Pregnant patients are at increased risk for COVID-19 vs nonpregnant patients. Pregnancy should be considered a ‘high risk category’ (CDC) and should be managed as such. SMFM has updated a document regarding perinatal care that provides valuable information to professionals managing women with COVID-19 during pregnancy as well as helpful counseling tips to encourage vaccination to avoid complications due to infection.
COVID-19 Disease Severity During Pregnancy
SMFM and ACOG recommend that pregnant people receive a COVID-19 booster shot at least 6 months after their primary series for mRNA-based vaccines (ie, Pfizer or Moderna) and at least 2 months after their primary vaccination for the Janssen vaccination
As with the primary series, the booster dose can be given at any stage during pregnancy and postpartum
…all pregnant, recently pregnant, or lactating people receive a bivalent booster, to mitigate increased risk of adverse maternal, fetal, and obstetric outcomes of COVID-19 disease
Additionally, the bivalent booster should be given at any point in pregnancy
Note: Additional information regarding vaccination in pregnancy can be found below in ‘Related ObG Topics’
Therapies that would otherwise be given should not be withheld specifically due to pregnancy or lactation
Therapies including monoclonal antibodies, remdesivir, dexamethasone, baricitinib, and tocilizumab, can and should be provided to pregnant patients with COVID-19 who meet clinical qualifications
Note: Additional information on use of monoclonal antibodies, including use for postexposure prophylaxis, can be found in the NIH management summary in ‘ObG Project Topics’
SMFM supports the use of Paxlovid (nirmatrelvir [PF-07321332] tablets and ritonavir tablets) for treatment of pregnant patients with COVID-19 who meet clinical qualifications
Any therapy that would otherwise be given should not be withheld specifically due to pregnancy or lactation
The Panel recommends against the use of molnupiravir for the treatment of COVID-19 in pregnant patients unless there are no other options and therapy is clearly indicated
Note: More information on the CDC data regarding stillbirth and COVID-19 can be found in ‘Related ObG Topics’ below
…should be a joint effort between the patient and the clinical team, including infant care providers
COVID-19 and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know
SMFM: FDA Issues EUA for the Treatment of Mild-to-Moderate COVID-19 (Paxlovid)
SMFM: COVID-19 Outpatient Treatment in Pregnancy
NIH: Molnupiravir and COVID-19 Treatment Guidelines
SMFM: SARS-CoV-2 Bivalent Vaccination in Pregnancy
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