Abstract
BackgroundCoronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women.MethodsA PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively.ResultsOne thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed.ConclusionsGeographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.
Highlights
Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes
Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes
Lopinavir /Ritonavir, a HIV-1 protease inhibitor [7] has been used as a treatment option for COVID-19 as an antiviral, there is no clear benefit observed in the treatment of COVID-19 [8]
Summary
Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. We and others have observed high rates of adverse pregnancy outcomes including preterm birth among COVID-19 women [5]. It becomes imperative to provide observational evidence of the current therapeutic practice of COVID-19 in clinical care for the management of pregnant women. The most common therapeutics for managing COVID-19 in pregnant women were antibiotics, antivirals, and oxygen supports. Remdesivir [9] and dexamethasone [10] are considered acceptable treatments with evidence for hospitalized and severe COVID-19 patients. The potential benefits of zinc/magnesium have been demonstrated especially in elderly or immunocompromised patients and these treatments have been used for managing COVID-19 as well [17]
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