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Online ISSN
1305-3124
Established
1993
Editors-in-Chief
Cihat Şen, Nicola Volpe
Editors
Cecilia Villalain, Daniel Rolnik, M. Mar Gil
Managing Editors
Murat Yayla
Statistics Editor
Resul Arısoy
The use of antenatal corticosteroids for fetal maturation in COVID-19: clinical practice statement by WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
Themistoklis Dagklis,
Cihat Şen,
Ioannis Tsakiridis,
Cecilia Villalaín,
Karel Allegaert,
Sven Wellmann,
Satoshi Kusuda,
Bernat Serra,
Manuel Sanchez Luna,
Erasmo Huertas,
Nicola Volpe,
Rodrigo Ayala,
Nelly Jekova,
Amos Grunebaum,
Milan Stanojevic
Article info
The use of antenatal corticosteroids for fetal maturation in COVID-19: clinical practice statement by WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation. Perinatal Journal 2022;30(1):12-13 DOI: 10.2399/prn.22.0301005
Author(s) Information
Themistoklis Dagklis1, Cihat Şen2, Ioannis Tsakiridis1, Cecilia Villalaín3, Karel Allegaert4, Sven Wellmann5, Satoshi Kusuda6, Bernat Serra7, Manuel Sanchez Luna8, Erasmo Huertas9, Nicola Volpe10, Rodrigo Ayala11, Nelly Jekova12, Amos Grunebaum13, Milan Stanojevic14- Third Department of Obstetrics & Gynaecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Perinatal Medicine Foundation and Department of Obstetrics & Gynecology, Memorial Bahçelievler Hospital, Istanbul, Turkey
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
- Department of Development and Regeneration, and Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Leuven, Belgium; and Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands
- Department of Neonatology, University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Department of Pediatrics, Kyorin University, Tokyo, Japan
- Department of Obstetrics, Gynecology & Reproduction, Hospital Universitari Dexeus, Barcelona, Spain
- Neonatology Division and NICU, Hospital General Universitario “Gregorio Marañón” Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics & Gynecology, San Marcos National University, Lima, Peru
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Department of Obstetrics & Gynecology, Centro Medico ABC Santa Fe, Mexico City, Mexico
- Department of Neonatology, University Hospital of Obstetrics & Gynecology “Maichin dom”, Medical University Sofia, Bulgaria
- Department of Obstetrics & Gynecology, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, New York, USA
- Neonatal Unit, Department of Obstetrics & Gynecology, Clinical Hospital “Sveti Duh”, Zagreb, Medical School, University of Zagreb, Croatia
Correspondence
Cihat Şen, Perinatal Medicine Foundation and Department of Obstetrics & Gynecology, Memorial Bahçelievler Hospital, Istanbul, Turkey, [email protected]
Publication History
Manuscript Received: February 05, 2022
Last Revision Date: February 05, 2022
Manuscript Accepted: February 05, 2022
Earlyview Date: February 06, 2022
Publication date: April 05, 2022
Conflicts of Interest
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Conflicts of interest: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Not applicable.
This statement follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation in Coronavirus Disease 2019 (COVID-19). Pregnant women with COVID-19 are at increased risk of hospitalization, admission to intensive care unit and mechanical ventilation compared to non-pregnant patients. Thus, obstetricians may face the dilemma of initiating maternal corticosteroid therapy for maternal indication while weighing its potential adverse effects on the fetus. As there is no evidence on the effect of betamethasone in pregnant women with COVID-19, dexamethasone should be preferably used for fetal maturation, if available. As a recommendation, for pregnant women with COVID-19 who are oxygen dependent or under mechanical ventilation and meet the criteria for ACS, the usual doses of dexamethasone should be administered, followed by oral prednisolone 40 mg OD or intravenous hydrocortisone 80 mg BD for up to 10 days.
Keywords
Corticosteroids, fetal maturation, COVID-19.
