Evolution of National Guidelines on Medicines Used to Treat COVID-19 in Pregnancy in 2020-2022: A Scoping Review.

Publication date: Jul 06, 2023

The lack of inclusion of pregnant women in clinical trials evaluating the effectiveness of medicines to treat COVID-19 has made it difficult to establish evidence-based treatment guidelines for pregnant women. Our aim was to provide a review of the evolution and updates of the national guidelines on medicines used in pregnant women with COVID-19 published by the obstetrician and gynecologists’ societies in thirteen countries in 2020-2022. Based on the results of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, the national societies successively recommended against prescribing hydroxychloroquine, lopinavir-ritonavir and azithromycin. Guidelines for remdesivir differed completely between countries, from compassionate or conditional use to recommendation against. Nirmatrelvir-ritonavir was authorized in Australia and the UK only in research settings and was no longer recommended in the UK at the end of 2022. After initial reluctance to use corticosteroids, the results of the RECOVERY trial have enabled the recommendation of dexamethasone in case of severe COVID-19 since mid-2020. Some societies recommended prescribing tocilizumab to pregnant patients with hypoxia and systemic inflammation from June 2021. Anti-SARS-CoV-2 monoclonal antibodies were authorized at the end of 2021 with conditional use in some countries, and then no longer recommended in Belgium and the USA at the end of 2022. The gradual convergence of the recommendations, although delayed compared to the general population, highlights the importance of the inclusion of pregnant women in clinical trials and of international collaboration to improve the pharmacological treatment of pregnant women with COVID-19.

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Concepts Keywords
Australia clinical practice guidelines
Belgium COVID-19
Hypoxia national guidelines
Pharmacological pregnancy


Type Source Name
disease MESH COVID-19
disease VO LACK
disease VO pregnant women
disease VO effectiveness
drug DRUGBANK Hydroxychloroquine
drug DRUGBANK Lopinavir
drug DRUGBANK Ritonavir
drug DRUGBANK Azithromycin
drug DRUGBANK Dexamethasone
drug DRUGBANK Tocilizumab
disease MESH inflammation
disease VO USA
disease VO population
disease VO Iss
drug DRUGBANK Coenzyme M
disease MESH Pneumonia
disease VO time
disease MESH infectiON
disease VO Canada
disease VO organization
disease IDO process
disease MESH emergency
drug DRUGBANK Isoxaflutole
disease VO effective
disease IDO intervention
disease VO vaccination
drug DRUGBANK Oxygen
disease VO ineffective
disease MESH contraindication
drug DRUGBANK Diethylstilbestrol
disease MESH malformations
drug DRUGBANK Chloroquine
disease MESH malaria
pathway KEGG Malaria
disease MESH viral shedding
disease IDO replication
disease IDO country
disease IDO immunodeficiency
disease MESH virus infection
pathway KEGG Viral replication
drug DRUGBANK Methionine
disease VO regulatory agency
disease MESH critically ill
disease MESH infectious diseases
disease MESH intrauterine growth retardation
disease MESH chronic conditions
disease MESH asthma
pathway KEGG Asthma
disease VO organ
drug DRUGBANK Hyaluronic acid
disease MESH rheumatoid arthritis
pathway KEGG Rheumatoid arthritis
drug DRUGBANK Medical air
drug DRUGBANK Sarilumab
disease MESH pregnancy outcomes
disease VO efficient
disease MESH morbidities
disease VO vaccinated
drug DRUGBANK Immune Globulin Human
disease MESH autoimmune thrombocytopenia
disease MESH venous thromboembolism
drug DRUGBANK Heparin
disease MESH immobilization
disease MESH thrombocytopenia
disease MESH bacterial infection
drug DRUGBANK Hydrocortisone
drug DRUGBANK Methylprednisolone
drug DRUGBANK Prednisolone
disease MESH respiratory failure
disease MESH shock
drug DRUGBANK Oseltamivir
disease MESH cytomegalovirus infection
disease VO protocol
disease VO Equity
drug DRUGBANK Esomeprazole
disease VO dose
disease IDO pathogen
disease VO vaccine
disease MESH Stillbirth
disease MESH birth defects
disease VO report
disease VO adverse event
drug DRUGBANK Anakinra
drug DRUGBANK Siltuximab
disease IDO blood
disease MESH Thrombosis
drug DRUGBANK Aminosalicylic Acid

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