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

COVID-19 therapeutics for the pregnant patient

SARS-CoV-2 infection can cause severe disease among pregnant persons. Pregnant persons were not included in initial studies of therapeutics for COVID-19, but cumulative experience demonstrates that most are safe for pregnant persons and the fetus, and effective for prevention or treatment of severe COVID-19.

Asymptomatic Children as a Missing Link in Preventing COVID-19 Transmission

BACKGROUND

Investigating the prevalence of the coronavirus disease 2019 (COVID-19) infection in asymptomatic children who have been in close contact with symptomatic individuals is instrumental for refining public health approaches, protecting vulnerable populations, and mitigating the broader impact of the pandemic. Accordingly, this study aimed to evaluate the incidence of COVID-19 infection in asymptomatic children who had been in close contact with parents exhibiting COVID-19 symptoms. Study Design: A cross-sectional study.

METHODS

The present cross-sectional study was conducted on 175 asymptomatic children who had been in close contact with COVID-19 confirmed cases in Hamadan County from March 2021 to August 2021. Reverse transcription polymerase chain reaction (RT-PCR) testing was performed on all asymptomatic children who had been in close contact with an individual with COVID-19. Furthermore, multiple logistic regressions were conducted to determine the predictors of COVID-19 transmission from family members to children.

RESULTS

Out of the 175 children in close contact with index cases, 53 (30.29%) tested positive for COVID-19 through PCR. Regarding factors related to the index case, male cases (Adjusted odds ratio [AOR]=2.29; 95% confidence interval [CI]: 1.03-5.09, P=0.041), rural dwellers (AOR=3.22; 95% CI: 1.02-10.16, P=0.046), illiterate cases (AOR=8.45; 95% CI: 1.76-40.65, P=0.008), and cases presenting with nasal congestion symptoms (AOR=9.12; 95% CI: 2.22-37.40, P=0.002) were more prone to transmitting the virus to children who had close contact with them.

CONCLUSION

The findings of the present study suggested that asymptomatic COVID-19 infection in household contacts is significant in children who were in close contact with a COVID-19-positive patient. Therefore, it is crucial to continue to monitor this group closely.

Preeclampsia to COVID-19: A journey towards improved placental and vascular function using sulforaphane

Excess inflammation and oxidative stress are common themes in many pathologies of pregnancy including preeclampsia and more recently severe COVID-19. The risk of preeclampsia increases following maternal infection with COVID-19, potentially relating to significant overlap in pathophysiology with endothelial, vascular and immunological dysfunction common to both. Identifying a therapy which addresses these injurious processes and stabilises the endothelial and vascular maternal system would help address the significant global burden of maternal and neonatal morbidity and mortality they cause. Sulforaphane is a naturally occurring phytonutrient found most densely within cruciferous vegetables. It has anti-inflammatory, antioxidant and immune modulating properties via upregulation of phase-II detoxification enzymes. This review will cover the common pathways shared by COVID-19 and preeclampsia and offer a potential therapeutic target via nuclear factor erythroid 2-related factor upregulation in the form of sulforaphane.

Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience

OBJECTIVES

This study aimed to present perinatal outcomes, clinical challenges, and basic ICU management in pregnant women with severe-critical COVID-19 at our tertiary referral center.

METHODS

In this prospective cohort study, patients were divided into two groups, whether they survived or not. Clinical characteristics, obstetric and neonatal outcomes, initial laboratory test results and radiologic imaging findings, arterial blood gas parameters at ICU admission, and ICU complications and interventions were compared between groups.

RESULTS

157 of the patients survived, and 34 of the patients died. Asthma was the leading health problem among the non-survivors. Fifty-eight patients were intubated, and 24 of them were weaned off and discharged healthfully. Of the 10 patients who underwent ECMO, only 1 survived (p<0.001). Preterm labor was the most common pregnancy complication. Maternal deterioration was the most common indication for a cesarean section. Higher neutrophil-to-lymphocyte-ratio (NLR) values, the need for prone positioning, and the occurrence of an ICU complication were important parameters that influenced maternal mortality (p<0.05).

