COVID-19 Treatment: Drug Safety Prior to Conception and During Pregnancy and Breastfeeding

COVID-19 in pregnancy: prevalence, management, and outcomes in a single large health system

OBJECTIVE

This study assessed the prevalence of SARS-CoV-2 positivity in a cohort of pregnant patients served by a single health system. Treatments and outcomes are compared by maternal SARS-CoV-2 status and COVID-19 symptomatology.

METHODS

This was a retrospective cohort study of patients with delivery outcomes from March 2020-December 2021. SARS-CoV-2 positivity was defined by patients who had a positive test or COVID-19 diagnosis during pregnancy. Descriptive analysis compared demographics, medical management during pregnancy, and both perinatal and non-obstetric outcomes by SARS-CoV-2/COVID-19 status (negative, positive-asymptomatic, and positive-symptomatic).

RESULTS

Of 24,310 pregnancies, 94.6% were negative, 3.9% were positive-asymptomatic, and 1.5% were positive-symptomatic. Non-delivery hospitalizations were highest among positive-symptomatic patients (16.8%), followed by positive-asymptomatic patients (3.9%) and lastly negative patients (2.7%) (p < 0.001). Likewise, Intensive Care Unit (ICU) admissions during an antepartum or delivery admission were higher for positive-symptomatic patients (13.0%) compared to positive-asymptomatic patients or negative patients (0.7% and 0.5%, respectively, p < 0.001). The rate of preterm birth was significantly higher in positive-symptomatic patients compared to positive-asymptomatic and negative patients (15.7% vs. 9.5% and 9.8%, respectively, p = 0.002). There were no statistically significant differences in rates of miscarriage or intrauterine fetal demise. Maternal readmission, administration of corticosteroids for fetal lung maturity, birthweight, and neonatal intensive care unit (NICU) admission were significantly affected by SARS-CoV-2 status.

CONCLUSION

Pregnant patients testing positive for SARS-CoV-2 were mostly asymptomatic and identified during routine screening. Symptomatic patients were significantly more likely to require hospitalization and ICU admission with some increase in adverse perinatal outcomes.

COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies

The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.

Pharmacological consideration of COVID-19 infection and vaccines in pregnancy

COVID-19 is a pandemic of the 21st century that recorded 234 809 103 confirmed cases and more than 4 800 375 deaths. Many studies report the effect of COVID-19 in the overall population; nevertheless, there is information scarceness related to pharmacological management and pregnancy and fetal outcomes during the epidemic. Pregnancy is a state of change in immune physiology and anatomy modulation in preference to immune suppression. Additionally, manifold interactions with the health care system during pregnancy increases the chance of infection, and managing, pregnant population poses a more significant challenge. This review will summarize the available data on pharmacological considerations and vaccines in pregnancy and their adverse effects on fetal outcomes. Several drug choices include but are not limited to antivirals and antimalarial and combinations, corticosteroids, nonsteroidal anti-inflammatory drugs, and antipyretics. Approved vaccines for pregnancy include Pfizer/BioNTech and mRNA-1273 Moderna/National Institutes of Health. COVID-19 treatment approaches vary across different countries; the WHO and the Centers for Disease Control and Prevention guidelines and country regulators advise managing adverse effects on pregnancy and fetal outcome. But the efficacy of these drugs is questionable. There is no adequate literature to demonstrate the safety of these drugs in pregnant and lactating women. Hence, well-conducted studies that assess the safety of anti-COVID-19 medications and vaccines in pregnancy and lactating women are needed.

Impact of the COVID-19 Pandemic on Delivery of Gynecology and Obstetrics Services at a Maximum Care University Hospital in Germany

Einleitung Die COVID-19-Pandemie bedeutet einschneidende Maßnahmen für das nationale Gesundheitssystem. Dies bot den Anlass, die klinischen und ökonomischen Leistungsindikatoren der gynäkologischen und geburtshilflichen Versorgung des Universitätsklinikums Marburg als regionaler universitärer Maximalversorger zu analysieren. Hierzu wurden die Auswirkungen auf die monatlichen stationären und ambulanten Fallzahlvolumina sowie die entsprechenden ICD- und DRG-Kodierungen ausgewertet, um etwaige Versorgungsdefizite aufzudecken.

Material und Methoden Die Studie basiert auf einer retrospektiven Datenanalyse therapierter stationären und ambulanten Fälle der Jahre 2016 bis 2020. Hierzu wurden über das klinikinterne Leistungscontrolling-Programm QlikView die Daten von 9487 Fällen der Klinik für Gynäkologie und 19597 Fällen der Klinik für Geburtshilfe ausgewertet.

Ergebnisse Es bildet sich eine der nationalen Pandemiedynamik folgende Abnahme der gynäkologischen stationären Fallzahlen um –6% ab, während das geburtshilfliche Fallzahlvolumen um +11% im Jahr 2020 steigt. Insgesamt fallen die Effekte für die ambulante Versorgung geringer aus. Zudem lässt sich eine standortbezogene Abnahme der C50 „Bösartige Neubildungen der Brustdrüse“ und C56 „Bösartige Ovarialtumoren“ Diagnosen um –7,4% bzw. –14% feststellen. Eine Rückkehr zu dem Leistungsniveau des Vorjahres konnte im ambulanten in 3 und im stationären Sektor in 5 Monaten erreicht werden.

