Selected References:
- American College of Obstetricians and Gynecologists (ACOG). 2026. COVID-19 FAQs for obstetrician-gynecologists, obstetrics. https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics. Accessed June 2026
- Anderson PO. 2022. COVID-19 drugs and breastfeeding update. Breastfeed Med; 17:377–9.
- Chourasia P, et al. 2023. Paxlovid (nirmatrelvir and ritonavir) use in pregnant and lactating woman: Current evidence and practice guidelines-a scoping review. Vaccines (Basel); 11:107.
- Chuang MT, et al. 2024. Transplacental passage of nirmatrelvir in pregnant women with COVID-19. Int J Gynaecol Obstet; 164(1):351-353.
- Corbett AH, al. 2014. Antiretroviral pharmacokinetics in mothers and breastfeeding infants from 6 to 24 weeks post-partum: Results of the BAN Study. Antivir Ther; 19:587–595.
- Dai J, et al. 2024. Low Nirmatrelvir and Ritonavir Exposure through Breastmilk: Analyzing Milk Concentrations and Infant Risk. Clin Pharmacol Ther; 116(5):1217-1221.
- Gandhi M, et al. 2013. Hair and plasma data show that lopinavir, ritonavir, and efavirenz all transfer from mother to infant in utero, but only efavirenz transfers via breastfeeding. J Acquir Immune Defic Syndr; 63:578-584.
- Garneau WM, et al. 2022. Analysis of clinical outcomes of pregnant patients treated with nirmatrelvir and ritonavir for acute SARS-CoV-2 infection. JAMA Netw Open; 5(11):e2244141.
- Lin CY, et al. 2023. Nirmatrelvir-ritonavir (Paxlovid) for mild coronavirus disease 2019 (COVID-19) in pregnancy and lactation. Obstet Gynecol; 141:957–60.
- Lin CW, et al. 2023. Clinical outcomes of nirmatrelvir-ritonavir use in pregnant women during the Omicron wave of the coronavirus disease 2019 pandemic. J Infect Public Health; 16(12):1942-1946.
- Loza A, et al. 2022. Short-term pregnancy outcomes after nirmatrelvir-ritonavir treatment for mild-to-moderate coronavirus disease 2019 (COVID-19). Obstet Gynecol; 140(3):447-449.
- Palombi L, et al. 2012. Antiretroviral prophylaxis for breastfeeding transmission in Malawi: drug concentrations, virological efficacy and safety. Antivir Ther; 17:1511–1519.
- Pfizer Laboratories Div Pfizer Inc. Last updated October 18, 2023. Paxlovid drug label. Source: National Library of Medicine. Available at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8a99d6d6-fd9e-45bb-b1bf-48c7f761232a. Accessed June 2026.
- Ramírez-Ramírez A, et al. 2018. Simultaneous quantification of four antiretroviral drugs in breast milk samples from HIV-positive women by an ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method. PLoS One; 13:e0191236.
- Rezk NL, et al. 2008. Studies on antiretroviral drug concentrations in breast milk: Validation of a liquid chromatography-tandem mass spectrometric method for the determination of 7 anti-human immunodeficiency virus medications. Ther Drug Monit; 30:611–9.
- Yang H, et al. 2025. Birth Outcomes Following Anti-viral Therapy for Treatment of COVID-19 During Pregnancy. Matern Child Health J; 29(5):599-603.