CONCLUSIONS

Overweight pregnant women and pregnant women with comorbidities, especially asthma, may have a higher risk of mortality related to COVID-19. A worsening maternal health condition can lead to increased rates of cesarean delivery and iatrogenic prematurity.

CO-Sprout-A Pilot Double-Blinded Placebo-Controlled Randomised Trial of Broccoli Sprout Powder Supplementation for Pregnant Women with COVID-19 on the Duration of COVID-19-Associated Symptoms: Study Protocol

Since its discovery in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been estimated to be responsible for at least 769.3 million infections and over 6.95 million deaths. Despite significant global vaccination efforts, there are limited therapies that are considered safe and effective for use in the management of COVID-19 during pregnancy despite the common knowledge that pregnant patients have a much higher risk of adverse outcomes. A bioactive compound found in broccoli sprout-sulforaphane-is a potent inducer of phase-II detoxification enzymes promoting a series of potentially beneficial effects notably as an antioxidant, anti-inflammatory, and anti-viral. A pilot, double-blinded, placebo-controlled randomised trial is to be conducted in Melbourne, Australia, across both public and private hospital sectors. We will assess a commercially available broccoli sprout extract in pregnant women between 20+0 and 36+0 weeks gestation with SARS-CoV-2 infection to investigate (i) the duration of COVID-19 associated symptoms, (ii) maternal and neonatal outcomes, and (iii) biomarkers of infection and inflammation. We plan to enrol 60 outpatient women with COVID-19 irrespective of vaccination status diagnosed by PCR swab or RAT (rapid antigen test) within five days and randomised to 14 days of oral broccoli sprout extract (42 mg of sulforaphane daily) or identical microcrystalline cellulose placebo. The primary outcome of this pilot trial will be to assess the feasibility of conducting a larger trial investigating the duration (days) of COVID-19-associated symptoms using a broccoli sprout supplement for COVID-19-affected pregnancies. Pregnant patients remain an at-risk group for severe disease following infection with SARS-CoV-2 and currently unclear consequences for the offspring. Therefore, this study will assess feasibility of using a broccoli sprout supplement, whilst providing important safety data for the use of sulforaphane in pregnancy.

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.

COVID-19 Model with High- and Low-Risk Susceptible Population Incorporating the Effect of Vaccines

It is a known fact that there are a particular set of people who are at higher risk of getting COVID-19 infection. Typically, these high-risk individuals are recommended to take more preventive measures. The use of non-pharmaceutical interventions (NPIs) and the vaccine are playing a major role in the dynamics of the transmission of COVID-19. We propose a COVID-19 model with high-risk and low-risk susceptible individuals and their respective intervention strategies. We find two equilibrium solutions and we investigate the basic reproduction number. We also carry out the stability analysis of the equilibria. Further, this model is extended by considering the vaccination of some non-vaccinated individuals in the high-risk population. Sensitivity analyses and numerical simulations are carried out. From the results, we are able to obtain disease-free and endemic equilibrium solutions by solving the system of equations in the model and show their global stabilities using the Lyapunov function technique. The results obtained from the sensitivity analysis shows that reducing the hospitals' imperfect efficacy can have a positive impact on the control of COVID-19. Finally, simulations of the extended model demonstrate that vaccination could adequately control or eliminate COVID-19.

COVID-19 and Pregnancy: Have We Gotten through the Darkest Hour?

On December 2019, a new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) was isolated and identified in Wuhan (China) [...].

Pregnancy and COVID-19

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.

