Journal
JOURNAL OF CLINICAL MEDICINE
Volume 12, Issue 13, Pages -Publisher
MDPI
DOI: 10.3390/jcm12134519
Keywords
COVID-19; national guidelines; clinical practice guidelines; pregnancy
Categories
Ask authors/readers for more resources
The lack of inclusion of pregnant women in clinical trials has hindered the establishment of evidence-based treatment guidelines for COVID-19 during pregnancy. This review examines the guidelines on medicines for pregnant women with COVID-19 published by obstetrician and gynecologists' societies in thirteen countries from 2020 to 2022. The recommendations regarding different medications varied among countries, but there was a gradual convergence towards certain treatments based on evidence from trials like RECOVERY.
The lack of inclusion of pregnant women in clinical trials evaluating the effectiveness of medicines to treat COVID-19 has made it difficult to establish evidence-based treatment guidelines for pregnant women. Our aim was to provide a review of the evolution and updates of the national guidelines on medicines used in pregnant women with COVID-19 published by the obstetrician and gynecologists' societies in thirteen countries in 2020-2022. Based on the results of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, the national societies successively recommended against prescribing hydroxychloroquine, lopinavir-ritonavir and azithromycin. Guidelines for remdesivir differed completely between countries, from compassionate or conditional use to recommendation against. Nirmatrelvir-ritonavir was authorized in Australia and the UK only in research settings and was no longer recommended in the UK at the end of 2022. After initial reluctance to use corticosteroids, the results of the RECOVERY trial have enabled the recommendation of dexamethasone in case of severe COVID-19 since mid-2020. Some societies recommended prescribing tocilizumab to pregnant patients with hypoxia and systemic inflammation from June 2021. Anti-SARS-CoV-2 monoclonal antibodies were authorized at the end of 2021 with conditional use in some countries, and then no longer recommended in Belgium and the USA at the end of 2022. The gradual convergence of the recommendations, although delayed compared to the general population, highlights the importance of the inclusion of pregnant women in clinical trials and of international collaboration to improve the pharmacological treatment of pregnant women with COVID-19.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available