Table 1.

COVID-19 pharmacotherapy in pregnancy: Summary of data.

	Efficacy	Safety	Current Recommendations
Antiviral therapy
Remdesivir	Early administration in COVID-19 pregnancy was associated with Improved clinical outcomes including higher recovery rate, decreased ICU admissions and progression to critical disease Improved pregnancy outcomes including decreased maternal deaths from COVID-19 and lower rates of preterm delivery	No obstetric indications for preterm delivery or neonatal deaths were noted There is lack of data on lactation, but no adverse effects are expected due to low oral bioavailability	Recommended
Nirmatrelvir/ritonavir	Outpatient treatment in COVID-19 pregnancy resulted in increased recovery According to ACOG and the Society of Maternal Fetal Medicine, the benefits outweigh the risks	It is considered safe No data are available for nirmatrelvir, while limited data suggest the presence of ritonavir in breast milk No information on breastfeeding infants or milk production Lactation should continue with monitoring for infant side effects	Recommended
Molnupiravir	It has shown antiviral activity against SARS-CoV-2 in vitro and in clinical trials Lower efficacy than the other approved antiviral agents No human clinical data in pregnancy	Fetal toxicity has been reported in animal studies Lactating people should not breastfeed until four days after the final dose	Not recommended, unless there are no other options and therapy is clearly indicated
Immunomodulation
Corticosteroids	Dexamethasone decreases mortality in individuals with COVID-19 in need of oxygen supplementation	It has been associated with adverse pregnancy outcomes including congenital malformations, intrauterine growth restriction, gestational diabetes, preterm birth, and preeclampsia Low amount of dexamethasone present in breast milk High doses may temporarily decrease milk production	Recommended (hydrocortisone, methylprednisolone, prednisolone, and prednisone preferred to dexamethasone)
Tocilizumab	Mortality reduction in hospitalized adults with severe or critical COVID-19 Limited human cases in otherwise critical COVID-19 pregnant patients	Transplacental transport is thought to be very low during the first semester and then increase steadily No new congenital malformations were recorded Preterm births and spontaneous abortions in presence of confounders, e.g., critical disease Detectable amounts in breast milk, but no adverse effects are recorded due to low oral bioavailability Live vaccines should be delayed to 6 months of age	Recommended
Baricitinib	Faster recovery when used in combination with remdesivir Reduced mortality when added to corticosteroids No data in human COVID-19 pregnancy	There is no data for human transplacental transport. In line with animal data, it is expected to cross the human placenta and cause teratogenesis or fetal death No human studies available for lactating individuals, but its presence in breastmilk is expected As a JAK inhibitor, it shows an increased thrombotic risk	Recommended
Anakinra	Improved clinical outcomes both in short and long term Limited human data in COVID-19 pregnancy, in combination with other regimens	Supratherapeutic doses on animal studies showed no fetal harm No adverse effects reported when used by breastfeeding women	Insufficient evidence to recommend for or against
Prevention
Vaccination *	Similar immunogenicity to nonpregnant individuals and independent of trimester of vaccination Protected against maternal severe disease and infant hospitalization during the first 6 months of life	Similar rates with nonpregnant population No safety signals among obstetric or neonatal outcomes including rates of pregnancy loss, preterm birth or congenital anomalies	Recommended
Monoclonals (Tixagevimab-cilgavimab)	Until recently, tixagevimab–cilgavimab was used as preexposure prophylaxis for individuals, including pregnant women, with suboptimal response to vaccination due to an immunocompromising condition or who are unable to vaccinate for COVID-19 because of adverse effects There was marked reduction in the in vitro effectiveness against the current omicron variants	The safety is not well defined There was no additional risk of significant adverse maternal or perinatal outcomes Transplacental transport is likely, but no significant fetal cross-reactivity binding was recorded There is lack of data on lactation, but no adverse effects are expected due to low oral bioavailability	Recommended against (due to currently circulating variants)

* Data mainly deriving from mRNA vaccines.