Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review

Abstract

The treatment of COVID-19 is particularly critical in pregnant women, considering the potential teratogenic effects of antiviral agents and the immune-depression related with pregnancy. The aim of this review is to systematically examine the current evidence on the clinical use of convalescent plasma during pregnancy. The electronic databases Medline PubMed Advanced Search Builder, Scopus, Web Of Science and Google Scholar were searched (until 1 January 2021). Inclusion criteria were pregnant women with COVID-19 (or SARS-CoV-2 infection), in whom convalescent plasma (or hyperimmune plasma) was used as treatment. We searched clinical trial registries (censored 5 January 2021) for eligible studies under way. After elimination of duplications, the initial search yielded 79 potentially relevant records, of which 67 were subsequently excluded. The 12 remaining records were case reports involving 12 pregnancies. Six of the mothers were reported to be well, two were reported to have preeclampsia, and in one case each the maternal outcome was described as survival, clinical improvement, discharged with oxygen and rehabilitation. With regard to the neonates, two were declared to be well, four had transient morbidity, two were critically ill and one died; normal ongoing pregnancies, but no post-delivery information, were reported for the remaining three cases. Clinical trials under way or planned to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. This is the first systematic review of the literature regarding the treatment of COVID-19 in pregnancy. The published literature data seem to indicate that convalescent plasma administered to pregnant women with severe COVID-19 provides benefits for both the mother and the fetus. The quality of the available studies is, however, very limited since they are all case reports and thus suffer from relevant reporting bias.

Coronavirus Disease-2019 in Pregnancy

“…However, these studies suffer from relevant reporting bias. 53 Clinical trials to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. More recent evidence showed no benefit, including in pregnant and nonpregnant populations.…”

Use of convalescent plasma in pregnant women with early stage COVID-19 infection in a tertiary care hospital in Dubai, February to March 2021: a case series study

“…Since then, studies in the non-pregnant population have pointed that this route of management may not prove effective because by then organ damage has started through the now understood acute inflammatory response associated with COVID-19 infection [ 20 ]. Consequently, researchers put forward a hypothesis; what if the convalescent plasma was given early in the course of the disease before the onset of the more severe signs and symptoms, to give the body the defense mechanism to fight the virus off [ 8 , 9 , 11 ]. This seemed like a promising idea worth investigating and even more so in pregnant women as plasma components have been shown to be used safely and widely before in pregnancy [ 21 ].…”

“…Convalescent plasma has been used since the 1918 flu epidemic, 2015 SARS epidemic and more recently during the MERS (Middle East Respiratory virus) and the Ebola virus epidemics [5] and is of significant interest in the current COVID-19 pandemic. It seems to be a safe and effective treatment strategy in pregnancy since current antiviral or immunomodulatory therapies as of now lack definite safety profile in pregnancy [5][6][7][8]. This is one of the few studies on the favorable outcome of the early use of convalescent plasma (CCP) in pregnant women with moderate COVID-19.…”

Pharmacological consideration of COVID-19 infection and vaccines in pregnancy

“…The quality of the accessible studies is still low as there are only case reports and therefore agonize from applicable reportage bias. 59…”