(89) COVID-19 Related Drug Utilization Study in Pregnancy – The COVI-Preg Cohort

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 763

Presenting Author(s)

Guillaume FAVRE
– Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland

Co-Author(s)

Eva GERBIER
– Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, University Hospital, Lausanne, Switzerland, La sarraz, Vaud, Switzerland
Emeline MAISONNEUVE
– Institute of Primary Health Care (BIHAM), University of Bern, Switzerland, Switzerland
Ursula WINTERFELD
– Swiss Teratogen Information Service, Clinical pharmacology unit, Lausanne University Hospital and University of Lausanne, Switzerland, Switzerland
Leo POMAR
– Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, University Hospital, Lausanne, Switzerland, Switzerland
Miriam C. Sturkenboom, PharmD, PhD, FISPE
– prof. dr., University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
Eimir Hurley, PhD
– Researcher, University of Oslo, Oslo, Oslo, Norway
Hedvig Nordeng, PhD, FISPE
– Professor, University of Oslo, Oslo, Oslo, Norway
Kitty WM Bloemenkamp
– Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands, Utrecht, Utrecht, Netherlands
Hilde Engjom, PhD
– Specialist consultant and postdoctoral researcher, Division for Mental and Physical Health, the Norwegian Institute of Public Health,, Bergen, Norway
Odette de Bruin
– UMC Utrecht, UMC Utrecht, Utrecht, Utrecht, Netherlands
Satu SIISKONEN
– Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands., Netherlands
David BAUD
– Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, University Hospital, Lausanne, Switzerland, Switzerland
Alice PANCHAUD
– Institute of Primary Health Care (BIHAM), University of Bern, Switzerland, Switzerland

Background: Pregnant women tested positive for SARS-CoV-2 are particularly at risk of maternal and pregnancy adverse outcomes. Since the beginning of the pandemic, clinical guidelines have drastically changed, as new treatments and data have emerged overtime.

Objectives: The aim of this study was to describe the use of COVID-19 related drugs during pregnancy and their evolution between the early and late period of the pandemic.

Methods: This was an international prospective cohort study including pregnant women tested positive for SARS-CoV-2 from March, 2020, to July, 2021, through the COVI-PREG registry. We collected exposure to the following COVID-19 related drug categories: antibiotics, antivirals, hydroxychloroquine (HCQ), corticosteroids, anti-interleukin-6 (anti-IL-6) and immunoglobulins. A descriptive analysis was performed to determine the prevalence of drugs used at the substance level and category level stratified by trimester of pregnancy, maternal COVID-19 severity level and early and late period of the pandemic (before and after July, 1 , 2020).

Results: We included 1'964 patients who tested positive for SARS-CoV-2 during pregnancy. Overall, 10.4% (205/1964) of pregnant women received at least one COVID-19 related drug. Antibiotics (8.6%; 169/1694) were the most frequently used category, followed by corticosteroids (3.2%; 62/1964), antivirals (2.0%; 39/1964), HCQ (1.4%; 27/1964), and anti-IL-6 (0.3%; 5/1964). Among all drug categories, antibiotics represented 56.0%, corticosteroids 20.5%, antivirals 12.9%, HCQ 8.9% and anti-IL-6 1.7% of drugs used. The use of at least one COVID-19 related drug was 3.1% (12/381) in asymptomatic patients, 4.2% (52/1233) in outpatients, 19.7% (46/233) in inpatients without oxygen, 72.1% (44/61) in those requiring standard oxygen, 95.7% (22/23) in those requiring high flow oxygen, 96.2% (25/26) in intubated patients and 57.1% (4/7) among patients who died. The proportion of patients who received at least one drug to treat COVID-19 was higher during the early period than in the late period (16.7% vs. 7.7%).Antibiotics, antivirals, and HCQ had a lower rate of use in the late compared to the early pandemic period.

Conclusions: Drug use in pregnant women was associated with disease severity. The use of drugs not recommended for the treatment of COVID-19 has decreased after the emergence of the first scientific evidence. The trend towards increased use of corticosteroids seems to be aligned with the evolution of guidelines. Finally, there is still a lack of evidence regarding the effectiveness and safety of COVID-19 related drugs in pregnant women which call for further studies.