COVID-19 Antiviral Medication Use Among Pregnant and Recently Pregnant US Outpatients

Pregnant people are at risk of severe coronavirus disease 2019 (COVID-19) and associated complications. While withholding treatment from pregnant patients is not recommended, little is known about the frequency of antiviral medication use during pregnancy.

Using Medicaid and commercial insurance databases, we constructed a national claims-based cohort study of pregnant, recently pregnant, and nonpregnant female patients 18-49 years old with an outpatient diagnosis of COVID-19 between 21 December 2021 and 30 September 2022. Outpatient treatment with a recommended antiviral medication was identified within 5 days of diagnosis, using national drug codes in outpatient prescription drug claims. Propensity score-matched prevalence ratios (PRs) were used to compare antiviral treatment by pregnancy status.

A total of 412 755 publicly and privately insured patients with COVID-19 were identified, including 33 855 currently pregnant, 2460 recently pregnant, and 376 440 nonpregnant female patients; 6.8% had a record of antiviral medication use, including 1.3% of pregnant, 5.4% of recently pregnant, and 7.3% of nonpregnant women. Most commonly ritonavir-boosted nirmatrelvir was administered. The prevalence of antiviral medication use was 67% lower among pregnant patients compared with nonpregnant patients (PR, 0.33 [95% confidence interval, .30-.36]), even among patients with ≥1 high-risk medical condition (0.29 [.25-.33]). Antiviral medication use was slightly lower among recently pregnant women with ≥1 high-risk medical condition than among nonpregnant women with similar conditions (PR, 0.57; [95% confidence interval, .44-.72]).

Despite US clinical guidelines, we observed low rates of outpatient treatment for COVID-19 among pregnant patients, indicating possible missed opportunities to treat COVID-19 illness during pregnancy and lactation.