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Jorgensen SCJ, Tabbara N, Burry L. A review of COVID-19 therapeutics in pregnancy and lactation. Obstet Med 2022; 15:225-232. [PMID: 36514791 PMCID: PMC9732495 DOI: 10.1177/1753495x211056211] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 12/16/2022] Open
Abstract
Pregnant people have an elevated risk of severe COVID-19-related complications compared to their non-pregnant counterparts, underscoring the need for safe and effective therapies. In this review, we summarize published data on COVID-19 therapeutics in pregnancy and lactation to help inform clinical decision-making about their use in this population. Although no serious safety signals have been raised for many agents, data clearly have serious limitations and there are many important knowledge gaps about the safety and efficacy of key therapeutics used for COVID-19. Moving forward, diligent follow-up and documentation of outcomes in pregnant people treated with these agents will be essential to advance our understanding. Greater regulatory push and incentives are needed to ensure studies to obtain pregnancy data are expedited.
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Affiliation(s)
- Sarah CJ Jorgensen
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
- Sarah CJ Jorgensen, 1 Kings College Circle,
Toronto, ON, Canada, M5S 1A8.
| | - Najla Tabbara
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lisa Burry
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada
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2
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Pregnancy and COVID-19. J Clin Med 2022; 11:jcm11226645. [PMID: 36431122 PMCID: PMC9695358 DOI: 10.3390/jcm11226645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/30/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Evidence indicates that SARS-CoV-2 infection increases the likelihood of adverse pregnancy outcomes. Modifications in the circulatory, pulmonary, hormonal, and immunological pathways induced by pregnancy render pregnant women as a high-risk group. A growing body of research shows that SARS-CoV-2 infection during pregnancy is connected to a number of maternal complications, including pneumonia and intensive care unit (ICU) hospitalization. Miscarriages, stillbirth, preterm labor, as well as pre-eclampsia and intrauterine growth restriction are also among the most often documented fetal implications, particularly among expecting women who have significant COVID-19 symptoms, often affecting the timing and route of delivery. Thus, prevention of infection and pharmacological treatment options should aim to minimize the aforementioned risks and ameliorate maternal, obstetric and fetal/neonatal outcomes.
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3
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Marzban-Rad S, Ghafarzadeh M, Bahmani S, Kazemi A. The use of remdesivir among pregnant women and associated clinical outcomes in mother and the child. Ann Med Surg (Lond) 2022; 77:103681. [PMID: 35506126 PMCID: PMC9047404 DOI: 10.1016/j.amsu.2022.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
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4
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Gutierrez R, Mendez-Figueroa H, Biebighauser JG, Bhalwal A, Pineles BL, Chauhan SP. Remdesivir use in pregnancy during the SARS-CoV-2 pandemic. J Matern Fetal Neonatal Med 2022; 35:9445-9451. [PMID: 35168447 DOI: 10.1080/14767058.2022.2041595] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To ascertain the composite maternal and neonatal outcomes in pregnant individuals with moderate, severe, or critical coronavirus disease 2019 (COVID-19) treated with remdesivir. MATERIALS AND METHODS This is a secondary analysis of the COVID in Pregnancy Registry in Houston, Texas. Women were included if they met the criteria of moderate, severe or critical COVID-19 illness. Composite adverse maternal outcome was defined as any of the following outcomes: placental abruption, pregnancy-related hypertension, chorioamnionitis, stroke, delivery with estimated blood loss >1000 mL, diagnosis of pulmonary embolism or deep venous thromboembolism, or maternal death. Composite adverse neonatal outcome was defined as any of the following: Apgar score ≤3 at 5 min, arterial cord pH <7.0, positive SAR-CoV-2 test, intraventricular hemorrhage, periventricular leukomalacia, stillbirth, or neonatal death. Comparative analyses between participants receiving remdesivir versus those not exposed were performed. RESULTS A total of 994 patients were diagnosed with COVID-19 infection. Of these, 95 (9.6%) met criteria for moderate, severe, or critical disease. Forty-one percent of these patients (n = 39) received remdesivir. Baseline demographic characteristics were not different between groups. No patients reported an allergic reaction with the administration of remdesivir; however, 16.7% of the patients had the medication discontinued due to transaminitis. Patients receiving the drug were more likely to have a longer illness duration on admission, more likely to require oxygen support on arrival and have a longer hospital stay. CONCLUSIONS Remdesivir appears to be safe, well tolerated within our cohort with no cases of recorded adverse reaction.
