Pregnant women suffer a higher rate of severe viral infections, but are often excluded from clinical trials of antiviral and immunotherapies. The study synthesized evidence from 43 systematic reviews and 27 cohort studies on the safety and efficacy of therapies for infections such as COVID-19, mpox, HSV, VZV, HBV, HCV and HIV. Strong evidence supports the safety of oseltamivir for influenza, acyclovir/valacyclovir for HSV/VZV, tenofovir disoproxil fumarate and lamivudine for HBV, and combination antiretroviral therapy (ART) for HIV. Evidence for nirmatrelvir/ritonavir (Paxlovid) and remdesivir in COVID-19 is limited but encouraging without excess birth defects. There are very limited data for tecovirimat in mpox and ribavirin in hemorrhagic fevers. No antiviral drug has shown consistent teratogenic signals, most of the evidence is of medium to low certainty. Heterogeneity of data and exclusion of pregnant women from studies hampers the evidence, but many therapies have a favorable safety profile.