Focusing Treatment on Pregnant Women With COVID Disease (original) (raw)
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Safety of COVID-19 vaccines, their components or their platforms for pregnant women: A rapid review
2021
ABSTRACTBackgroundPregnant women with COVID-19 are at an increased risk of severe COVID-19 illness as well as adverse pregnancy and birth outcomes. Many countries are vaccinating or considering vaccinating pregnant women with limited available data about the safety of this strategy. Early identification of safety concerns of COVID-19 vaccines, including their components, or their technological platforms is therefore urgently needed.MethodsWe conducted a rapid systematic review, as the first phase of an ongoing full systematic review, to evaluate the safety of COVID-19 vaccines in pregnant women, including their components, and their technological platforms (whole virus, protein, viral vector or nucleic acid) used in other vaccines, following the Cochrane methods and the PRISMA statement for reporting (PROSPERO-CRD42021234185).We searched literature databases, COVID-19 and pregnancy registries from inception February 2021 without time or language restriction and explored the referenc...
Vaccine, 2021
Background: Rapid assessment of COVID-19 vaccine safety during pregnancy is urgently needed. Methods: We conducted a rapid systematic review, to evaluate the safety of COVID-19 vaccines selected by the COVID-19 Vaccines Global Access-Maternal Immunization Working Group in August 2020, including their components and their technological platforms used in other vaccines for pregnant persons. We searched literature databases, COVID-19 vaccine pregnancy registries, and explored reference lists from the inception date to February 2021 without language restriction. Pairs of reviewers independently selected studies through COVIDENCE, and performed the data extraction and the risk of bias assessment. Discrepancies were resolved by consensus. Registered on PROSPERO (CRD42021234185). Results: We retrieved 6757 records and 12 COVID-19 pregnancy registries from the search strategy; 38 clinical and non-clinical studies (involving 2,398,855 pregnant persons and 56 pregnant animals) were included. Most studies (89%) were conducted in high-income countries and were cohort studies (57%). 2 Most studies (76%) compared vaccine exposures with no exposure during the three trimesters of pregnancy. The most frequent exposure was to AS03 adjuvant, in the context of A/H1N1 pandemic influenza vaccines, (n=24) and aluminum-based adjuvants (n=11). Only one study reported exposure to messenger RNA in lipid nanoparticles COVID-19 vaccines. Except for one preliminary report about A/H1N1 influenza vaccination (adjuvant AS03), corrected by the authors in a more thorough analysis, all studies concluded that there were no safety concerns. Conclusion: This rapid review found no evidence of pregnancy-associated safety concerns of COVID-19 vaccines or of their components or platforms when used in other vaccines. However, the need for further data on several vaccine platforms and components is warranted, given their novelty. Our findings support current WHO guidelines recommending that pregnant persons may consider receiving COVID-19 vaccines, particularly if they are at high risk of exposure or have comorbidities that enhance the risk of severe disease.
Effectiveness and safety of available treatments for COVID-19 during pregnancy: a critical review
The Journal of Maternal-Fetal & Neonatal Medicine
Background: COVID-19 is a pandemic disease caused by the SARS-CoV-2 and it spread globally in the last few months. The complete lack of specific treatment forced clinicians to use old drugs, chosen for their efficacy against similar viruses or their in vitro activity. Trials on patients are ongoing but the majority of information comes from small case series and single center reports. We aimed to provide a literature review on the putative effectiveness and safety of available treatments for COVID-19 in pregnant women. Methods: We reviewed all the available literature concerning the drugs that have been used in the treatment of COVID-19 during pregnancy and whose safe assumption during pregnancy had been demonstrated by clinical studies (i.e. including studies on other infectious diseases). Drugs contra-indicated during pregnancy or with unknown adverse effects were not included in our review. Results and conclusions: Clinical trials are not often conducted among pregnant patients for safety reasons and this means that drugs that may be effective in general population cannot be used for pregnant women due to the lack of knowledge of side effects in this category of people .The choice to use a specific drug for COVID-19 in pregnancy should take into account benefits and possible adverse events in each single case. In the current situation of uncertainty and poor knowledge about the management of COVID-19 during pregnancy, this present overview may provide useful information for physicians with practical implications.
COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices
Viruses
The clinical management of COVID-19 in pregnant women, who are considered a vulnerable population, remains uncertain even as the pandemic subsides. SARS-CoV-2 affects pregnant individuals in multiple ways and has been associated with severe maternal morbidity and mortality, as well as neonatal complications. The unique anatomy and physiology of gestation make managing COVID-19 in this population a complex and challenging task, emphasizing the importance of spreading knowledge and expertise in this area. Therapeutic interventions require distinct clinical consideration, taking into account differences in pharmacokinetics, vertical transmission, drug toxicities, and postnatal care. Currently, there is limited data on antiviral and immunomodulating COVID-19 pharmacotherapy in pregnancy. Some medication has been shown to be safe and well tolerated among pregnant women with COVID-19; however, the lack of randomized clinical trials and studies in this patient population is evident. Availa...
