ACOG committee statement recommends influenza vaccination, treatment in pregnancy

Key takeaways:

• OB/GYNs should recommend influenza vaccination and counsel pregnant people on its benefits.
• Clinicians should consider both influenza and SARS-CoV-2 infection in pregnant people presenting with symptoms.

Annual influenza vaccinations are important for pregnant individuals due to higher risks for complications for the mother, fetus and infant, according to an ACOG committee statement.

“Pregnant and postpartum individuals are at significantly higher risk of serious complications related to seasonal and pandemic influenza infections compared with nonpregnant people,” Laura E. Riley, MD, FACOG, member of the ACOG’s Immunization, Infectious Disease and Public Health Preparedness Expert Work Group and chair of obstetrics and gynecology at Weill Cornell Medicine, and colleagues wrote. “This increased risk also has been seen for other respiratory infections, including SARS-CoV-2, and is amplified if a pregnant individual has underlying health conditions.”

In the committee statement, ACOG and the CDC recommend the following regarding influenza vaccinations:

• all adults receive an annual influenza vaccine and those who are or will become pregnant during influenza season receive inactivated or recombinant influenza vaccine;
• administering other inactivated or non-virus-containing vaccines is recommended in pregnancy if aligned with influenza vaccine timing; and
• OB/GYNs and other health care professionals should recommend the influenza vaccine and counsel pregnant women about benefits of vaccination for themselves and their newborns.

Regarding assessing other respiratory infections, such as SARS-CoV-2, during pregnancy and treatment options for pregnant women, ACOG and the CDC recommend:

• OB/GYNs and other health care professionals consider influenza and SARS-CoV-2 infection in pregnant women presenting with respiratory illness symptoms;
• clinicians initiate empiric antiviral treatment immediately for pregnant women with suspected influenza, ideally within 48 hours of symptom onset;
• patients with moderate risk for severe illness have in-person evaluation immediately;
• patients with high risk for severe illness be seen in an ED or equivalent setting immediately;
• no delay in antiviral treatment while awaiting respiratory infection test results; and
• prescription of both oseltamivir and nirmatrelvir/ritonavir (Paxlovid, Pfizer) if there is suspected or confirmed coinfection with influenza and SARS-CoV-2.

According to the authors, adults of historically underrepresented groups have higher rates of hospitalization and mortality from influenza and lower influenza vaccination rates vs. white counterparts. Using culturally responsive language and partnering with community groups and trusted messengers are key strategies to increase vaccination rates in some racial and ethnicity communities, Riley and colleagues noted.

“Timely assessment and treatment of respiratory virus infections is essential to improving outcomes for pregnant patients,” the committee wrote. “Obstetrician-gynecologists and other obstetric care professionals can help reduce disparities in influenza vaccination rates as well as severe outcomes related to influenza infection by strongly recommending influenza vaccination to all patients.”