A December 2023 COVID-19 outbreak in Southeast Asia prompted an update on Malaysia's existing understanding of COVID-19 and pregnancy. Research suggests that COVID-19 increases the risk of adverse maternal and perinatal outcomes. Pregnant women are more susceptible to COVID-19 due to physiological changes in the coagulation, immune, respiratory, and cardiovascular systems during pregnancy. Evidence indicates that pregnant COVID-19 patients are at an increased risk for severe illness and intensive care unit (ICU) admission. Stillbirth, neonatal death, and preterm labour are some of the most often reported adverse foetal outcomes. Data shows vertical transmission of COVID-19 is possible but rare. Currently, vaccination remains the most effective and safest strategy for protecting risk groups from severe illness, complications, and death. Although Malaysia has no plans to reinstate its movement control order, following a sharp rise in COVID-19 cases across the country, the Ministry of Health Malaysia (MOH) has prepared a five-point strategy as well as updated the COVID-19 Management Guidelines, including the therapeutic management of pregnant patients with COVID-19. The MOH encourages safe public practices and general measures including vaccinations, wearing masks, and maintaining hand hygiene. This review provides important insights into the COVID-19 pregnancy in Malaysia, susceptibility to COVID-19 in pregnancy, maternal and perinatal outcomes in pregnant women with COVID-19, transmission of COVID-19 to a newborn, COVID-19 treatment in pregnancy, COVID-19 vaccination in pregnancy and breastfeeding, and management of unvaccinated pregnant and lactating mothers in Malaysia.