The impact of COVID‐19 on pregnancy and therapeutic drug development

Abstract

Emerging data shows pregnant women with COVID‐19 are at significantly higher risk of severe outcomes compared to non‐pregnant women of similar age. This review discusses the invaluable insight revealed from vaccine clinical trials in women who were vaccinated and inadvertently became pregnant during the trial period. It further explores a number of clinical avenues in their management and proposes a drug development strategy in‐line with clinical trials for vaccines and drug treatments for the drug development community. Little is known of the long‐term effects of COVID‐19 on the mother and the baby. Our hypothesis that COVID‐19 predisposes pregnant women to preeclampsia or hypertensive disorders during pregnancy is supported by a clinical study and this may also adversely impact a woman’s cardiovascular disease risk later in life. It may also increase the risk of preeclampsia in their subsequent pregnancy. This is an ever‐evolving landscape and early knowledge for healthcare providers and drug innovators is offered to ensure benefits outweigh the risks. COVID‐19 mRNA vaccines appear to generate robust humoral immunity in pregnant and lactating women. This novel approach to vaccination also offers new ways to therapeutically tackle disorders of many unmet medical needs.

miRNAs as a Potential Biomarker in the COVID-19 Infection and Complications Course, Severity, and Outcome

“…IgG antibodies to the SARS-CoV-2 virus cross the placenta, which is why immunization against this virus is recommended for women in the reproductive period [ 75 ]. Comparing vaccinated and unvaccinated gravid women, Lin et al detected different expressions of the seven miRNAs [ 76 ].…”

Clinical-epidemiological characteristics and maternal-foetal outcomes in pregnant women hospitalised with COVID-19 in Venezuela: a retrospective study

“…In this study, hypertensive pregnancy syndrome was the most frequent maternal complication (17.5%), similar to previous reports [ 21 , 27 ]. Hypertensive disorders of pregnancy and COVID-19 share an exaggerated inflammatory response, guided by cytokines such as IL-6, TNF-α and IFN-γ leading to endothelial damage [ 28 ]. Likewise, studies in Latin America [ 21 ] and other regions of the world [ 14 – 16 , 29 ] found that preterm delivery and low birth weight were the most frequent perinatal complications in our patient population, which could be associated with excessive host inflammatory response to COVID-19 and poor foetal vascular perfusion of the placenta [ 14 ].…”

“…Of these, 59 (73.8%) survived and 21 (26.2%) died. The median (IQR) age of pregnant women was 29 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) years; most were of mixed race (85%; n = 68) and in the third trimester of pregnancy (81.2%; n = 65). No statistically significant differences were found between the epidemiological and gynaecobstetric characteristics of the surviving and dead pregnant women (Table 1).…”

“…1). On physical examination, median heart rate and median respiratory rate were significantly higher in dead pregnant women compared with survivors (101 [86-112] vs. 85 [80-98], p = 0.015; 24 [20][21][22][23][24][25][26][27][28][29] vs. 19 [18][19][20][21][22], p = 0.007; respectively), while median oxygen saturation was significantly higher in surviving pregnant women compared to dead (94 [90-97] vs. 81 [72-89], p < 0.001). A higher proportion of oxygen saturation ≥ 94% was found in surviving pregnant women compared to dead (54.2% vs. 14.3%, p < 0.001), while a higher proportion of oxygen saturation < 80% was found in dead pregnant women compared to survivors (47.6% vs. 6.8%, p < 0.001).…”

Covid-19 treatments and vaccines must be evaluated in pregnancy

“…This, coupled with the increased transmissibility of new variants and relaxing of social distancing restrictions, contributed to the surge in hospital admissions seen in successive waves. Concerns around the longer term effect of covid-19 post partum, including long covid, cardiovascular complications of covid-19, and widening socioeconomic disparities are also mounting 6. Despite a desperate need for treatments, pregnant women continue to be left behind.…”