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
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
Molnupiravir is an antiviral medication with a reported 30% efficacy
Although the EUA recommends against its use in pregnancy due to mutagenicity concerns, this
drug may be reasonably considered for use in pregnancy if there are no other
therapies available and with documented counseling that the patient understands
the risks and benefits
Note: More information on the CDC data regarding stillbirth and COVID-19 can be found in ‘Related ObG Topics’ below
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)
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