Clinical Manifestation and Obstetric Outcomes in Pregnant Women with SARS-CoV-2 Infection at Delivery: A Retrospective Cohort Analysis

This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Theaflavin 3-gallate inhibits the main protease (Mpro) of SARS-CoV-2 and reduces its count in vitro

The main protease (M^pro) of SARS-CoV-2 has been recognized as an attractive drug target because of its central role in viral replication. Our previous preliminary molecular docking studies showed that theaflavin 3-gallate (a natural bioactive molecule derived from theaflavin and found in high abundance in black tea) exhibited better docking scores than repurposed drugs (Atazanavir, Darunavir, Lopinavir). In this study, conventional and steered MD-simulations analyses revealed stronger interactions of theaflavin 3-gallate with the active site residues of M^pro than theaflavin and a standard molecule GC373 (a known inhibitor of M^pro and novel broad-spectrum anti-viral agent). Theaflavin 3-gallate inhibited M^pro protein of SARS-CoV-2 with an IC₅₀ value of 18.48 ± 1.29 μM. Treatment of SARS-CoV-2 (Indian/a3i clade/2020 isolate) with 200 μM of theaflavin 3-gallate in vitro using Vero cells and quantifying viral transcripts demonstrated reduction of viral count by 75% (viral particles reduced from Log10^6.7 to Log10^6.1). Overall, our findings suggest that theaflavin 3-gallate effectively targets the M^pro thus limiting the replication of the SARS-CoV-2 virus in vitro.

COVID-19 in pregnancy-what study designs can we use to assess the risk of congenital anomalies in relation to COVID-19 disease, treatment and vaccination?

BACKGROUND

The COVID-19 pandemic has accelerated pregnancy outcome research, but little attention has been given specifically to the risk of congenital anomalies (CA) and first trimester exposures.

OBJECTIVES

We reviewed the main data sources and study designs used internationally, particularly in Europe, for CA research, and their strengths and limitations for investigating COVID-19 disease, medications and vaccines.

POPULATION

We classify research designs based on four data sources: a) spontaneous adverse event reporting, where study subjects are positive for both exposure and outcome, b) pregnancy exposure registries, where study subjects are positive for exposure, c) congenital anomaly registries, where study subjects are positive for outcome and d) population healthcare data where the entire population of births is included, irrespective of exposure and outcome.

STUDY DESIGN

Each data source allows different study designs, including case series, exposed pregnancy cohorts (with external comparator), ecological studies, case-control studies and population cohort studies (with internal comparator).

METHODS

The quality of data sources for CA studies is reviewed in relation to criteria including diagnostic accuracy of CA data, size of study population, inclusion of terminations of pregnancy for foetal anomaly, inclusion of first trimester COVID-19-related exposures and use of an internal comparator group. Multinational collaboration models are reviewed.

RESULTS

Pregnancy exposure registries have been the main design for COVID-19 pregnancy studies, but lack detail regarding first trimester exposures relevant to CA, or a suitable comparator group. CA registries present opportunities for improving diagnostic accuracy in COVID-19 research, especially when linked to other data sources. Availability of inpatient hospital medication use in population healthcare data is limited. More use of ongoing mother-baby linkage systems would improve research efficiency. Multinational collaboration delivers statistical power.

CONCLUSIONS

Challenges and opportunities exist to improve research on CA in relation to the COVID-19 pandemic and future pandemics.

Managing COVID-19 in pregnant women

Principles of management of COVID-19 in the general population apply in pregnancy with few exceptions. Clinical inertia can lead to preventable morbidity and mortality. COVID-19 vaccines are safe and should be recommended at any stage of pregnancy. https://bit.ly/3Rj8nWr.

COVID-19 and Pregnancy

It is of greatest concern how COVID-19 is affecting pregnancy, mothers, and babies. Scientists are studying the impact of COVID-19 on pregnant women and babies and are understanding a little more every day. Reports show that there is an increased risk in pregnant women compared to nonpregnant women to get more serious illness due to COVID-19. Researchers are also investigating COVID-19 and its potential impact on a fetus. There are exceedingly rare cases of COVID-19 transmission to the fetus, and newborns can pick up COVID-19 when exposed. Vaccines are proved to be safe for pregnant women and help prevent both mother and the fetus from getting COVID-19 and are also highly effective to prevent COVID-19 infection, critical sickness, and fatalities in general. There are specific guidelines for labor and delivery during the COVID-19 pandemic which are to be imposed and followed to achieve safer and healthier childbirth. In this article, the overall influence of COVID-19 in pregnancy, its pathophysiology, effects on placenta and neonates, maternal and perinatal features and outcomes, the role of vaccination, available treatment options, and the guidelines to be followed during the pandemic are discussed based on the available scientific evidence.

