Treatment Options for Pregnant Women

111 views 0 04/15/2020 05/11/2020

  1. Confirmed cases should be treated in a negative pressure isolation room when available. Critically ill patients should be placed in left lateral decubitus.
  2. Treatment options include oxygen therapy, hydration, and empirical antibiotic therapy. The use of antiretroviral therapy and chloroquine is under investigation.
  3. Target saturation is ≥ 95%.

 

Is hydroxychloroquine safe in pregnancy?

  1. Some evidence suggest that the risk for malformation is not increased by the use of hydroxychloroquine during pregnancy.
  2. Long term use while pregnant does not seem to lead to teratogenicity.
  3. Studies show no increased risk for stillbirth, low weight birth and prematurity.
  4. Relative infant dose (RID) has been demonstrated to be safe with the use of rheumatological doses (200-400 mg/day) during breastfeeding.
  5. Breastfeeding while using the medication does not seem to provoke adverse effects on growth, motor skills, developpement or retinal findings in infants.

 

Is the medication under study safe in pregnancy?

  1. The use of lopinavir/ritonavir regiment is considered safe and should be considered as part of the antiviral therapy.
  2. Interferon is considered safe.
  3. Ribavirin is contraindicated due to evidence demonstrating teratogenicity in all animal species exposed to the medication during pregnancy.
  4. The is currently no data about the safety and efficacy of remdesivir treatment in pregnancy.
  5. The data about the possible adverse fetal events with the use of Tocilizumab is still missing.
  6. Host-directed therapy including metformin and/or statins could be considered as adjuvant to the antiviral treatment.

 

This data comes from multiple sources. Bardon and al. wrote a commentary about the antiviral treatment options and their safety throughout pregnancy. Donders and al. provided guidelines about management of COVID-19 during pregnancy. The authors are part of the International Society of Infectious Disease in Obstetrics and Gynecology. Poon L.C. and al. provided guidelines from the International Federation of Gynecology & Obstetrics on the management of infected pregnant women. Segars et al. conducted a systematic review on coronaviruses, reproduction and pregnancy. A total of 79 documents were included. The effects of chloroquine/hydroxychloroquine, Lopinavir/ritonavir, Remdesivir and Tocilizumab in pregnancy are discussed among other subjects. Sinclair and al. conducted a clinical trial to demonstrate the effects of Ribavinir in pregnant women and their fetuses. The study included 272 pregnant women and 180 live births. Zhao and al. analyzed the potential and the safety of different treatment options in pregnancy. The studied drugs are chloroquine and hydroxychloroquine, interferon, Lopinavir/ritonavir, host-directed therapies, Glycyrrhizin and nanoparticle-mediated drug delivery.

The data specific to hydroxychloroquine comes from a small literature review about the use and the safety of hydroxychloroquine during pregnancy and lactation. It is mainly based on two articles. Kaplan and al. conducted a meta-analysis about outcomes of using hydroxychloroquine for rheumatological indications during pregnancy. It includes seven observational cohorts and one controlled trial, for a total of 740 infants exposed to hydroxychloroquine and 1080 non-exposed. The second one is from LactMed database and is about hydroxychloroquine and lactation.

Sources :

  1. Bardon VF., Salomon LJ. and al. (April 23 2020) How should we treat pregnant women infected with SARS-CoV-2? BJOG. https://doi.org/10.1111/1471-0528.16270 
  2. Donders F., Lonnee-Hoffmann R. and al. (April 1 2020) ISIDOG recommendations concerning COVID 19 and pregnancy. International Society of Infectious Disease in Obstetrics and Gynecology. Retrieved from :  https://www.ginasoc.lv/uploads/content/ISIDOG%2Bguidelines%2Bfor%2BCOVID19%2Bin%2Bpregnancy.pdf
  3. Poon LC., Yang H., Kapur A. et al. (April 4 2020) Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.13156
  4. Segars J., Katler Q., McQueen D.B. et al. (April 16 2020). Prior and Novel Coronairuses, COVID-19, and Human Reproduction: What Is Known? Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2020.04.025  
  5. Sinclair SM., Jones JK. and al. (July 8 2017) The Ribavirin Pregnancy Registry: An Interim Analysis of Potential Teratogenicity at the Mid-Point of Enrollment. Drug Safety Journal. https://doi.org/10.1007/s40264-017-0597-z. 
  6. Zhao X., Jiang Y. and al. (April 23 2020) Analysis of the Susceptibility to COVID-19 in Pregnancy and Recommendations on Potential Drug Screening. European Journal of Microbiology and Infectious Diseases. Retrieved from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178925/pdf/10096_2020_Article_3897.pdf

 

Sources about hydroxychloroquine : 

  1. Kaplan, YC. and Koren G. (March 29 2020). Use of hydroxychloroquine in pregnancy and breastfeeding : An update for the recent coronavirus pandemic (COVID-19). Motherisk International Journal. Retrieved from : https://motheriskinternational.com/use-of-hydroxychloroquine-during-pregnancy-and-breastfeeding-an-update-for-the-recent-coronavirus-pandemic-covid-19/ 
  2. Kaplan, YC., Ozsarfati J. and al. (December 23 2015) Reproductive outcomes following hydroxychloroquine use for autoimmune diseases: a systematic review and meta-analysis. British Journal of Clinical Pharmacology. https://doi.org/10.1111/bcp.12872 
  3. LactMed database. (February 17 2020). Hydroxychloroquine. Drugs and Lactation Database (LactMed). Retrieved from : https://www.ncbi.nlm.nih.gov/books/NBK501150/

 

 

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