What drugs are approved for management of pregnant women?
Pregnant women have historically been excluded from trials of therapeutic interventions, and coronavirus is no different. However, they were included in the RECOVERY Trial and most arms have been open to recruitment.
Through RECOVERY we know that pregnant patients hospitalized with COVID-19 should receive steroids. However, Dexamethasone should not be given due to implications for fetal brain development and growth. Instead, the pregnant population should receive prednisolone 40md once a day or hydrocortisone 80mg IV twice daily for 10 days or until hospital discharge, whichever is shorter (13).
If dexamethasone is needed for fetal lung maturation then that should be given as normal, no other steroids are needed for those days.
Pregnant women were also eligible for Tocilizumab in the RECOVERY trial, and indeed 3 received it. Four nation guidance (Interim Clinical Commissioning Policy) would suggest that it is not given ‘unless clearly necessary’ in pregnancy and as part of an MDT discussion due to lack of safety evidence. However, if a pregnant women is requiring respiratory support in a critical care area for COVID-19 then this makes consideration of Tocilizumab ‘clearly necessary’. Tocilizumab, and other biologics, have been and are used in pregnancy for inflammatory conditions when other medications do not suffice, eg: RhA. Most maternity units and maternal medicine networks will have experience of this and can provide reassurance.