Outcomes of mechanical ventilation in COVID-19 pregnant patients

BACKGROUND

Pregnancy poses a risk factor for respiratory infections due to hormonal changes, reduced tolerance to hypoxia, immunodeficiency, and increased susceptibility towards viral infections. Pregnant women might develop a broad spectrum of clinical conditions associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, from asymptomatic to potentially life-threatening complications. Critical respiratory failure associated with the progression of viral pneumonia is the most severe complication of the coronavirus disease (COVID-19). In some cases, it may require intubation and invasive mechanical ventilation.

CASE SERIES

In this case series, we evaluated the outcomes and clinical features of eight critically ill pregnant patients requiring invasive mechanical ventilation during treatment. The most commonly observed symptoms were fever at admission to the hospital, cough, difficulty breathing, and fatigue. Less frequently observed were sore throat and loss of smell and taste. All patients had anemia, and hypertension was the second most common comorbidity in pregnancy. Pregnant patients with lethal outcomes were older than those who recovered. They had higher body mass index values, more symptoms at admission, and higher C-reactive protein values and ferritin levels. Acute Respiratory Distress Syndrome (ARDS) was diagnosed in five cases, and none of these patients survived.

CONCLUSION

Obesity, maternal age, and diagnosis of ARDS were most commonly observed in our group of patients with lethal outcomes. Preventive measurements, counseling, and enlightenment of potential risk factors, such as obesity, advanced maternal age, and pregnancy-related comorbidities, should be the cornerstones in crises such as COVID-19 when medical care and resources are limited or restricted. HIPPOKRATIA 2022, 26 (1):32-37.

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.

Focusing Treatment on Pregnant Women With COVID Disease

Since the emergence of a novel coronavirus in China at the end of December 2019, its infection - COVID-19 - has been associated with high morbidity and mortality and has left healthcare systems wrestling with the optimal management strategy, especially for vulnerable populations, such as pregnant women. At this moment, few resources exist to guide the multi-disciplinary team through decisions regarding optimal maternal-fetal treatment and delivery timing. In this article, we present the drugs and vaccines under investigation as potential treatments and prevention for COVID-19 infection. Based on a comprehensive evaluation, we prioritized these possible treatments, and provide dose-response and dose-toxicity information on each drug. Currently, there is limited but very increasing reassuring information concerning vaccines to prevent SARS-CoV-2 during pregnancy, and in this review, we also emphasize the results (mostly positive) provided by the few small trials evaluating COVID-19 vaccines in pregnant patients.

SARS CoV-2 (COVID-19) Current Pharmacotherapy for Mother and Infant

The novel coronavirus disease 2019 (COVID-19), appeared in the United States over 1 year ago. This virus has a wide range of presentations, from being asymptomatic to causing severe acute respiratory syndrome, which can lead to death. It has led to a worldwide effort to find effective treatments, from repurposed medications to new discoveries, as well as the push to develop effective vaccines. As the race to fight this pandemic unfolds, this column provides what is currently available to combat this virus, how it has been utilized in the pregnant population, and what data have been made available about how these treatments affect fetal development and the neonate.

Evidence and the Main Adverse Effects Regarding Drug Therapies in the War Against COVID-19

BACKGROUND

Nowadays, the breakthrough of COVID-19 pandemic around the world is the biggest health challenge for the clinicians, and it represents an unexpected effort to identify an effective treatment for those patients. No proven definitive therapies for this infection currently exist. Unfortunately, the infected patients increased in an alarming way every day, faster than medical evidence. At present, the expanding knowledge regarding SARS-COV-2 virology provides several potential drug targets.

