Open AccessCorticosteroids Use in Pregnant Women with COVID-19: Recommendations from Available Evidence
Author(s) -
Abdul Magala Ssekandi,
Quraish Sserwanja,
Emmanuel Olal,
Joseph Kawuki,
Mohammed Adam
Publication year - 2021
Publication title -
journal of multidisciplinary healthcare
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.65
H-Index - 30
ISSN - 1178-2390
DOI - 10.2147/jmdh.s301255
Subject(s) - medicine , pregnancy , prednisolone , dexamethasone , corticosteroid , covid-19 , fetus , respiratory distress , obstetrics , mechanical ventilation , pediatrics , anesthesia , disease , infectious disease (medical specialty) , genetics , biology
Pregnant women experience immune system changes to accommodate and tolerate the growing foetus, these changes also increase their susceptibility to viral infections such as SARS-COV-2. COVID-19 in pregnancy increases the likelihood of hospital admission and intensive care compared to non-pregnant women. Early administration of low-dose corticosteroids to patients with acute respiratory distress syndrome can reduce all-cause mortality among such patients. However, during pregnancy, prolonged use of corticosteroids that readily cross the placenta like dexamethasone can negatively impact both the mother and foetus. Evidence is thus needed on the choice, timing, and duration for corticosteroids use among pregnant women with COVID-19. This article aims to provide evidence on corticosteroid use in pregnant women with COVID-19. The RECOVERY trial deduced that low-dose dexamethasone (6 milligrams) reduced mortality by up to one-third among COVID-19 patients on mechanical ventilation and one-fifth among those who received supplemental oxygen. Pregnant women in this trial received either oral prednisolone or intravenous hydrocortisone. Based on the RECOVERY trial findings, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends that pregnant women with moderate-to-severe COVID-19 receive oral prednisolone or intravenous hydrocortisone. However, currently, the World Health Organisation (WHO) does not explicitly specify which corticosteroid to use among pregnant women with moderate-to-severe COVID-19. We also note that there are no published articles on corticosteroid use among pregnant women with severe COVID-19 in Africa.