Corticosteroids use in pregnant women with covid-19: Recommendations from available evidence

Abstract

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 admis-sion 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 corticos-teroid 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 moder-ate-to-severe COVID-19 receive oral prednisolone or intravenous hydrocortisone. However, currently, the World Health Organisation (WHO) does not explicitly specify which corticos-teroid 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.