SARS-CoV-2: do corticosteroids for fetal lung maturation worsen maternal or fetal outcomes?
Immune system changes during pregnancy could make pregnant women more susceptible to SARS-Cov-2 infection. The use of corticosteroids within obstetrics has been shown to reduce the risks of respiratory distress syndrome, intraventricular haemorrhage, necrotizing enterocolitis and neonatal death in the baby associated with premature delivery. During the COVID-19 pandemic, corticosteroids have been trialled as a treatment to dampen the ‘cytokine storm’ and associated inflammatory processes. Corticosteroids have long been known to have immunosuppressive effects that could hinder the body's ability to mount a defence against COVID-19 and thereby delaying viral clearance. In this clinical case studies, antenatal steroids for fetal lung maturation appear to be of benefit and did not result in a deterioration of maternal disease. Our clinical case studies support the current recommendations from the Royal College of Obstetricians and Gynaecologists ie corticosteroids for fetal lung maturation is appropriate in patients who are suspected or have confirmed SARS-CoV-2 infection.
The SARS-Cov-2 virus is a virulent pathogen which first emerged in December 2019 in Hubei province of China. This virus is thought to cause severe acute respiratory syndrome and the associated illness was termed by the World Health Organization (WHO) as the coronavirus disease 2019 (COVID-19) (Pascarella et al, 2020). Due to the virulence of this disease and global movement of infected people, COVID-19 has quickly become a global pandemic and crisis (Pascarella et al, 2020).
There are well-established changes within the immune system during pregnancy. These immune changes occur both locally at the uterine decidua (in order to tolerate the semi-allogeneic fetus) and also peripherally, as maternal blood comes into contact with fetal cells once placental circulation is established. An unfortunate consequence of this is that pregnant women are more vulnerable to external pathogens.
Thus, pregnant women are considered a high-risk group during this COVID-19 pandemic. However, there remains a paucity of data pertaining to the care of pregnant women with SARS-Cov-2 infection.
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