Early data show disparities in RSV vaccine uptake among pregnant patients

Early data show disparities in RSV vaccine uptake among pregnant patients | Image Credit: © Chanita- stock.adobe.com.

In the first season following the rollout of a novel maternal respiratory syncytial virus (RSV) vaccine, new data presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting suggest that uptake of RSV immunization during pregnancy remains uneven and may be influenced by both systemic and educational factors.

The retrospective cohort study examined 1,059 pregnant individuals who delivered at a tertiary referral center between October 1, 2023, and March 31, 2024. During that period, pregnant patients between 32 0/7 and 36 6/7 weeks’ gestation were eligible to receive the RSV vaccine, which protects infants against respiratory syncytial virus (RSV)—a leading cause of infant hospitalization in the United States. Alternatively, families could choose neonatal monoclonal antibody treatment for their newborns.

Overall, 68.5% (n=725) of the patients received some form of RSV protection. Those who received the maternal RSV vaccine were significantly less likely to deliver preterm (defined as before 37 weeks’ gestation), with a rate of 9.9% compared to 17.8% in those who did not receive the vaccine (P<.001).

However, the study found notable disparities. Patients with Medicaid insurance were significantly less likely to receive RSV protection compared with those holding commercial insurance (63.6% vs. 71.3%, P=.037). Uptake of RSV protection also closely mirrored acceptance of other routine prenatal immunizations, such as Tdap, COVID-19, and influenza vaccines. Patients who declined RSV immunization were also more likely to have declined these other vaccinations, all with P values less than .001.

These findings come as many health care professionals still report limited confidence and inconsistent practices regarding RSV immunization discussions. According to a recent Contemporary OB/GYN survey of 72 health care providers, most of them practicing ob-gyns, only 19.05% said they were “extremely familiar” with RSV and its impact on infants. While 38.10% reported always discussing RSV immunization with their patients, a combined 40% said they did so only “sometimes,” “rarely,” or “never.”

Confidence in counseling was also variable: only 23.81% of respondents felt extremely confident in their ability to advise patients on RSV immunization. Nearly 1 in 4 respondents (23.81%) said they believed it is “extremely important” for pregnant patients to receive the RSV vaccine, while others noted moderate or low importance.

A recurring barrier to vaccine uptake was patient education. A majority of providers (61.90%) identified lack of awareness as the top obstacle, followed by safety concerns (54.76%), time constraints (23.81%), and questions about efficacy (14.29%). Many patients reportedly entered appointments with little to no prior knowledge about RSV; 38.10% of providers said that 0–20% of their patients were aware of RSV immunization options before discussion.

To support better patient communication, 85.71% of providers said educational brochures or pamphlets would help them improve counseling, while others cited the need for better online resources, association support, and more structured training.

Cost and insurance coverage also emerged as common discussion points. Several survey respondents highlighted insurance as a deciding factor in where and how patients could access the RSV vaccine—a dynamic reflected in the cohort study’s finding that commercial insurance was associated with higher protection rates.

Providers also weighed a number of factors when recommending RSV immunization, including vaccine efficacy, potential side effects, fetal safety, and personal anecdotes. One physician noted that many patients are more motivated to receive the RSV vaccine if they or someone they know has had a child severely affected by the virus.

Ultimately, both the clinical data and survey responses point to the importance of proactive, informed conversations in driving uptake of RSV protection. The authors concluded, “In the inaugural season of prenatal RSV vaccination, receipt of other routine prenatal vaccinations and commercial insurance support were associated with receipt of RSV protection. These data will inform ongoing system-wide quality improvement initiatives.”

References:

1. Boller MJ, Ward LR, Gibbins KJ, Valent AM, Bayer LL. Uptake of Respiratory Syncytial Virus Protection in the Inaugural Prenatal Vaccination Season: A Tertiary Referral Center Experience. Abstract. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.

2. Krewson C. Practitioner attitudes toward RSV counseling revealed. Contemporary OB/GYN. September 30, 2024. Accessed May 15, 2025.