Open Journal of Proteomics and Genomics, 2021
In a growing global effort to combat the fatal spread of SARS-CoV-2, while vaccines are released and delivered as fast as the pharmaceutical companies can, to restrict and decrease the death worldwide; several drugs are being reused in patients infected by coronavirus [1]. Meanwhile, several countries are suffering with the COVID-19 second wave, that shown to be worse than the fi rst one, affecting especially countries such as USA and Brazil that did not assume the necessary measures involving mask-use everywhere and isolating individuals in their homes, especially the risk groups [2,3]. Despite the vaccines distribution, the fact is that we still lack a systematic research about long-term risks such as those regarding the vaccines using mRNA, especially related to pregnant women, due to the absence of data for reproductive toxicology and reactogenicity in this group [4]. In this context, Opinion COVID-19 and SARS-CoV-2: Despite the vaccination, new targets/drugs for treatment and the virus cycle mechanisms still have to be continually investigated
Prevention of COVID-19 in pregnant women, eventual use of new vaccines
2021
Pregnant women who have COVID-19 have an increased risk of hospitalization and death;however, there are many restrictions for the application of COVID-19 vaccines on pregnant patients, mainly because there is no confirmation of the safety of their use during pregnancy. None of the vaccines approved to date are based on live attenuated SARS-CoV-2, so the possibility of generating an infection in the fetus is nonexistent. Likewise, current evidence does not suggest that COVID-19 vaccines can induce a complication or adverse pregnancy outcome and due to the emergence of new waves of COVID-19, the potential protective benefits of these vaccines far outweigh the possible risks in most patients. A review of the evidence of the safety of COVID-19 vaccines, recommendations, and restrictions for the use of COVID-19 vaccines in pregnant women made by international health organisms and professional associations, as well as prospects and information on clinical trials of these vaccines in pregn...
Microorganisms
Background: The SARS-CoV-2 pandemic has involved a severe increase of cases worldwide in a wide range of populations. The aim of the present investigation was to evaluate recent insights about COVID-19 infection in children, infants and pregnant subjects. Methods: a literature overview was performed including clinical trials, in vitro studies, reviews and published guidelines regarding the present paper topic. A descriptive synthesis was performed to evaluate recent insights and the effectiveness of therapies for SARS-CoV-2 infection in children, infants and pregnant subjects. Results: Insufficient data are available regarding the relationship between COVID-19 and the clinical risk of spontaneous abortion and premature foetus death. A decrease in the incidence of COVID-19 could be correlated to a minor expression of ACE2 in childrens’ lungs. At present, a modulation of the dose-effect posology for children and infants is necessary. Conclusions: Pregnant vertical transmission has bee...
Drug Safety
To date, four vaccines have been authorised for emergency use and under conditional approval by the European Medicines Agency to prevent COVID-19: Comirnaty, COVID-19 Vaccine Janssen, Spikevax (previously COVID-19 Vaccine Moderna) and Vaxzevria (previously COVID-19 Vaccine AstraZeneca). Although the benefit-risk profile of these vaccines was proven to be largely favourable in the general population, evidence in special cohorts initially excluded from the pivotal trials, such as pregnant and breastfeeding women, children/adolescents, immunocompromised people and persons with a history of allergy or previous SARS-CoV-2 infection, is still limited. In this narrative review, we critically overview pre-and post-marketing evidence on the potential benefits and risks of marketed COVID-19 vaccines in the above-mentioned special cohorts. In addition, we summarise the recommendations of the scientific societies and regulatory agencies about COVID-19 primary prevention in the same vaccinee categories. Nicoletta Luxi and Alexia Giovanazzi contributed equally to the paper as first authors. The members of Ilmiovaccino COVID19 collaborating group are listed in acknowledgements section.
The Overall Consequence of Antiviral Drugs Given to Pregnant Women with COVID-19
Journal of Bacteriology & Parasitology, 2021
During pregnancy, the anatomical structure of the respiratory system changes, and the virus transmitted by droplets and aerosols are more easily inhaled and difficult to remove by pregnant women. Women are generally more susceptible to various pregnancy-related complications and respiratory pathogens, increasing the risk of developing adverse pregnancy and neonatal outcomes. Anecdotal evidence suggests that pregnant women do not appear to differ from the general population in terms of disease transmission, and to date, there is no evidence of vertical transmission from mother to fetus. However, in another study, it is known that members of the coronavirus family are responsible for serious complications such as miscarriage, fetal growth restriction, and congenital anomalies during pregnancy. To date, only a few studies have reported relatively higher rates of adverse birth outcomes in women affected by SARS-CoV-2 infection in late pregnancy. This literature review presents the use of drugs used for the treatment of COVID-19 disease in pregnancy and pregnancy outcomes. It is also aimed to examine the effective control and management of SARS CoV-2 infection in the pregnancy, delivery, and postpartum period in line with the existing literature and guide health personals. Large-scale epidemiological studies are needed to evaluate the course of the infection during pregnancy and the effects of the drugs used on pregnancy and fetus.