Title : Nirmatrelvir-Ritonavir Counseling and Acceptance in Pregnancy
Abstract:
The National Institute of Health recommends Nirmatrelvir-Ritonavir (NIR) treatment for pregnant patients with COVID-19. However, little is known about NIR treatment acceptance rates in pregnant patients and what strategies may increase access and acceptance rates of NIR treatment. In April 2022, an NIR access program was started at our institution to offer standardized counseling and access to NIR treatment for all COVID-19-positive pregnant patients who were eligible for treatment. The access program included a standardized workflow with a high-risk nurse triaging and determining eligibility for NIR treatment in COVID-19 positive pregnant patients and a telehealth visit with a Maternal Fetal Medicine subspecialist that same day to review and offer NIR treatment. We observed a 58.3% acceptance rate for NIR treatment in our cohort (n=36). Patients who accepted NIR treatment had lower gravidity and were more likely to have the symptom of myalgia from their COVID-19 infection than those who did not accept NIR treatment. Patients who accepted NIR treatment also were more likely to be SARS-CoV-2 vaccinated although the difference (81% versus 60%) was not statistically significant (p=0.260). We did not observe any significant differences in neonatal outcomes. NIR access programs should be considered to increase access and acceptance of NIR treatment during pregnancy, and future studies with larger sample sizes should explore maternal and neonatal outcomes with NIR access programs in place.
Audience Take Away:
- Potential for adverse maternal-fetal outcomes with COVID-19 infection
- Importance of COVID-19 vaccination in pregnancy populations and use of paxlovid
- Increased awareness for provider counseling and instructions with Paxlovid use in pregnant populations
- Formation of formal Paxlovid counseling programs to help standardize patient education and access
