COVID in Pregnancy and Treatment
- Multiple outpatient therapies have received EUA for the treatment of patients with symptomatic COVID-19 infection to prevent progression to severe illness.
- Pregnancy is considered a high-risk condition for severe COVID-19 illness and as such may benefit from treatment that prevents severe disease.
- FDA has included pregnant people as eligible for these treatments under the EUA even though pregnant individuals were not included in these trials
Am I eligible for treatment?
- You are eligible for treatment if you meet all the below requirements:
- You have had a positive COVID test
- Your symptoms started within the last 5 days (7 days for alternative treatment)
- You have some symptoms, but not severe symptoms of COVID.
- You are pregnant or recently postpartum
Should I get the treatment?
- There is strong evidence that these treatments can prevent people with COVID from developing severe disease that leads to needing to be in the hospital.
- The majority of patients included in these studies were at high risk for severe COVID illness such as older adults, unvaccinated individuals, or those with medical conditions. Although pregnant and vaccinated people were not included in the studies, we do know that pregnancy is a high-risk condition for severe COVID illness and will likely benefit from this treatment, we don’t know if the efficacy will be as high for younger, healthier, vaccinated, or pregnant people.
- The studies on which these results are based were done on previous variants and do not necessarily hold true with newer and seemingly more mild variants.
- Highest risk patients are likely those that are unvaccinated, incompletely vaccinated, or vaccinated but NOT Boosted, or those who are vaccinated but have additional risk factors such as Immune suppression, elevated BMI, diabetes (gestational or pregestational, hypertension (or other cardiovascular disease), chronic kidney disease, chronic lung disease), psychiatric disorder, or physical disability
What treatment is available?
While there are multiple treatments available the main medication used currently is Paxlovid.
- Paxlovid is an anti-viral medication. It is a combination of a new medication (called Nirmatrelvir) plus a second medication (called Ritonavir).
- This treatment has been shown to decrease the risk of hospitalizations due to COVID by 89% when given to patients early in the course of their symptoms
- Although this combination of antiviral medications is new and has not been studied in pregnant patients, this class of antiviral medication has been used for many years, and thousands of pregnant patients around the world who have HIV without evidence of harm. The second component of this medication combination (Ritonavir) has been around for a long time and has a long safety record in pregnancy.
- We do not anticipate that this combination medication will cause harm to the baby however at this time, we do not have information to suggest that exposure to this medicine would help or harm the developing fetus.
- This medication is convenient to use as it is a pill that you can pick up from the pharmacy and take at home for a 5-day course.
- We need to know about other medications, including over-the-counter medications, that you are taking, to make sure there are no drug interactions
What are the side effects?
Although Paxlovid is generally well tolerated, the main side effects reported are diarrhea, abdominal pain, nausea and altered taste (usually metallic). Other symptoms include high blood pressure and muscle aches.
Are there other options?
Yes, there are other options for treatment that are mainly used if you have a contraindication to using Paxlovid. If you would like more information about these please schedule an appointment with your provider.
What about rebound?
Rebound is when you stop having COVID symptoms and test negative, and then subsequently test positive again with or without developing symptoms again. There is a large variation in data with regards to the rates of rebound after taking Paxlovid (2% – 10%, or higher as there is likely a large population that we are not catching as they do not retest). There is also data to show that there is a possibility for rebound in those people who choose not to take Paxlovid. We will likely see new research on this topic shortly but at this time it is unclear what the rates of rebound are when taking Paxlovid versus no treatment.
So now what?
- With this information, some people choose to take the treatment in hopes that it could prevent them from becoming sicker, even though the treatment might have risks that we do not yet know about.
- Other people would choose not to take the treatment because the risks have not yet been fully studied, even though the treatment might actually help prevent them from getting sicker.