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Affiliation(s)
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - John G Biebighauser
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Asha Bhalwal
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Beth L Pineles
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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5
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Jermy BR, Ravinayagam V, Almohazey D, Alamoudi WA, Dafalla H, Akhtar S, Tanimu G. PEGylated green halloysite/spinel ferrite nanocomposites for pH sensitive delivery of dexamethasone: A potential pulmonary drug delivery treatment option for COVID-19. APPLIED CLAY SCIENCE 2022; 216:106333. [PMID: 34776567 PMCID: PMC8576101 DOI: 10.1016/j.clay.2021.106333] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 05/07/2023]
Abstract
Dexamethasone (Dex) is used in drug regimen for treatment of Coronavirus disease (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fusion and entry into the cell occurs at pH 5.5. In our present study, we have identified a green, cheap clay based halloysite (Hal) nanoformulation with release capability of Dex at such interactive pH condition. 30%ZnFe2O4/Hal and 30%NiFe2O4/Hal were prepared by one-pot synthesis technique. Dex (5% wt/wt) was functionalized over both nanocomposites. Finally, polyethylene glycol (PEG) was coated over ZnFe2O4/Hal/Dex and NiFe2O4/Hal/Dex nanocomposite using lyophilization technique (0.08 μl/mg of nanocarrier). The release ability of Dex was studied under pulmonary infection and normal pH conditions (pH = 5.6 and 7.4). The characterization study using X-ray diffraction (XRD) and UV-visible diffuse reflectance (DRS) spectra confirmed the presence of spinel ferrites over Hal. Nitrogen adsorption isotherm showed the surface area of ZnFe2O4/Hal (75 m2/g), pore volume (0.27 cm3/g) with average pore size (14.5 nm). Scanning electron microscope/Energy dispersive spectroscopy (SEM-EDS) and Transmission electron microscopy analysis revealed a textural change in halloysite tubular type indicating drug adsorption and PEG adhesion. DRS spectra indicated an intergrowth of zinc ferrite nanoparticles on the halloysite nanotubes. Interestingly, ZnFe2O4/Hal/Dex/PEG exhibited a high Dex release ability (17.5%, 168 h) at pH = 5.6 relevant to SARS-CoV-2 fusion entry into the cell pH condition of 5.5. Comparatively, the nanocomposite showed a less Dex release (<5%) release for 168 h at neutral pH = 7.4. The drug release kinetics were studied and the obtained data were fitted for the release constant and release exponent, using the Korsmeyer-Peppas model. To test the compatibility of our nanocomposites, we performed the cell viability assay (MTT) using HEK293 cells. Our results showed that at 0.3 mg/ml, Dex-loaded nanocomposite had a statistically significant improvement in cell viability compared to Dex alone. These results suggest that our nanocomposite has prevented the toxic effect of Dex and has huge potential to act as pulmonary drug delivery system for targeted lung infection therapeutics.