OBJECTIVE

Therefore, clinicians need a rapid review and guideline about the main adverse effects regarding the most prescribed drugs and, specifically, the efficacy and potential risk of each pharmacological therapy, during hospital care.

METHODS

The articles review was performed using PubMed to identify relevant papers in English language reported through July 20th, 2020; a second review was performed using Web of Science until August 28th, 2020. Due to the lack of randomized clinical trials, we included case reports, case series and reviews. We found a total of 1606 related articles. The authors independently reviewed the titles and abstracts for inclusion.

CONCLUSION

At present, despite the enormous medical effort for publishing several trials or case reports, we have not yet discovered a definitive therapy against the COVID-19 infection. This brief review aims to prompt identification of risk factors and main adverse effects in a systematic view related to therapy with partial evidence proposed to date.

COVID-19 and pregnant women - An overview on diagnosis, treatment approach with limitation, and clinical management

Coronavirus disease or more popularly called COVID-19 is known to be caused by a novel coronavirus 2. The COVID-19 has been identified to be originated from Wuhan, Hubei, China. This pandemic started in December 2019, and since then it has spread across the world within a short period. The health and family welfare ministry of the Government of India reported 227,546 active, 9,997,272 discharged cases, and 150,114 deaths due to COVID-19 as of 06 January 2021. Indian Council of Medical Research (ICMR) reports that the cumulative testing status of SARS-CoV-2 (COVID-19) was 931,408 up to November 03, 2020. Currently, no specific anti-viral drug for COVID-19 management is recommended in the current scenario. Vulnerable populations such as pregnant women affected by COVID-19 infection need to be recognized and followed up for effective handling concerning morbidity and mortality. At present, very few case reports on COVID-19 infected pregnant women have been published in India and there is no proven exclusive treatment protocol. This article summarizes a review of signs and symptoms, etiopathogenesis, risk factors, diagnosis, and possible management of COVID-19 infection in pregnant women. This overview may be useful for health care providers for practical approach and limitation of drugs used in the current management and considers the choice of drugs with their special attention given to adverse effects to improvise maternal health, pregnancy, and birth outcomes.

Management and Prevention of COVID-19 in Pregnancy and Pandemic Obstetric Care: A Review of Current Practices

Constant accumulation of data results in continuous updates of guidelines and recommendations on the proper management of pregnant women with COVID-19. This study aims to summarize the up-to-date information about the prevention and management of suspected/confirmed SARS-CoV-2 infection in obstetric patients and obstetric care during prenatal, intrapartum, and postpartum periods. We conducted a comprehensive literature search in PubMed for relevant English-written full-text reviews. We also included relevant guidelines and recommendations. In women with a low risk for infection and uncomplicated pregnancy, elective and non-urgent appointments should be postponed or completed through telehealth. Vaccination should be discussed and distance and personal hygiene preventive measures should be recommended. Routine ultrasound examinations should be adjusted in order to minimize exposure to the virus. Standardized criteria should evaluate the need for admission. Women with moderate/high-risk for infection should be isolated and tested with RT-PCR. The mode and timing of delivery should follow routine obstetric indications. In case of infection, glucocorticoids are recommended in critically ill pregnant women, after individualized evaluation. During labor and concomitant infection, the duration of the first two stages should be reduced as possible to decrease aerosolization, while minimization of hemorrhage is essential during the third stage. Close maternal monitoring and adequate oxygenation when necessary always remain a prerequisite. Discharge should be considered on the first or second day postpartum, also depending on delivery mode. Breastfeeding with protective equipment is recommended, as its benefits outweigh the risks of neonatal infection. Recommendations are currently based on limited available data. More original studies on infected pregnant women are needed to establish totally evidence-based protocols of care for these patients.

Contracting COVID-19 in the first and second trimester of pregnancy: what we know - a concise qualitative systematic review

INTRODUCTION

Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies. As the coherence of results seems to vary, especially in relation to first and second trimester pregnancies, a concise qualitative systematic review can shed light on the most recent data.

