Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , COVID-19 , Dexamethasone/administration & dosage , Fetal Organ Maturity/drug effects , Obesity , Oxygen Inhalation Therapy/methods , SARS-CoV-2/isolation & purification , Adenosine Monophosphate/administration & dosage , Adult , Alanine/administration & dosage , Antiviral Agents/administration & dosage , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Compassionate Use Trials/methods , Female , Glucocorticoids/administration & dosage , Humans , Obesity/complications , Obesity/diagnosis , Pregnancy , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Severity of Illness Index , Treatment OutcomeABSTRACT
INTRODUCTION: The study was implemented to provide guidance to decision-makers and clinicians by describing hospital care offered to women who gave birth with confirmed SARS-CoV-2 infection. MATERIALS AND METHODS: National population-based prospective cohort study involving all women with confirmed SARS-CoV-2 infection who gave birth between February 25 and April 22, 2020 in any Italian hospital. RESULTS: The incidence rate of confirmed SARS-CoV-2 infection in women who gave birth was 2.1 per 1000 maternities at a national level and 6.9/1000 in the Lombardy Region. Overall one third of the women developed a pneumonia and 49.7% assumed at least one drug against SARS-CoV-2 infection. Caesarean rate was 32.9%, no mothers nor newborns died. Six percent of the infants tested positive for SARS-CoV-2 at birth. CONCLUSIONS: Clinical features and outcomes of COVID-19 in women who gave birth are similar to those described for the general population, most women developing mild to moderate illness.
Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adrenal Cortex Hormones/therapeutic use , Adult , COVID-19 , Cesarean Section/statistics & numerical data , Coronavirus Infections/congenital , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Emigrants and Immigrants/statistics & numerical data , Female , Fetal Organ Maturity/drug effects , Humans , Incidence , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Italy/epidemiology , Lung/embryology , Pneumonia, Viral/congenital , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Pregnancy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Premature Birth/epidemiology , Procedures and Techniques Utilization , Prospective Studies , SARS-CoV-2 , Stillbirth/epidemiology , COVID-19 Drug TreatmentABSTRACT
Recent evidence supports the use of an early, short course of glucocorticoids in patients with COVID-19 who require mechanical ventilation or oxygen support. As the number of coronavirus disease 2019 (COVID-19) cases continues to increase, the number of pregnant women with the disease is very likely to increase as well. Because pregnant women are at increased risk for hospitalization, intensive care unit admission, and mechanical ventilation support, obstetricians will be facing the dilemma of initiating maternal corticosteroid therapy while weighing its potential adverse effects on the fetus (or neonate if the patient is postpartum and breastfeeding). Our objective is to summarize the current evidence supporting steroid therapy in the management of patients with acute respiratory distress syndrome and COVID-19 and to elaborate on key modifications for the pregnant patient.
Subject(s)
Coronavirus Infections , Critical Care/methods , Glucocorticoids , Medication Therapy Management/standards , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Drug Monitoring/methods , Female , Fetal Organ Maturity/drug effects , Glucocorticoids/classification , Glucocorticoids/pharmacology , Humans , Infant, Newborn , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Respiration, Artificial/methods , Risk Assessment , SARS-CoV-2Subject(s)
Coronavirus Infections , Fetal Organ Maturity/drug effects , Glucocorticoids , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Prenatal Care/methods , Renin-Angiotensin System/drug effects , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/metabolism , Female , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Pneumonia, Viral/drug therapy , Pneumonia, Viral/metabolism , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/metabolism , Risk Assessment , SARS-CoV-2ABSTRACT
The novel coronavirus disease 2019 (COVID-19) pandemic is causing a necessary, rapid adjustment within the field of obstetrics. Corticosteroid use is a mainstay of therapy for those women delivering prematurely. Unfortunately, corticosteroid use has been associated with worse outcomes in COVID-19 positive patients. Given this information, it is necessary that obstetricians adjust practice to carefully weigh the fetal benefits with maternal risks. Therefore, our institution has examined the risks and benefits and altered our corticosteroid recommendations. KEY POINTS: · Corticosteroid use is an important part of prematurity treatment because it provides benefit to the fetus.. · Corticosteroid use may be related with increased morbidity and mortality in novel coronavirus disease 2019 (COVID-19).. · Therefore, during the COVID-19 pandemic, an alteration in current corticosteroid practices is necessary to uniquely weigh the maternal risks and fetal benefits..