Society for Maternal-Fetal Medicine Special Statement: Assessment and management of reported penicillin allergy in pregnancy

Approximately 8% of pregnant people report being allergic to penicillin, yet most of these patients are not truly allergic, either because their allergy has waned or was misdiagnosed in the first place. Penicillin allergy testing can distinguish those who are at risk for reaction to penicillin from those with no or minimal risk. Pregnant patients who report a penicillin allergy may need alternative antibiotics, which are more costly and less effective than first-line antibiotics and are associated with increased maternal risks. Identifying patients who can tolerate penicillin and other β-lactam antibiotics through testing contributes to antibiotic stewardship, improves health outcomes, and saves costs. This Special Statement describes the steps for obstetrical providers to develop a penicillin allergy testing program for pregnant people using a quality improvement framework and multidisciplinary collaboration. It describes in detail how to plan an effective program and provides sample documents that can be modified to support planning, implementation, and evaluation.