Medication Use and Adverse Maternal, Pregnancy and Neonatal Outcomes among Pregnant Women with COVID-19: A Prospective Individual Patient Data Meta-analysis in Europe and North America

Abstract

Pregnant women are a vulnerable group during the COVID-19 pandemic, yet they have been largely left out of important studies on how to treat and prevent the virus. This leaves big gaps in our knowledge about how different treatments affect pregnant women and their babies at different stages of pregnancy. We also don't know much about the medications pregnant women with COVID-19 are actually using in real life. To fill in these gaps, we looked at data from 11 different healthcare databases across Europe, the USA, and Canada. We wanted to see what medications pregnant women were using and what outcomes they experienced if they had COVID-19. We found that out of over 59,000 pregnant women with COVID-19, about half got sick in the last trimester of their pregnancy, and most of them did not need to be hospitalized. We discovered that more pregnant women were using antibiotics after getting COVID-19 compared to before, especially in the last trimester. We also found that pregnant women with COVID-19 were more likely to be prescribed medicines to prevent blood clots. Interestingly, pregnant women with COVID-19 were less likely to be prescribed certain types of medications like painkillers and medicines for mental health issues compared to non-pregnant women with COVID-19. This suggests there might be differences in how doctors treat pregnant women with COVID-19. The study also looked at outcomes for pregnant women and their babies. We didn't find any increased risks for pregnant women who did not need to go to the hospital for COVID-19. However, if a pregnant woman did have to be hospitalized for COVID-19, she was more likely to have a cesarean section, give birth prematurely, or have a baby with low birth weight. Importantly, if a pregnant woman got COVID-19 in the last trimester and had to be hospitalized, there was a higher risk of the baby being stillborn. But if a pregnant woman got COVID-19 in the first trimester and had to go to the hospital, there wasn't an increased risk of certain complications like gestational diabetes or pre-eclampsia. Overall, this study helps us understand how pregnant women are being treated for COVID-19 and what outcomes they might experience. This information can help doctors make better decisions about how to care for pregnant women with COVID-19 and keep them and their babies safe.