Generic placeholder image

Infectious Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

Review Article

COVID-19 Infection in Pregnancy: A Review

Author(s): Sabrina Jahan Mily, Kazi Mahmuda Akter, Nowshin Jabin, Saikat Mitra, Talha Bin Emran, Monisha Nandi, Sumit Kumar Baral, Md. Zia Uddin, Jewel Mallick, Arkajyoti Paul, Syed Uzair Ali Shah, Abdur Rauf, Ishaq N. Khan and Mohammad S. Mubarak*

Volume 22, Issue 5, 2022

Published on: 26 April, 2022

Article ID: e050122199976 Pages: 10

DOI: 10.2174/1871526522666220105111358

Price: $65

Abstract

Coronavirus disease 2019 (COVID-19), which is a highly contagious viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a catastrophic effect on the world's demographics, resulting in more than 3.8 million deaths worldwide and establishing itself as the most serious global health crisis since the 1918 influenza pandemic. Several questions remain unanswered regarding the effects of COVID-19 disease during pregnancy. Although most infections are mild in high-risk populations, the severe disease frequently leads to intubation, intensive care unit admission, and, in some cases, death. Hormonal and physiological changes in the immune and respiratory systems, cardiovascular function, and coagulation may affect the progression of COVID-19 disease in pregnancy. However, the consequences of coronavirus infection on implantation, fetal growth and development, labor, and newborn health have yet to be determined, and, consequently, a coordinated global effort is needed in this respect. Principles of management concerning COVID-19 in pregnancy include early isolation, aggressive infection control procedures, oxygen therapy, avoidance of fluid overload, consideration of empiric antibiotics (secondary to bacterial infection risk), laboratory testing for the virus and co-infection, fetal and uterine contraction monitoring, prevention, and / or treatment of thromboembolism early mechanical ventilation for progressive respiratory failure, individualized delivery planning, and a team-based approach with multispecialty consultations. This review focuses on COVID-19 during pregnancy, its management, and the area where further investigations are needed to reduce the risk to mothers and their newborns.

Keywords: COVID-19, coronavirus, pandemic, pregnancy, management, infection.

