancy. GSK’s Arexvy and Moderna’s mResvia should not be given during pregnancy. Timing matters too: if you are already beyond 36 weeks and 6 days, there may not be enough time for protective antibodies to cross the placenta before birth, so infant protection after delivery may make more sense. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html))

A second detail that surprises many people is repeat pregnancy. CDC says that if you already received maternal RSV vaccination in a previous pregnancy, it is not currently recommended again in a later pregnancy. In that situation, the infant would usually be protected after birth with nirsevimab instead. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html))

What applies after birth, while breastfeeding, or while trying to conceive

The new schedule also covers postpartum and breastfeeding care, which matters because some vaccines are handled before pregnancy or after delivery rather than during pregnancy itself. HHS notes that postpartum vaccination helps protect the mother, and some antibodies can also be passed through breastmilk. ([acog.org](https://www.acog.org/clinical-information/maternal-immunization-schedule?utm_source=openai))

CDC says MMR and varicella are contraindicated during pregnancy because they are live vaccines. If you are trying to conceive, this is one reason it can help to review your vaccine record early: CDC says patients should avoid becoming pregnant for 28 days after MMR vaccination and for 1 month after varicella vaccination. HPV vaccination is not recommended during pregnancy and is usually resumed or started after pregnancy. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html))

If Tdap was not given during pregnancy and the patient has not previously received Tdap, CDC says it should be given immediately postpartum. Postpartum visits can also be a practical time to catch up on vaccines that were deferred because they were contraindicated or not recommended during pregnancy. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html))

What is still uncertain

RSV is also the place where safety evidence is still maturing. A recent JAMA Network Open cohort study looked at 13,619 RSVpreF-exposed pregnancies in early U.S. postapproval surveillance. The study found no association with preterm birth. But it also said potential increased risks for pregnancy-associated hypertensive disorders, premature rupture of membranes, and preterm premature rupture of membranes could not be ruled out. ([jamanetwork.com](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847996))

That is important context, but it is not proof that the vaccine caused those outcomes. This was an observational surveillance study using insurance data, not a randomized clinical trial, and the authors said the findings should be interpreted as hypothesis generating because confounding control was limited in the early postlicensure period. In plain language: the signal deserves follow-up, not panic. ([jamanetwork.com](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847996))

This is one reason different organizations can sound slightly different even when they agree on much of the practical bottom line. Vaccine recommendations are built from the best evidence available at the time, and they may become more precise as more safety and effectiveness data accumulate. ([jamanetwork.com](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847996))

What readers can do now

Bring your vaccine record to your first prenatal or preconception visit.
Ask which vaccines are routine for you now, which depend on risk factors, and which should wait until after delivery.
If you will be 32 to 36 weeks pregnant during RSV season, ask whether maternal RSV vaccination or infant nirsevimab makes more sense in your situation.
If you are seeing different COVID-19 wording on different federal pages, ask your obstetric clinician how they are interpreting the current guidance for your pregnancy stage and medical history.
If you are postpartum, ask whether deferred vaccines such as MMR, varicella, HPV, or Tdap should be addressed before the postpartum period slips by.

If you are pregnant and develop severe breathing symptoms, chest pain, dehydration, or signs of serious infection, or if you think you have had a high-risk exposure to a vaccine-preventable illness, contact a clinician promptly or seek urgent care. Vaccine timing questions can usually wait for a scheduled visit, but serious symptoms should not. ([cdc.gov](https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html))

The bottom line is that ACOG’s 2026 schedule is less about a brand-new list of shots and more about giving pregnant and postpartum patients one clearer roadmap for timing, follow-up, and informed questions. If you are pregnant or planning pregnancy, the most useful next step is a timing-focused conversation with a qualified clinician who can match the schedule to your due date, the season, your prior vaccines, and any special risk factors. ([acog.org](https://www.acog.org/clinical-information/maternal-immunization-schedule?utm_source=openai))

Sources

Editorial note: Weence articles are researched from cited public-health, medical, regulatory, journal, and reputable news sources and may be drafted with AI assistance. They are checked for source support, clarity, and safety guardrails before publication.

This article is for general informational purposes only and is not medical advice. Research findings can be early or incomplete, and health guidance can change. Always talk with a qualified healthcare professional about personal symptoms, diagnosis, medications, vaccines, screenings, or treatment decisions. If you think you may have a medical emergency, call emergency services right away.