Effectiveness and safety of available treatments for COVID-19 during pregnancy: a critical review

Abstract

Background: COVID-19 is a pandemic disease caused by the SARS-CoV-2 and it spread globally in the last few months. The complete lack of specific treatment forced clinicians to use old drugs, chosen for their efficacy against similar viruses or their in vitro activity. Trials on patients are ongoing but the majority of information comes from small case series and single center reports. We aimed to provide a literature review on the putative effectiveness and safety of available treatments for COVID-19 in pregnant women. Methods: We reviewed all the available literature concerning the drugs that have been used in the treatment of COVID-19 during pregnancy and whose safe assumption during pregnancy had been demonstrated by clinical studies (i.e. including studies on other infectious diseases). Drugs contra-indicated during pregnancy or with unknown adverse effects were not included in our review. Results and conclusions: Clinical trials are not often conducted among pregnant patients for safety reasons and this means that drugs that may be effective in general population cannot be used for pregnant women due to the lack of knowledge of side effects in this category of people .The choice to use a specific drug for COVID-19 in pregnancy should take into account benefits and possible adverse events in each single case. In the current situation of uncertainty and poor knowledge about the management of COVID-19 during pregnancy, this present overview may provide useful information for physicians with practical implications.

SARS-CoV-2 in pregnancy: characteristics and outcomes of hospitalized and non-hospitalized women due to COVID-19

“…Tocilizumab has been proposed to mitigate the hyperinflammatory response related to severe cases. However, the safety profile during pregnancy is still unclear and its use in pregnant patients remains controversial [18]. On the contrary, low molecular weight heparin has demonstrated to be safe during pregnancy and its use with prophylactic purposes is widely recommended due to concerns regarding increased thromboembolic risk in SARS-CoV-2 obstetric patients [19].…”

Pregnancy and Childbirth in the COVID-19 Era—The Course of Disease and Maternal–Fetal Transmission

“…This applies to both chloroquine or hydroxychloroquine combined with or without azithromycin as well as lopinavir/ritonavir and ivermectin. Another drug proposed to use in COVID-19 therapy is interferon (IFN-a/β) [ 98 , 99 ]. Nevertheless, recent WHO studies show that interferon, hydroxychloroquine, and lopinavir do not improve the condition of COVID-19 patients [ 91 ].…”

Recommendations for prenatal, intrapartum, and postpartum care during COVID‐19 pandemic in India

“…2 Its mean incubation period is 5-7 days (range 2-14 days) with period of infectivity starting 2 days before the onset of symptoms and lasts up to 8 days highlighting the transmission potential of asymptomatic and mildly symptomatic patients. 7,8,18,19 Most patients have respiratory tract infection, but some can progress to more severe and systemic disease of acute respiratory distress syndrome (ARDS), sepsis, septic shock, acute kidney injury, cardiac injury, multiorgan failure, thromboembolism, and disseminated intravascular coagulation. 14,20 COVID-19 case can be a confirmed case with laboratory confirmation of SARS-CoV-2, probable case in which the testing for COVID-19 is inconclusive or testing could not be performed and a suspect case with acute respiratory illness (fever with cough or shortness of breath) or history of travel to a place with community transmission of COVID-19 within last 14 days or in a contact with COVID-19 in last 14 days.…”

“…54 Most guidelines also recommend vaginal delivery. 12,[14][15][16][17][18] In their systematic review of ma- However, the current consensus is that vaginal delivery can be conducted safely for COVID-19 pregnancies and the maternal and perinatal outcome is not much adversely affected especially in asymptomatic and mild COVID-19. 12,14-17,54…”

“…In our hospital, after doffing, the staff takes bath with soap before wearing their own clothes. TA B L E 2 Drugs used in management of COVID-19 in pregnancy 8,10,14,18 (with pulse oximeter). 27,28,88,89 Electronic fetal monitoring is recommended during labor.…”