COVID-19 Vaccines and Pregnancy: Conversation Guide

Updated August 2025

Key Recommendations

• The American College of Obstetricians and Gynecologists (ACOG) strongly recommends that pregnant individuals be vaccinated against COVID-19. ACOG continues to recommend that all pregnant and lactating individuals receive an updated COVID-19 vaccine or “booster.”
• Vaccination may occur in any trimester, and emphasis should be on vaccine receipt at the earliest opportunity to maximize maternal and fetal health.
• 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.
• COVID-19 vaccines may be administered simultaneously with other vaccines. This includes vaccines routinely recommended during pregnancy, such as the influenza, respiratory syncytial virus (RSV), and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines.

Key Messages

The following messages are intended to help guide conversations with pregnant patients:

Risk Associated with COVID-19 Infection during Pregnancy

• COVID-19 infection during pregnancy has historically been associated with an increased risk of severe disease, adverse pregnancy outcomes, and maternal death
• There is a known increased risk of complications from COVID-19 in pregnant patients with underlying health conditions (eg, diabetes mellitus, obesity, increasing age, and cardiovascular disease)
• Pregnant people with COVID-19 are at an increased risk of preterm delivery and neonatal death
• There is increased risk of severe illness and death from COVID-19 for certain racial and ethnic populations

Safety of COVID-19 Vaccines

• There is no evidence that any of the COVID-19 vaccines available under emergency use authorization or U.S. Food and Drug Administration (FDA) license causes infertility or spontaneous abortion
• There is no evidence of adverse maternal or fetal effects from vaccinating pregnant individuals with the COVID-19 vaccine, and a growing body of data demonstrates the safety of such use
• Injection site and systemic events (side effects) are common (eg, pain at the site of injection, fever, muscle pain, joint pain, headaches, fatigue, and other symptoms may be present after vaccination)
  • Acetaminophen is recommended for pregnant women who experience fever or if desired for other side effects
  • These side effects are a normal part of the body’s reaction to the vaccine and developing antibodies to protect against COVID-19 illness
• Ongoing safety monitoring is occurring through many government and nongovernment programs

Efficacy of COVID-19 Vaccines

• The effectiveness of COVID-19 vaccines is similar in pregnant and nonpregnant individuals of similar age for prevention of COVID-19 infection and hospitalizations
• All currently available COVID-19 vaccines have demonstrated high efficacy among their respective clinical trial endpoints
• COVID-19 vaccines decrease the risk of severe COVID-19 disease
  • Even if a patient gets sick after being vaccinated, their chance of becoming severely ill is extremely low
• The majority of hospitalized patients are individuals who did not receive a COVID-19 vaccine

Safety and Efficacy for the Newborn

• There are accumulating data demonstrating that antibodies are passed to the newborn when a pregnant person is vaccinated
  • IgG antibodies after maternal vaccination in the third trimester have been shown in observational studies. 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.
  • COVID-19 vaccination in pregnancy reduces the rate of symptomatic and severe COVID-19 resulting in hospitalization in the infant in the first six months of life
• mRNA vaccines are available to children aged six months and older

Health Equity Considerations

• Access to and confidence in COVID-19 vaccines are of critical importance for all communities, but willingness to consider vaccination varies by patient context, in part because of historic and continued injustices and systemic racism that have eroded trust in some communities. When discussing COVID-19 vaccines with an individual who expresses concerns, it is critical to ...
  • Be aware of historical and current injustices perpetrated against certain communities
  • Actively listen to expressed fears and concerns
  • Continue to care for patients who decide not to be vaccinated, share resources, and encourage the continued use of prevention measures

Continued Support

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.

For more information on vaccinating pregnant people against COVID-19, see ACOG’s Practice Advisory.