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Affiliation(s)
- B Rabindran Jermy
- Department of Nano-Medicine Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 31441 Dammam, Saudi Arabia
| | - Vijaya Ravinayagam
- Deanship of Scientific Research & Department of Nano-Medicine Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 31441 Dammam, Saudi Arabia
| | - D Almohazey
- Department of Stem Cell Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 3144 Dammam, Saudi Arabia
| | - W A Alamoudi
- Department of Stem Cell Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 3144 Dammam, Saudi Arabia
| | - H Dafalla
- College of Engineering Research (CER), King Fahd University of Petroleum and Minerals, 31261 Dhahran, Saudi Arabia
| | - Sultan Akhtar
- Department of Biophysics Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 31441 Dammam, Saudi Arabia
| | - Gazali Tanimu
- Center for Refining and Advanced Chemicals, Research Institute, King Fahd University of Petroleum and Minerals, 31261 Dhahran, Saudi Arabia
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Budi DS, Pratama NR, Wafa IA, Putra M, Wardhana MP, Wungu CDK. Remdesivir for pregnancy: A systematic review of antiviral therapy for COVID-19. Heliyon 2022; 8:e08835. [PMID: 35128114 PMCID: PMC8802673 DOI: 10.1016/j.heliyon.2022.e08835] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/26/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The use of remdesivir for pregnant patients with coronavirus disease 2019 (COVID-19) showed conflicting results in prior studies. We aimed to systematically review its efficacy and safety for this population from the existing literature. METHODS On July 26, 2021, registries (ClinicalTrials.gov) and databases (MEDLINE, ScienceDirect, Cochrane Library, JSTOR, DOAJ, and medRxiv) were systematically searched for research articles investigating remdesivir use in pregnant people with COVID-19. Clinical outcome, hospitalization duration, laboratory outcome, mortality, and adverse events were investigated. RESULTS We obtained 13 observation studies with 113 pregnant people. In these studies, remdesivir improved the clinical condition of pregnant patients with COVID-19, especially those who had a better clinical status at baseline and received earlier remdesivir treatment. Most fetuses were delivered via cesarean section, primarily because of emergency causes. No vertical transmissions were noted. The most reported adverse event was transaminitis, in which 10-day remdesivir treatment yielded more incidence than the 5-day treatment. CONCLUSIONS In pregnancy, the use of Remdesivir in combination with other COVID-19 treatments is inconclusive but its use should be followed with careful monitoring of adverse reactions and transaminase enzyme levels. Further studies are required to confirm its finding.
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Affiliation(s)
| | | | - Ifan Ali Wafa
- Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Manesha Putra
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz School of Medicine, Aurora, United States
| | - Manggala Pasca Wardhana
- Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Indonesia
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7
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Jorgensen SCJ, Davis MR, Lapinsky SE. A review of remdesivir for COVID-19 in pregnancy and lactation. J Antimicrob Chemother 2021; 77:24-30. [PMID: 34427297 PMCID: PMC8499800 DOI: 10.1093/jac/dkab311] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mounting evidence suggests that pregnant people have an elevated risk of severe COVID-19-related complications compared with their non-pregnant counterparts, underscoring the need for effective prevention and treatment strategies. However, despite progress in innovative and flexible trial designs during the COVID-19 pandemic, regressive policies excluding pregnant and breastfeeding people from biomedical research persist. Remdesivir, a broad-spectrum antiviral, was the first drug licensed for the treatment of COVID-19, based on data showing it reduced the time to recovery in hospitalized patients. Pregnant and breastfeeding people were specifically excluded from all clinical trials of remdesivir in COVID-19, but data are accumulating from post-marketing registries, compassionate use programmes and case series/reports. In this review we synthesize these data and highlight key knowledge gaps to help inform clinical decision-making about its use in pregnancy and lactation.
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Affiliation(s)
| | - Matthew R Davis
- Department of Pharmacy, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, CA, USA
| | - Stephen E Lapinsky
- Division of Respirology, Mount Sinai Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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8
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Ward T, Johnsen A. Understanding an evolving pandemic: An analysis of the clinical time delay distributions of COVID-19 in the United Kingdom. PLoS One 2021; 16:e0257978. [PMID: 34669712 PMCID: PMC8528322 DOI: 10.1371/journal.pone.0257978] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
Understanding and monitoring the epidemiological time delay dynamics of SARS-CoV-2 infection provides insights that are key to discerning changes in the phenotype of the virus, the demographics impacted, the efficacy of treatment, and the ability of the health service to manage large volumes of patients. This paper analyses how the pandemic has evolved in the United Kingdom through the temporal changes to the epidemiological time delay distributions for clinical outcomes. Using the most complete clinical data presently available, we have analysed, through a doubly interval censored Bayesian modelling approach, the time from infection to a clinical outcome. Across the pandemic, for the periods that were defined as epidemiologically distinct, the modelled mean ranges from 8.0 to 9.7 days for infection to hospitalisation, 10.3 to 15.0 days for hospitalisation to death, and 17.4 to 24.7 days for infection to death. The time delay from infection to hospitalisation has increased since the first wave of the pandemic. A marked decrease was observed in the time from hospitalisation to death and infection to death at times of high incidence when hospitals and ICUs were under the most pressure. There is a clear relationship between age groups that is indicative of the youngest and oldest demographics having the shortest time delay distributions before a clinical outcome. A statistically significant difference was found between genders for the time delay from infection to hospitalisation, which was not found for hospitalisation to death. The results by age group indicate that younger demographics that require clinical intervention for SARS-CoV-2 infection are more likely to require earlier hospitalisation that leads to a shorter time to death, which is suggestive of the largely more vulnerable nature of these individuals that succumb to infection. The distinction found between genders for exposure to hospitalisation is revealing of gender healthcare seeking behaviours.