MATERIAL AND METHODS

A structured systematic search was performed to collect all COVID-19 pregnancy-related articles published between January 1 and September 16, 2020. Two independent reviewers evaluated studies using the STROBE statement in combination with the CERQual quality assessment of findings.

RESULTS

In total 1387 articles were screened and finally 22 studies were evaluated (179 1st/2nd trimesters of pregnant women with COVID-19). The majority of reported mothers who contracted COVID-19 during 1st/2nd trimesters are yet to complete their pregnancy.

CONCLUSIONS

Evidently a limited amount of data is available. Usually, mothers and newborns are discharged from the hospital without any serious complications. Further observations are imperative.

Inclusion of pregnant women in COVID-19 treatment trials: a review and global call to action

Inclusion of pregnant women in COVID-19 clinical trials would allow evaluation of effective therapies that might improve maternal health, pregnancy, and birth outcomes, and avoid the delay of developing treatment recommendations for pregnant women. We explored the inclusion of pregnant women in treatment trials of COVID-19 by reviewing ten international clinical trial registries at two timepoints in 2020. We identified 155 COVID-19 treatment studies of non-biological drugs for the April 7–10, 2020 timepoint, of which 124 (80%) specifically excluded pregnant women. The same registry search for the July 10–15, 2020 timepoint, yielded 722 treatment studies, of which 538 (75%) specifically excluded pregnant women. We then focused on studies that included at least one of six drugs (remdesivir, lopinavir–ritonavir, interferon beta, corticosteroids, chloroquine and hydroxychloroquine, and ivermectin) under evaluation for COVID-19. Of 176 such studies, 130 (74%) listed pregnancy as an exclusion criterion. Of 35 studies that evaluated high-dose vitamin treatment for COVID-19, 27 (77%) excluded pregnant women. Despite the surge in treatment studies for COVID-19, the proportion excluding pregnant women remains consistent. Exclusion was not well justified as many of the treatments being evaluated have no or low safety concerns during pregnancy. Inclusion of pregnant women in clinical treatment trials is urgently needed to identify effective COVID-19 treatment for this population.

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

From the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, special attention has been paid to pregnant women and to monitoring comorbidities, such as gestational diabetes and hypertension, which could increase their risk of disease and death. The purpose of this review is to synthesize the available knowledge on the course of COVID-19 in pregnant women as well as the risk of maternal-fetal transmission. The study indicated that the course of COVID-19 is worse in pregnant women who are more often admitted to intensive care units or who require mechanical ventilation than nonpregnant women with COVID-19. Some symptoms, such as dyspnea and cough, were similar to those observed in nonpregnant women, but fever, headache, muscle aches, chills, and diarrhea were less frequent. A study revealed that premature delivery and cesarean section were more common in pregnant women diagnosed with COVID-19. In addition, recent studies confirm the possibility of intrauterine maternal-fetal transmission by positive genetic tests and the presence of IgM in newborns just after delivery; at the moment, the probability of transmission through mother's milk is inconclusive. Considering all the above, a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is an important factor that threatens the health and life of both the mother and the fetus, but further studies are still needed.

Multi-omics-based identification of SARS-CoV-2 infection biology and candidate drugs against COVID-19

SARS-CoV-2 has ushered a global pandemic with no effective drug being available at present. Although several FDA-approved drugs are currently under clinical trials for drug repositioning, there is an on-going global effort for new drug identification. In this paper, using multi-omics (interactome, proteome, transcriptome, and bibliome) data and subsequent integrated analysis, we present the biological events associated with SARS-CoV-2 infection and identify several candidate drugs against this viral disease. We found that: (i) Interactome-based infection pathways differ from the other three omics-based profiles. (ii) Viral process, mRNA splicing, cytokine and interferon signaling, and ubiquitin mediated proteolysis are important pathways in SARS-CoV-2 infection. (iii) SARS-CoV-2 infection also shares pathways with Influenza A, Epstein-Barr virus, HTLV-I, Measles, and Hepatitis virus. (iv) Further, bacterial, parasitic, and protozoan infection pathways such as Tuberculosis, Malaria, and Leishmaniasis are also shared by this virus. (v) A total of 50 candidate drugs, including the prophylaxis agents and pathway specific inhibitors are identified against COVID-19. (vi) Betamethasone, Estrogen, Simvastatin, Hydrocortisone, Tositumomab, Cyclosporin A etc. are among the important drugs. (vii) Ozone, Nitric oxide, plasma components, and photosensitizer drugs are also identified as possible therapeutic candidates. (viii) Curcumin, Retinoic acids, Vitamin D, Arsenic, Copper, and Zinc may be the candidate prophylaxis agents. Nearly 70% of our identified agents are previously suggested to have anti-COVID-19 effects or under clinical trials. Among our identified drugs, the ones that are not yet tested, need validation with caution while an appropriate drug combination from these candidate drugs along with a SARS-CoV-2 specific antiviral agent is needed for effective COVID-19 management.

