What is the recommended treatment for Covid-19 in pregnant women?

COVID-19 Treatment in Pregnancy

Pregnant women with COVID-19 should receive the same evidence-based treatments as non-pregnant patients—including corticosteroids (non-fluorinated), antivirals, monoclonal antibodies, IL-6 inhibitors, and thromboprophylaxis with low molecular weight heparin—while maintaining essential antenatal care and avoiding unfounded concerns about fetal risk. 1, 2

Core Treatment Principles

Antiviral and Immunomodulatory Therapy

• Use non-fluorinated glucocorticoids (such as prednisone, prednisolone, or hydrocortisone) instead of fluorinated steroids (dexamethasone, betamethasone) for COVID-19 treatment during pregnancy to minimize fetal exposure 2
• IL-6 inhibitors and monoclonal antibodies are not contraindicated and should be considered when clinically indicated for severe disease 2
• Specific antiviral therapies may be considered following the same criteria as non-pregnant patients 2

Thromboprophylaxis (Critical Component)

All hospitalized pregnant women with COVID-19 require weight-adjusted low molecular weight heparin (LMWH) for VTE prophylaxis unless active bleeding is present 3

• Pregnancy already increases VTE risk 4-6 fold, and COVID-19 further exacerbates this hypercoagulable state 3
• For outpatient management, consider thromboprophylaxis if risk factors present: immobility, high fever, dehydration, or additional maternal VTE risk factors 3
• Duration should be based on disease severity, D-dimer levels, and trimester 3
• Monitor coagulation parameters using pregnancy-adjusted thresholds: PT and APTT ratios ≥1.5 indicate coagulopathy 1

Respiratory Support (No Pregnancy Restrictions)

Pregnancy is NOT a contraindication for any respiratory support modality—use the same criteria as the general population 2

• Oxygen supplementation 2
• Non-invasive ventilation 2
• Prone positioning (can be done safely in pregnancy with proper abdominal support to avoid compression) 2, 4
• Intubation and mechanical ventilation 2
• Extracorporeal membrane oxygenation (ECMO) 2

Antenatal Care Modifications

Monitoring and Surveillance

• Continue routine antenatal care with infection control precautions; only defer if patient requires self-isolation 1
• Continuous electronic fetal monitoring during labor for all suspected or confirmed COVID-19 cases 1
• Fetal growth surveillance via ultrasound 14 days after symptom resolution for confirmed cases 1
• Screen for differential diagnoses: pulmonary embolism and sepsis (both more common in pregnancy with COVID-19) 1

Infection Control Measures

• After 28 weeks gestation, enforce stricter social distancing due to increased vulnerability 1
• Healthcare providers must wear appropriate PPE, which may cause delays in emergencies 1
• Mental health assessment at every consultation with appropriate referrals 1

Intrapartum Management

Delivery Decisions

Delivery should be a bridge to recovery only when medically indicated—not a solution for COVID-19 recovery itself 4

• Timing, place, and mode of delivery require multidisciplinary team input: obstetricians, physicians, anesthetists, and intensivists experienced in COVID-19 pregnancy care 2
• No specific mode of delivery is recommended based on COVID-19 status alone 1
• Avoid birthing pools for suspected or confirmed COVID-19 1
• Nitrous oxide (Entonox) can be used with single-patient microbiological filter 1

Emergency Protocols

• In maternal cardiac arrest: high-quality CPR with lateral uterine displacement 1
• Consider perimortem cesarean delivery within 5 minutes if indicated 1

Postpartum Care

Mother-Infant Interaction

Do NOT separate COVID-19 positive mothers from healthy newborns 1

• Breastfeeding is encouraged—benefits outweigh infection transmission risks 1
• This represents a shift from early pandemic recommendations and is now strongly supported 1

Critical Pitfalls to Avoid

• Never deny investigations or treatments due to unfounded fetal concerns—pregnant women are at greater risk of severe COVID-19 than non-pregnant peers and deserve full treatment 2
• Do not use fluorinated corticosteroids (dexamethasone/betamethasone) for COVID-19 treatment—reserve these for fetal lung maturity only 2
• Do not withhold thromboprophylaxis—COVID-19 dramatically increases already elevated pregnancy VTE risk (adjusted OR 1.57 for preeclampsia/eclampsia) 3
• Do not delay prone positioning in severe hypoxemia due to pregnancy—it can be done safely with proper support 2, 4