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Affiliation(s)
- Thomas Ward
- Public Health England, London, United Kingdom
- Joint Biosecurity Centre, London, United Kingdom
- * E-mail:
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9
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Khan A, Patrick A, Patil V, Nnochiri A, Wijayatilake S. The obstetric patient in the Covid pandemic: anaesthesia and perioperative care. Curr Opin Obstet Gynecol 2021; 33:361-369. [PMID: 34402480 DOI: 10.1097/gco.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW : The Coronavirus Disease 2019 (COVID-19) pandemic has had an unprecedented impact on pregnant women, maternity services and healthcare workers. We review recent literature on the course of COVID-19 infection in pregnancy, and recommendations for treatment and service provision. RECENT FINDINGS It has been increasingly recognised that pregnant women are at higher risk of severe disease associated with COVID-19 infection. Early critical care input is crucial to guide respiratory support and techniques such as prone positioning, with a low threshold for intubation in critical illness. Timing of delivery remains a highly individualised decision. Following the RECOVERY trial, the use of a course of steroids in cases of severe COVID-19 infection has been widely adopted, and emerging guidance recommends vaccination in pregnant women. SUMMARY Rapidly emerging evidence has helped guide clinicians to identify those patients most at risk of severe disease in COVID-19 and implement early interventions to reduce morbidity and mortality.
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Affiliation(s)
- Ayub Khan
- Department of Anaesthetics and Intensive Care, Queen's Hospital
| | - Adam Patrick
- Department of Anaesthetics and Intensive Care, Queen's Hospital
| | - Vinod Patil
- Department of Anaesthetics and Intensive Care, Queen's Hospital
| | - Akobundu Nnochiri
- Department of Obstetrics and Gynaecology, Havering and Redbridge University Hospitals NHS Trust, Barking, UK
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Yamamoto K, Hagiya H, Maki J, Okahara S, Hasegawa K, Otsuka F. High-Dose Corticosteroids for a Pregnant Woman Critically Ill With Coronavirus Disease 2019. Cureus 2021; 13:e17398. [PMID: 34584807 PMCID: PMC8457894 DOI: 10.7759/cureus.17398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Pregnancy was reported to be a risk factor for coronavirus disease 2019 (COVID-19), with an increased risk for premature birth. Corticosteroids and remdesivir are used for patients with COVID-19; however, there is no established treatment for these patients. In particular, the effective management of pregnant, critically ill patients with COVID-19 remains unknown. We describe a 34-year-old, critically ill woman at 30 weeks of gestation with COVID-19, who was successfully treated with remdesivir and combined high-dose betamethasone (12 mg/day for two days) and methylprednisolone (125 mg/day for three days) followed by steroid tapering. During treatment, fetal biophysical profile scores on obstetric ultrasound were normal; her pregnancy course progressed well. Since high-dose corticosteroids improve fetal lung maturation and as well as cytokine storm due to COVID-19, this case provides an insight into the management of pregnant COVID-19 patients.
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Affiliation(s)
- Koichiro Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Shuji Okahara
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
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11
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Agbontaen KO, Somasundram K, Baker M. Critical COVID-19 in a 24-week pregnant woman with 32 days of invasive mechanical ventilation before delivery of fetus: a case of successful collaborative multidisciplinary care. BMJ Case Rep 2021; 14:14/9/e243516. [PMID: 34497055 PMCID: PMC8438726 DOI: 10.1136/bcr-2021-243516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.
