Why we should not stop giving aspirin to pregnant women during the COVID‐19 pandemic

Kwiatkowski, Sebastian; Borowski, Dariusz; Kajdy, Anna; Poon, Liona C.; Rokitaⴕ, Wojciech; Wielgoś, Mirosław

doi:10.1002/uog.22049

Cited by 29 publications

(25 citation statements)

References 7 publications

(12 reference statements)

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“…Towards the end of 2019, a novel Coronavirus mutationlabelled as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) -was identified as the cause of a respiratory illness called COVID-19, that suddenly became epidemic in China, and then dramatically spread in many other countries worldwide as a global pandemic [1][2][3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Mascio

Şen

Saccone

et al. 2020

Journal of Perinatal Medicine

120

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ObjectivesTo evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19.MethodsSecondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI).ResultsMean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09–1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3–7.9; p=0.001) were independently associated with composite adverse fetal outcome.ConclusionsEarly gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

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Section: Introductionmentioning

confidence: 99%

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Mascio

Şen

Saccone

et al. 2020

Journal of Perinatal Medicine

120

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“…However, a rapid systematic review conducted by the World Health Organization (WHO) showed that use of NSAIDs was not associated with severe adverse events, increased acute health care utilization, decreased long-term survival, or reduced quality of life in patients with COVID-19 26 . As such, the known benefits of preeclampsia prevention appear to outweigh hypothetical risks of adverse outcomes of COVID-19 infection related to the usage of low-dose aspirin 27 . Accordingly, the International Federation of Gynecology and Obstetrics (FIGO) and the American College of Obstetricians and Gynecologists (ACOG) have stated that there is insufficient data available to recommend against the use of low dose aspirin for prophylaxis against placentally-mediated complications of pregnancy 15,17 .…”

Section: Low-dose Aspirin For Prevention Of Placentally-mediated Condmentioning

confidence: 99%

Pregnancy and COVID‐19: pharmacologic considerations

D’Souza

Ashraf

Rowe

et al. 2021

Ultrasound in Obstet & Gyne

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Medline, Embase, the Cochrane databases, CINAHL and Scopus were searched from inception until May 14, 2020 using MeSH terms and free text search terms related to "coronavirus infections", "pregnancy", "breastfeeding". This was supplemented with targeted searches of general medical and obstetric journals for publications related to routine, off-label, and investigational medications used in COVID-19 patients either for symptomatic relief or in the context of clinical trials, and discussions with international experts. In addition, we reviewed product monographs of all drugs, and conducted targeted literature searches involving the use of each drug in pregnant women. Finally, clinical practice recommendations were summarized from pregnancy guidelines of international societies and ongoing trials were reviewed from three clinical trial registries-www.clinicaltrials.gov, Australian New Zealand Clinical Trials Registry (ANZCTR) and the World Health Organization International Clinical Trials Registry Platform (ICTRP). Given the limited experience with the management of COVID-19, research letters, editorials, commentaries, opinion pieces and special communications were included. No language restrictions were applied.

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“…In another study, in five pregnant women with COVID-19 who delivered at term without complications, all five placentas showed focal avascular villi and thrombi in larger vessels [ 83 ], although no direct SARS-CoV-2 infection of the placenta was noted and the placental changes were attributed to systemic rather than local infection [ 83 ]. Given that, in addition to the pro-thrombotic nature of pregnancy, COVID-19 appears to be associated with pro-thrombotic effects on both the placenta [ 83 ] and systemic infection [ 84 ], importance has been given to continuing prophylactic aspirin in women with COVID-19 at risk for preeclampsia, although some studies have questioned whether non-steroidal anti-inflammatory drugs can exacerbate COVID-19 symptoms [ 85 ].…”

Section: Bpa and Comorbidities Predisposing To Severe Covid-19mentioning

confidence: 99%

Is There a Link between Bisphenol A (BPA), a Key Endocrine Disruptor, and the Risk for SARS-CoV-2 Infection and Severe COVID-19?

Zahra

Sisu

Silva

et al. 2020

JCM

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Infection by the severe acute respiratory syndrome (SARS) coronavirus-2 (SARS-CoV-2) is the causative agent of a new disease (COVID-19). The risk of severe COVID-19 is increased by certain underlying comorbidities, including asthma, cancer, cardiovascular disease, hypertension, diabetes, and obesity. Notably, exposure to hormonally active chemicals called endocrine-disrupting chemicals (EDCs) can promote such cardio-metabolic diseases, endocrine-related cancers, and immune system dysregulation and thus, may also be linked to higher risk of severe COVID-19. Bisphenol A (BPA) is among the most common EDCs and exerts its effects via receptors which are widely distributed in human tissues, including nuclear oestrogen receptors (ERα and ERβ), membrane-bound oestrogen receptor (G protein-coupled receptor 30; GPR30), and human nuclear receptor oestrogen-related receptor gamma. As such, this paper focuses on the potential role of BPA in promoting comorbidities associated with severe COVID-19, as well as on potential BPA-induced effects on key SARS-CoV-2 infection mediators, such as angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Interestingly, GPR30 appears to exhibit greater co-localisation with TMPRSS2 in key tissues like lung and prostate, suggesting that BPA exposure may impact on the local expression of these SARS-CoV-2 infection mediators. Overall, the potential role of BPA on the risk and severity of COVID-19 merits further investigation.

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Why we should not stop giving aspirin to pregnant women during the COVID‐19 pandemic

Cited by 29 publications

References 7 publications

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Pregnancy and COVID‐19: pharmacologic considerations

Is There a Link between Bisphenol A (BPA), a Key Endocrine Disruptor, and the Risk for SARS-CoV-2 Infection and Severe COVID-19?

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