Table 2.

Safety of commonly used treatments for the management of COVID-19 in pregnancy8

TreatmentUse in pregnancy
OxygenShould be used to maintain saturations >94%
PrednisoloneDemonstrated to reduce 28-day mortality among those requiring invasive mechanical ventilation or oxygen alone:
Indicated in women who are receiving supplementary oxygen
Dose: prednisolone 40 mg OD PO or hydrocortisone 80 mg IV BD
Monitoring: Capillary blood glucose monitoring after meals
Omit if fetal steroids given that day
Best quality evidence does not suggest increased malformation rates, increased risk of miscarriage, intrauterine death or fetal growth restriction
A small number of studies have demonstrated increased risk of preterm birth (likely confounded by an underlying condition)
TocilizumabDemonstrated to improve survival and reduce the chance of progression to invasive mechanical ventilation in patients admitted to hospital with COVID-19 with hypoxia and systemic inflammation (RECOVERY):
Indicated in women with CRP >75 mg/L or admission to ICU
Dose: 800 mg if >90 kg; 600 mg if >65 kg and ≤90 kg; 400 mg if >40 kg and ≤65 kg; 8 mg/kg if weight ≤40 kg
Rates of congenital abnormality, spontaneous pregnancy loss (22%) and other adverse outcomes were no higher than in general population
Malformation rate reported as 4.5% (background 3%) but 20% of patients co-medicated with methotrexate
If used after 20 weeks’ gestation, avoid live vaccines (BCG or rotavirus) until the baby is 6 months old, as some evidence of transplacental transfer
RemdesivirDemonstrated to reduce time taken until clinical improvement in those with severe COVID-19 from a median of 15 to 11 days (ACTT-1 study), however, the SOLIDARITY trial showed no reduction in mortality rates, the need for invasive ventilation or duration of hospital stay:
Not routinely recommended in pregnancy
Very limited animal or human pregnancy exposure data are available
VTE prophylaxis
All pregnant women admitted with SARS-CoV-2 infection (or suspected SARS-CoV-2 infection) should receive prophylactic LMWH, unless birth is expected within 12 hours (eg for a woman with increasing oxygen requirements)
All women admitted to hospital with SARS-CoV-2 infection should receive at least 10 days of prophylactic LMWH following discharge from hospital
  • BD = twice a day; CRP = C-reactive protein; ICU = intensive care unit; IV = intravenous; LMWH = low-molecular weight heparin; OD = once a day; PO = orally; UKTIS = UK Teratology Information Service; VTE = venous thromboembolism.