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Affiliation(s)
| | - Khevan Somasundram
- Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Matthew Baker
- Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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12
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Franchini M, Prefumo F, Grisolia G, Bergamini V, Glingani C, Pisello M, Presti F, Zaffanello M. Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review. Viruses 2021; 13:1194. [PMID: 34206468 PMCID: PMC8310344 DOI: 10.3390/v13071194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022] Open
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.
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, I-46100 Mantova, Italy; (M.F.); (C.G.)
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, I-25123 Brescia, Italy;
| | - Gianpaolo Grisolia
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, I-46100 Mantova, Italy; (G.G.); (M.P.)
| | - Valentino Bergamini
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, I-37126 Verona, Italy; (V.B.); (F.P.)
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, I-46100 Mantova, Italy; (M.F.); (C.G.)
| | - Marlene Pisello
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, I-46100 Mantova, Italy; (G.G.); (M.P.)
| | - Francesca Presti
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, I-37126 Verona, Italy; (V.B.); (F.P.)
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, I-37126 Verona, Italy
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13
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Mastroianni A, Greco S, Mauro MV, Chidichimo L, Vangeli V. Convalescent plasma transfusion for pregnant patients with COVID-19. LANCET MICROBE 2021; 2:e350. [PMID: 34100001 PMCID: PMC8172147 DOI: 10.1016/s2666-5247(21)00130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Mastroianni
- Infectious & Tropical Diseases Unit, Annunziata Hub Hospital, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - Sonia Greco
- Infectious & Tropical Diseases Unit, Annunziata Hub Hospital, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - Maria Vittoria Mauro
- Microbiology & Virology Unit, Annunziata Hub Hospital, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - Luciana Chidichimo
- Infectious & Tropical Diseases Unit, Annunziata Hub Hospital, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - Valeria Vangeli
- Infectious & Tropical Diseases Unit, Annunziata Hub Hospital, Azienda Ospedaliera di Cosenza, Cosenza, Italy
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14
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Lampejo T. Remdesivir for the treatment of COVID-19 in pregnancy. J Med Virol 2021; 93:4114-4119. [PMID: 33788273 PMCID: PMC8250519 DOI: 10.1002/jmv.26986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Temi Lampejo
- Department of Infection, Imperial College Healthcare NHS Trust, London, UK
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15
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Langarizadeh MA, Ranjbar Tavakoli M, Abiri A, Ghasempour A, Rezaei M, Ameri A. A review on function and side effects of systemic corticosteroids used in high-grade COVID-19 to prevent cytokine storms. EXCLI JOURNAL 2021; 20:339-365. [PMID: 33746666 PMCID: PMC7975631 DOI: 10.17179/excli2020-3196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
In December 2019, a cluster of pneumonia caused by a novel coronavirus (2019-nCoV), officially known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, Hubei province, China. Cytokine storm is an uncontrolled systemic inflammatory response resulting from the release of large amounts of pro-inflammatory cytokines and chemokines that occurs at phase 3 of viral infection. Such emergence led to the development of many clinical trials to discover efficient drugs and therapeutic protocols to fight with this single-stranded RNA virus. Corticosteroids suppress inflammation of the lungs during the cytokine storm, weaken immune responses, and inhibit the elimination of pathogen. For this reason, in COVID-19 corticosteroid therapy, systemic inhibition of inflammation is observed with a wide range of side effects. The present review discusses the effectiveness of the corticosteroid application in COVID-19 infection and the related side effects of these agents. In summary, a number of corticosteroids, including and especially methylprednisolone and dexamethasone, have demonstrated remarkable efficacy, particularly for COVID-19 patients who underwent mechanical ventilation.
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Affiliation(s)
- Mohammad Amin Langarizadeh
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ardavan Abiri
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ghasempour
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Rezaei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Alieh Ameri
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
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16
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Dexamethasone. REACTIONS WEEKLY 2021. [PMCID: PMC7818682 DOI: 10.1007/s40278-021-89502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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