Limitations include the single integrated health system scope in Southern California, potential misclassification from ICD-10-CM codes, lack of data on reasons for nonprescribing or patient refusals, and the observational design that limits causal conclusions.

Disclosures show funding from Kaiser, with authors connected to industry; the article notes use of editorial tools and that human review was conducted.

Higher NMV/r treatment was associated with underlying medical conditions (two conditions vs none: aPR 1.42, 95% CI 1.16–1.75), whereas oseltamivir did not show a similar association (aPR 1.00, 95% CI 0.85–1.18).

A major gap identified was clinician prescribing practices, with 89.3% of pregnant COVID-19 patients never prescribed NMV/r despite guidelines.

Among those prescribed NMV/r, 62.5% were dispensed versus 78.5% for oseltamivir, indicating patient hesitancy contributes to uptake gaps for both conditions.

Among pregnant women with COVID-19, NMV/r was prescribed to about one in ten (10.7%), with a dispensing record in roughly two-thirds of those cases (6.7%), while for influenza, oseltamivir prescriptions were much higher, with 54.1% prescribed and 43% dispensed.

Clinicians are urged to recognize maternal benefits of NMV/r and to pursue targeted education to improve guideline-concordant prescribing.

The study suggests NMV/r prescribing in pregnancy tends to be restricted to patients with more severe clinical presentations.

The Kaiser Permanente Southern California retrospective cohort study analyzed 9,698 pregnancies with COVID-19 and 1,514 with influenza, covering December 22, 2021, to June 30, 2024, in women aged 18–34/49.

NMV/r treatment rose from 3.5% in 2022 to 19.4% in 2024 but remained well below oseltamivir, which stayed above 40% throughout the period.