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

The pandemic of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 19.7 million persons worldwide with 7 28 013 deaths till August 10, 2020. It has put an unprecedented workload on healthcare systems with special reference to labor rooms and obstetrics as deliveries cannot be stopped or postponed. Preparing their facilities using triage (COVID-positive patients, COVID-suspect patients, and COVID-negative patients) can help to better utilize the limited resources and help in prevention of spread of disease, and improve maternal and perinatal outcome. There is a need for proper training of healthcare providers for judicious use of personal protective equipment (PPE) for optimum outcome. Fortunately, the available literature suggests that there is no substantial increased risk of acquiring COVID-19 in pregnancy or its increased virulence in pregnancy and labor and there are no adverse effects on fetus and neonate with negligible fetal transmission rate. Nevertheless, utmost care is needed to manage such pregnancies, their prenatal care, and labor. This review aimed to highlight the main recommendations applied in Indian maternities for better management of pregnancy during the COVID-19 pandemic.

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

BACKGROUND

There is little evidence about how novel coronavirus (SARS-CoV-2) affects pregnant women and their newborns. Comparisons with other members of the coronavirus family responsible for severe acute respiratory syndrome (SARS) have been done to predict maternal and neonatal outcomes; however, more information is required to establish clinical patterns, disease evolution and pregnancy prognosis in this group of patients.

METHODS

This paper is reporting a series of 91 women diagnosed with SARS-CoV-2 infection during pregnancy and puerperium. The analysis showed that 40 patients developed pneumonia, bilateral in most cases, with a 46.2% rate of hospitalization and 4 patients requiring intensive care unit (ICU) admission. In confront with previous publications, we have found a higher rate of coronavirus disease (COVID-19) severe forms, even when compared to non-pregnant women with the same baseline characteristics. We have analyzed the demographic characteristics, pregnancy-related conditions and presenting symptoms to identify features that could determine which patients will need hospitalization because of COVID-19 (Group 1-G1) and those who not (Group 2-G2). We have found that obesity and Latin-American origin behave as risk factors: OR: 4.3; 95% CI: 1.4-13.2, and OR: 2.6; 95% CI: 1.1 - 6.2, respectively. Among the 23 patients that delivered with active SARS-CoV-2, the overall rate of cesarean section (CS) and preterm birth were 52.2% and 34.8%, respectively, but we observed that the rate of CS was even higher in G1 compared to G2: 81.8% versus 25%, p = .012. However, prematurity was equally distributed in both groups and only one preterm delivery was determined by poor maternal condition. There were no deaths among the patients neither their newborns.

CONCLUSION

In conclusion, the results of our cohort reveal that SARSC-CoV-2 infection may not behave as mild as suggested during pregnancy, especially when factors as obesity or Latin-American origin are present. No evidence of late vertical transmission was noticed but prematurity and high CS rate were common findings, although it is difficult to establish any causality between these conditions and COVID-19. Further evidence is required to establish if pregnancy itself can lead to severe forms of COVID-19 disease and whether risk factors for the general population are applicable to obstetric patients. Until larger studies are available, pregnant women should be monitored carefully to anticipate severe complications.