FOGSI Guidelines on Vaccination in Pregnancy

Important note on "2026" version: As of August 2026, there is no separate FOGSI 2026-specific guideline on vaccination in pregnancy that has been publicly released. The current authoritative FOGSI document is the FOGSI-ICOG Good Clinical Practice Recommendations (GCPR): "Vaccination in Women", published in April 2024. This is the most recent FOGSI-specific guidance. Where relevant, the 2026 ACOG Maternal Immunization Schedule (the most current international reference) is noted for comparison.

Overview

A. Routinely Recommended Vaccines in Every Pregnancy

1. Tdap (Tetanus, Diphtheria, Acellular Pertussis)

• Every pregnancy, irrespective of prior Tdap history
• Administer in the 27-36 weeks window (preferably early in this window)
• Passes maternal IgG antibodies to fetus - protects neonate before their own immunization schedule begins ("cocooning" effect)
• Grade A recommendation

2. Influenza (Inactivated Influenza Vaccine - IIV / Recombinant - RIV)

• Recommended for all women who are, or will be, pregnant during influenza season
• Any trimester is acceptable
• Live attenuated influenza vaccine (LAIV) is CONTRAINDICATED in pregnancy
• Reduces risk of influenza-associated complications (preterm birth, IUGR, ICU admission)
• Grade A recommendation

3. Tetanus / Td

• If Tdap is not available, Td should be administered for routine indications
• Women with unknown or incomplete tetanus immunization history should be given Td (at least 2 doses in pregnancy)
• Grade A recommendation

B. Vaccines Recommended Based on Risk Factors

C. CONTRAINDICATED Vaccines in Pregnancy

D. COVID-19 Vaccination

• FOGSI (consistent with WHO and IAP guidance) recommends COVID-19 vaccination during pregnancy
• Any trimester is appropriate
• Benefits of vaccination (preventing severe maternal illness, preterm birth, ICU admission) outweigh theoretical risks
• Both mRNA and recombinant vector vaccines are acceptable
• Can be co-administered with other indicated vaccines

E. RSV Vaccine (2026 Update - ACOG)

• Abrysvo (RSV vaccine, Pfizer): Recommended as a one-time dose in the first eligible pregnancy at 32 weeks 0 days to 36 weeks 6 days gestation
• Repeat vaccination in subsequent pregnancies is not indicated - infants in those pregnancies should receive RSV monoclonal antibody instead
• This recommendation is not yet formally adopted in FOGSI/Indian guidelines but is being monitored

F. Postpartum and Lactation

• MMR and varicella should be given postpartum if not immune (safe while breastfeeding)
• Tdap, influenza, and hepatitis B can be initiated postpartum and during breastfeeding
• HPV vaccine series can be resumed postpartum
• "Cocooning strategy": vaccinate all close household contacts and caregivers of the newborn

G. Practical Precautions (FOGSI/CDC Aligned)

• Always observe a 15-30 minute post-vaccination watch period for anaphylaxis
• Screen for contraindications before each vaccine
• Keep adrenaline (epinephrine 1:1000) available
• Document vaccination and counsel on expected side effects (local soreness, mild fever)
• Vaccines can generally be co-administered unless specific contraindication exists

Summary Flowchart (FOGSI GCPR 2024)

ALL PREGNANT WOMEN
├── Tdap (27-36 weeks, every pregnancy)   [Grade A]
├── Inactivated Influenza (any trimester)  [Grade A]
├── Td (if Tdap unavailable)              [Grade A]
├── COVID-19 (any trimester)
└── Based on Risk Assessment:
    ├── HBV (if unvaccinated / high risk)
    ├── HepA (if risk of exposure)
    ├── Pneumococcal (if diabetes/asplenia)
    ├── Meningococcal (if asplenia/travel)
    └── Travel vaccines (inactivated only)

CONTRAINDICATED: MMR, Varicella, LAIV, HPV, Oral Typhoid, BCG

Note: No standalone FOGSI document specifically titled "2026 guidelines" was found as of August 2026. The April 2024 GCPR is the most recent FOGSI-issued guidance. If a 2026 update exists, it has not been publicly released on fogsi.org at the time of this search. Always check the FOGSI GCPR page for the latest publications.

ACOG 2026 Maternal Immunization Schedule

Part 1: Routinely Recommended Vaccines During Pregnancy

1. Inactivated / Recombinant Influenza (IIV or RIV)

• Timing: Any gestational age, any time of year
• Ideally before influenza season begins (by end of October), but can be given any time viruses are circulating
• Every pregnancy
• Safe to continue postpartum and while breastfeeding
• Note: Live attenuated influenza vaccine (LAIV) is NOT recommended

2. COVID-19 Vaccine

• Timing: Any trimester, any gestational age, any time of year
• Every pregnancy
• Administer as soon as possible to maximize maternal and fetal benefit
• Any COVID-19 vaccine product is acceptable
• Can be initiated postpartum and while breastfeeding
• Key difference from CDC: The CDC states COVID-19 vaccines are no longer recommended for healthy pregnant women; ACOG explicitly continues to recommend COVID-19 vaccination in pregnancy - the central reason ACOG broke from federal guidance

3. Tdap (Tetanus, Diphtheria, Acellular Pertussis)

• Timing: 27-36 weeks gestation (preferably early in this window)
• Every pregnancy, regardless of prior Tdap history
• Any Tdap product is acceptable
• Can be continued postpartum and while breastfeeding
• Rationale: Generates maternal antibodies that transfer to fetus, protecting neonate before their own primary immunization series

4. Maternal RSV Vaccine (Abrysvo - Pfizer)

• Timing: 32 weeks 0 days to 36 weeks 6 days gestation
• Seasonal: September through January in most continental US regions (follow local/territorial guidance in Alaska and tropical climates)
• First eligible pregnancy only - repeat vaccination in subsequent pregnancies is NOT indicated
• In subsequent pregnancies: infants should receive RSV monoclonal antibody instead
• Monoclonal antibody is also acceptable as an alternative to maternal vaccination even in the first pregnancy
• Can be co-administered with other indicated vaccines

Part 2: Vaccines Recommended Based on Risk Factors (Comorbidities / Exposure)

Part 3: Vaccines NOT Recommended / Contraindicated During Pregnancy

Part 4: Postpartum and Breastfeeding

Key Themes: ACOG vs. CDC 2026 - Where They Differ

Clinical Implementation Guidance

1. Assess vaccination status at every prenatal visit
2. Counsel patients on vaccine-preventable diseases and the safety of recommended vaccines
3. Stock and administer vaccines in OB/GYN offices whenever feasible
4. Co-administer any combination of indicated vaccines when appropriate - no safety signal against concurrent administration
5. Treat immunization as an essential component of prepregnancy, prenatal, postpartum, and lactation care