Schlussfolgerung Die negativen Auswirkungen der COVID-19-Pandemie treffen vorwiegend die Klinik für Gynäkologie. Durch das Vertrauen in die Sicherheit der universitären Versorgung und das Serviceangebot, werdende Väter nach Schnelltestung am Geburtsprozess teilhaben zu lassen, konnte eine Fallzunahme in der Geburtshilfe erreicht werden. Die Rückkehr zu präpandemischen Leistungsniveaus gestaltet sich weiterhin schleppend, während sich der ohnehin weniger betroffene ambulante Sektor zügiger erholt. Der standortbezogene Rückgang der Diagnosen C50 und C56 ist besorgniserregend und bedarf epidemiologischer Aufarbeitung. Die fallzahlbezogenen Auswirkungen der Pandemie bilden sich gleichsam in den ökonomischen Leistungskennzahlen ab.

The Association of Serum Electrolytes with Disease Severity and Obstetric Complications in Pregnant Women with COVID-19: a Prospective Cohort Study from a Tertiary Reference Center

Introduction To evaluate the association of serum electrolytes with disease severity and obstetric complications in pregnant women with Coronavirus disease 2019 (COVID-19).

Materials and Methods This prospective cohort study was conducted on pregnant women with confirmed COVID-19. Study population was divided into two groups: 1) Mild COVID-19 group (n = 811) and 2) Moderate/severe COVID-19 group (n = 52). Demographic features, clinical characteristics, obstetric complications, and serum electrolytes were compared between the groups. Afterward, a correlation analysis was performed to investigate the association between serum electrolyte disturbances with COVID-19 severity and obstetric complications.

Results Highest serum sodium, hypernatremia, potassium replacement, hypopotassemia, hyperchloremia, initial serum magnesium, hypermagnesemia, and hypocalcemia were significantly higher in the moderate/severe COVID-19 group. The lowest serum sodium, lowest serum potassium, and initial serum calcium were significantly higher in the mild COVID-19 group (p < 0.05). Statistically significant positive weak correlations were found between hypernatremia, hypopotassemia, hyperchloremia, hypermagnesemia, hypocalcemia and COVID-19 severity (r values were 0.27, 0.20, 0.12, 0.18 and 0.12, p values were < 0.001, < 0.001, 0.02, 0.03 and 0.03, respectively). Furthermore, statistically significant positive weak correlations were found between hypopotassemia, hypochloremia, hypermagnesemia, and obstetric complications (r values were 0.10, 0.10, and 0.28, p values were 0.004, 0.03, and 0.001, respectively). A statistically significant negative weak correlation was found between hypomagnesemia and obstetric complications (r = − 0.23 and p = 0.01, respectively).

Conclusion Electrolyte disturbances in pregnant women with COVID-19 seem to be associated with disease severity and obstetric complications.

Strategies for the Emergency Treatment of Pregnant Women with Neurological Symptoms during the COVID-19 Pandemic

Coronavirus disease-19 (COVID-19) has been spreading all over the world for more than two years. Though several kinds of vaccines are currently available, emergence of new variants, spike mutations and immune escape have raised new challenges. Pregnant women are vulnerable to respiratory infections due to their altered immune defence and surveillance functions. Besides, whether pregnant persons should receive a COVID-19 vaccine is still under debate because limited data are available on the efficacy and safety of receiving a vaccine during pregnancy. Physiological features and lack of effective protection making pregnant women at high risk of getting infected. Another concern is that pregnancy may trigger the onset of underlying existing neurological disease, which is highly similar to those neurological symptoms of pregnant women caused by COVID-19. These similarities interfere with diagnosis and delay timely and effective management. Therefore, providing efficient emergency support for pregnant women suffering from neurological symptoms caused by COVID-19 remains a challenge among neurologists and obstetricians. To improve the diagnosis and treatment efficiency of pregnant women with neurological symptoms, we propose an emergency management framework based on the clinicians' experience and available resources. This emergency care system aimed at addressing the conundrums faced by the emergency guarantee system under COVID-19 pandemic and could serve as a potential multisystem project for clinical practice and medical education.

Pharmacological Treatments against COVID-19 in Pregnant Women

The recent respiratory virus known as SARS-CoV-2 has caused millions of deaths worldwide, causing great uncertainty due to the lack of a specific treatment, which has been mitigated by the use of various drugs traditionally used against other types of pathologies. Pregnancy presents special physiological conditions that expose the pregnant woman and the foetus to greater risk. Pregnant women are often excluded from trials due to possible risk of toxicity or side effects, resulting in a lack of knowledge about the use of drugs and treatments during pregnancy. The main objective of this review was to compile existing knowledge about currently available drug treatments for COVID-19 in pregnant women. The review report met the criteria of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) review protocol and was registered with the registration number CRD42021251036. The electronic databases searched were Scopus, PubMed, CINAHL and SciELO. Finally, 22 articles were included, resulting in an analysis of drugs with an acceptable safety profile in the treatment of pregnant women with COVID-19.