Pregnancy and COVID‐19: Pharmacologic Considerations

D'Souza, Rohan; Ashraf, Rizwana; Rowe, Hilary; Zipursky, Jonathan; Clarfield, Lauren; Maxwell, Cynthia; Arzola, Cristian; Lapinsky, Stephen; Paquette, Katryn; Murthy, Srinivas; Cheng, Matthew P.; Malhamé, Isabelle

The Severe Acute Respiratory Syndrome‐related Coronavirus‐2 (SARS‐CoV2) pandemic has sparked controversy regarding the use of certain routine and investigational pharmacologic interventions during pregnancy and the postpartum period. In this review, we critically appraise guidance in regard to pharmacologic considerations unique to pregnant and lactating women with coronavirus disease (COVID‐19). We summarize the evidence, which supports the routine use of antenatal corticosteroids, magnesium sulfate and low‐dose aspirin where clinically indicated, and if not contraindicated for medical reasons. We highlight that decision‐making about initiation, dose and duration of prophylactic anticoagulation for pregnant patients with COVID‐19 should be made by a multidisciplinary team and must consider disease severity, timing of delivery in relation to disease onset, inpatient versus outpatient status, underlying comorbidities, and contraindications to the use of anticoagulation. We discuss the rationale behind suggested modifications to the use of peripartum analgesia and anaesthesia at the time of the pandemic, as well as considerations specific to mechanically‐ventilated pregnant patients. Finally, we discuss emerging evidence supporting the reduction in mortality in patients with COVID‐19 with the use of corticosteroids, while tabulating up‐to‐date information on the safety of various investigational therapies for COVID‐19. It is hoped that this comprehensive review while providing guidance to clinicians caring for pregnant and postpartum women during the COVID‐19 pandemic will also encourage researchers to consider their inclusion in clinical trials of therapeutic interventions for COVID‐19. This article is protected by copyright. All rights reserved.