Pregnant women with Coronavirus Disease 2019 (COVID-19) are at increased risk of hospitalization, admission to intensive care unit and mechanical ventilation compared to non-pregnant patients. Thus, obstetricians may face the dilemma of initiating maternal corticosteroid therapy for maternal indication while weighing its potential adverse effects on the fetus.[1] On the other hand, the neonatal benefits of antenatal corticosteroids (ACS) in women at high risk of preterm birth within the next 7 days have been well established.[2]
The use of glucocorticoids as a means of immune-modulatory therapy in oxygen dependent COVID-19 patients is supported by the results of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial;[3] the use of dexamethasone for up to 10 days significantly reduced 28-day mortality in COVID-19 patients receiving invasive mechanical ventilation or oxygen without invasive mechanical ventilation (29.3% vs. 41.4%; RR: 0.64; 95% CI: 0.51–0.81) and in those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; RR: 0.82; 95% CI: 0.72–0.94). Conversely, there was a trend towards increased mortality in those patients receiving no respiratory support at randomization (17.8% vs 14.0%; RR: 1.19; 95% CI: 0.91–1.55).[3] It is worthy of note that only six pregnant women were included in the RECOVERY trial and, as per protocol for pregnant women, they received either oral prednisolone or intravenous hydrocortisone instead of dexamethasone, as these, contrary to dexamethasone, do not cross the placenta in significant quantity.[4] Based on this safety signal of possibly increased mortality among patients with mild COVID-19 receiving dexamethasone, the indications for ACS should be limited to obstetrical indications with expected preterm delivery within the next 7 days.[5] As there is no evidence on the effect of betamethasone in pregnant women with COVID-19, dexamethasone should be preferably used for fetal maturation, if available.
The use of glucocorticoids as a means of immune-modulatory therapy in oxygen dependent COVID-19 patients is supported by the results of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial;[3] the use of dexamethasone for up to 10 days significantly reduced 28-day mortality in COVID-19 patients receiving invasive mechanical ventilation or oxygen without invasive mechanical ventilation (29.3% vs. 41.4%; RR: 0.64; 95% CI: 0.51–0.81) and in those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; RR: 0.82; 95% CI: 0.72–0.94). Conversely, there was a trend towards increased mortality in those patients receiving no respiratory support at randomization (17.8% vs 14.0%; RR: 1.19; 95% CI: 0.91–1.55).[3] It is worthy of note that only six pregnant women were included in the RECOVERY trial and, as per protocol for pregnant women, they received either oral prednisolone or intravenous hydrocortisone instead of dexamethasone, as these, contrary to dexamethasone, do not cross the placenta in significant quantity.[4] Based on this safety signal of possibly increased mortality among patients with mild COVID-19 receiving dexamethasone, the indications for ACS should be limited to obstetrical indications with expected preterm delivery within the next 7 days.[5] As there is no evidence on the effect of betamethasone in pregnant women with COVID-19, dexamethasone should be preferably used for fetal maturation, if available.
Recommendation
- For pregnant women with COVID-19 who are oxygen dependent or under mechanical ventilation and meet the criteria for ACS, the usual doses of dexamethasone (4 doses of 6 mg IM at 12 h intervals) should be administered, followed by oral prednisolone 40 mg OD or intravenous hydrocortisone 80 mg BD for up to 10 days.
References
- Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al.; PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320. [PubMed] [CrossRef]
- Dagklis T, Tsakiridis I, Papazisis G, Athanasiadis A. Efficacy and safety of corticosteroids’ administration for pulmonary immaturity in anticipated preterm delivery. Curr Pharm Des 2021;27:3754–61. [PubMed] [CrossRef]
- Group RC, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al.; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384:693–704. [PubMed] [CrossRef]
- Kemp MW, Newnham JP, Challis JG, Jobe AH, Stock SJ. The clinical use of corticosteroids in pregnancy. Hum Reprod Update 2016;22:240–59. [PubMed] [CrossRef]
- Vidaeff AC, Aagaard KM, Belfort MA. Antenatal corticosteroids in COVID-19 perspective. World J Exp Med 2021;11:37–43. [PubMed] [CrossRef]
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Article's type Opinion |
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Pages 12-13 |
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Article info Online publication date: February 06, 2022 |
| Perinatal Journal 2022; 30 (1) |
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DOI 10.2399/prn.22.0301005 |
| Download as PDF |