Antenatal corticosteroid therapy and COVID‐19: Pathophysiological considerations

Sichitiu, Joanna; Fakhouri, Fadi; Desseauve, David

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many challenges in healthcare, including obstetrics. Therefore, we read with great interest the special editorial published in the AOGS regarding clinical recommendations for the management of coronavirus disease 2019 (COVID-19) in pregnant women.1 As illustrated by the authors, the usefulness and safety of corticosteroids as an adjuvant therapy for COVID-19 pneumonia remains controversial. Corticosteroids may diminish the inflammatory response, a major factor for lung damage and acute respiratory distress syndrome in viral respiratory tract infection. However, previous studies on corticosteroid therapy in severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus illustrated delayed viral clearance, with no survival benefit and perhaps even adverse outcomes.2 Some patients with COVID-19 exhibit biphasic disease evolution with a mild presentation followed by a secondary respiratory deterioration due to a cytokine storm, despite decreasing viral load.2 Therefore, timing of corticosteroid therapy might be particularly consequential, with early administration reducing inflammatory response and viral clearance during the initial phase.