Navigating Respiratory Illness among Pregnant Patients during the 2022–23 Influenza Season

The 2022–23 influenza season has started with unprecedented rates of influenza-like illness and hospitalizations. Meanwhile, COVID-19 cases are once again increasing in many parts of the United States. Pregnant and postpartum individuals are at high risk for serious complications of both influenza and COVID-19 infection. Therefore, prompt assessment and treatment when indicated is essential for pregnant and postpartum individuals.

Health care professionals should consider influenza and COVID-19 infection for pregnant individuals who present with symptoms of respiratory illness. Initial triage and treatment by telephone is acceptable to help reduce the spread of disease among other pregnant patients in the office. Following symptom assessment, obstetrician–gynecologists and other obstetric care professionals should ask patients questions to help determine the severity of the illness. Pregnant individuals who cannot maintain oral fluid intake, are experiencing difficulty breathing or pain in the chest, or exhibit any signs of obstetric complications are considered moderate or high risk and should be referred immediately to an emergency department or equivalent setting.

When testing is available, pregnant individuals presenting with symptoms of respiratory illness should be tested for both influenza and COVID-19.

If influenza is suspected, clinicians should initiate empiric treatment with oseltamivir as soon as possible, within 48 hours of symptom onset. Treatment should not be delayed while awaiting test results, and vaccination status should not affect the decision to treat. If a pregnant patient tests positive for COVID-19, obstetric care professionals should prescribe Paxlovid (nirmatrelvir and ritonavir). If there is suspected or confirmed coinfection with influenza and COVID-19, both oseltamivir and Paxlovid can be prescribed. There are no clinically significant drug-drug interactions between the antiviral agents or immunomodulators that are used to prevent or treat COVID-19 and the antiviral agents that are used to treat influenza.

Vaccination against seasonal influenza and COVID-19, including boosters, remains the best way to prevent serious illness and adverse outcomes in pregnant patients. ACOG urges all clinicians to strongly recommend vaccination to all pregnant patients and promptly recognize and treat influenza and COVID-19 infections.

For more information about influenza assessment and treatment, see ACOG Committee Opinion 753, “Assessment and Treatment of Pregnant Women With Suspected or Confirmed Influenza.” For more information about COVID-19 assessment and treatment, see ACOG’s COVID-19 FAQs for obstetrics.