Graphical Abstract

[1]
Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: Maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020; 144(7): 799-805.
[http://dx.doi.org/10.5858/arpa.2020-0901-SA] [PMID: 32180426]
[2]
Coronaviridae Study Group of the International Committee on Taxonomy of Viruses The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020; 5(4): 536-44.
[http://dx.doi.org/10.1038/s41564-020-0695-z] [PMID: 32123347]
[3]
Rakib A, Sami SA, Mimi NJ, et al. Immunoinformatics-guided design of an epitope-based vaccine against severe acute respiratory syndrome coronavirus 2 spike glycoprotein. Comput Biol Med 2020; 124: 103967.
[http://dx.doi.org/10.1016/j.compbiomed.2020.103967] [PMID: 32828069]
[4]
Rampal L, Liew BS. Coronavirus disease (COVID-19) pandemic. Med J Malaysia 2020; 75(2): 95-7.
[http://dx.doi.org/10.1201/9781003161066-1] [PMID: 32281587]
[5]
Ibrahim B, Önem E. Coronavirus disease 2019 (Covid-19): A literature review. Gevher Nesibe J IESDR 2021; 6: 56-72.
[http://dx.doi.org/10.46648/gnj.200]
[6]
Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: What about pregnancies? Lancet 2020; 395(10224): e40. [-undefined.].
[http://dx.doi.org/10.1016/S0140-6736(20)30311-1] [PMID: 32035511]
[7]
Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Obstet Anesthes Dig 2020; 222(5): 415-26.
[http://dx.doi.org/10.1097/01.aoa.0000719440.84472.52] [PMID: 32105680]
[8]
Huang C, Wang Y, Li X, Ren L, Zhao JHY, et al. Clinical features of patients infected with 2019. In: Nov Coronavirus Wuhan, China. Lancet 2020; 395: pp. (10223)497-506.
[9]
Ciobanu AM, Peltecu G, Panaitescu AM. Coronavirus in pregnancy. What we know so far? Maedica (Buchar) 2020; 15(1): 6-10.
[http://dx.doi.org/10.26574/maedica.2020.15.1.6] [PMID: 32419854]
[10]
Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37(8): 861-5.
[http://dx.doi.org/10.1055/s-0040-1710050] [PMID: 32305046]
[11]
Coronavirus disease (COVID-19): Similarities and differences with influenza. World Health Organization 2021.
[12]
Coronavirus disease (COVID-19): Pregnancy and childbirth. World Health Organization 2021.
[13]
Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? Acta Obstet Gynecol Scand 2020; 99(4): 439-42.
[http://dx.doi.org/10.1111/aogs.13836] [PMID: 32141062]
[14]
Donders F, Lonnée-Hoffmann R, Tsiakalos A, et al. Isidog covid-guideline workgroup. ISIDOG recommendations concerning COVID-19 and pregnancy. Diagnostics (Basel) 2020; 10(4): E243.
[http://dx.doi.org/10.3390/diagnostics10040243] [PMID: 32338645]
[15]
López M, Gonce A, Meler E, et al. on behalf of the COVID Collaborative Group Coronavirus lancy: A clinical management protocol and considerations for practice. Fetal Diagn Ther 2020; 47(7): 519-28.
[http://dx.doi.org/10.1159/000508487] [PMID: 32535599]
[16]
Akhtar H, Patel C, Abuelgasim E, Harky A. COVID-19 (SARS-CoV-2) infection in pregnancy: A systematic review. Gynecol Obstet Invest 2020; 85(4): 295-306.
[http://dx.doi.org/10.1159/000509290] [PMID: 32728006]
[17]
Molteni E, Astley CM, Ma W, et al. SARS-CoV-2 (COVID-19) infection in pregnant women: characterization of symptoms and syndromes predictive of disease and severity through real-time, remote participatory epidemiology. MedRxiv 2020; 2020.08.17.20161760.
[http://dx.doi.org/10.1101/2020.08.17.20161760]
[18]
Mahase E. Covid-19: Pregnant women with virus are more likely to need intensive care, study finds. BMJ 2020; 370: m3391.
[http://dx.doi.org/10.1136/bmj.m3391] [PMID: 32878867]
[19]
Begum MR, Ehsan N, Ehsan M. Sharif ABin Pregnancy and childbirth in COVID-19 positive/probable and suspected patients: A comprehensive review. J Bangladesh Coll Physicians Surg 2020; pp. 91-108.
[http://dx.doi.org/10.3329/jbcps.v38i0.47443]
[20]
Elshafeey F, Magdi R, Hindi N, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet 2020; 150(1): 47-52.
[http://dx.doi.org/10.1002/ijgo.13182] [PMID: 32330287]
[21]
World Health Organisation. What are the symptoms of COVID-19. World Health Organization 2021.
[22]
Yang H, Sun G, Tang F, Peng M, Gao Y, Peng J. Clinical features and outcomes of pregnant women suspected of coronavirus disease 2019. J Infect 2020; 81: e40-4.
[http://dx.doi.org/10.1016/j.jinf.2020.04.003]
[23]
Kader HA, Siddik-Sayyid S. Obstetric anesthesia care and Covid-19. Middle East J Anaesthesiol 2020; 27: 145-51.
[24]
Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; 382(10): 970-1.
[http://dx.doi.org/10.1056/NEJMc2001468] [PMID: 32003551]
[25]
Yu P, Zhu J, Zhang Z, Han Y. A familial cluster of infection associated with the 2019 novel coronavirus indicating possible person-to-person transmission during the incubation period. J Infect Dis 2020; 221(11): 1757-61.
[http://dx.doi.org/10.1093/infdis/jiaa077] [PMID: 32067043]
[26]
Mohan N, Deswal S. Corona Virus Disease (COVID-19) Fecal-oral transmission: Is it a potential risk for Indians? Indian J Gastroenterol 2020; 39(3): 305-6.
[http://dx.doi.org/10.1007/s12664-020-01072-5] [PMID: 32710226]
[27]
Tang A, Tong ZD, Wang HL, et al. Detection of novel coronavirus by RT-PCR in stool specimen from asymptomatic child, China. Emerg Infect Dis 2020; 26(6): 1337-9.
[http://dx.doi.org/10.3201/eid2606.200301] [PMID: 32150527]
[28]
Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020; 323(18): 1843-4.
[http://dx.doi.org/10.1001/jama.2020.3786] [PMID: 32159775]
[29]
Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta 2020; 508: 254-66.
[http://dx.doi.org/10.1016/j.cca.2020.05.044] [PMID: 32474009]
[30]
Kotlyar AM, Grechukhina O, Chen A, et al. Vertical transmission of coronavirus disease 2019: A systematic review and meta-analysis. Am J Obstet Gynecol 2020; 224(1): 35-53.e3.
[http://dx.doi.org/10.1016/j.ajog.2020.07.049] [PMID: 32739398]
[31]
Wu Y, Liu C, Dong L, et al. Coronavirus disease 2019 among pregnant Chinese women: Case series data on the safety of vaginal birth and breastfeeding. BJOG 2020; 127(9): 1109-15.
[http://dx.doi.org/10.1111/1471-0528.16276] [PMID: 32369656]
[32]
Groß R, Conzelmann C, Müller JA, et al. Detection of SARS-CoV-2 in human breastmilk. Lancet 2020; 395(10239): 1757-8.
[http://dx.doi.org/10.1016/S0140-6736(20)31181-8] [PMID: 32446324]
[33]
Buonsenso D, Costa S, Sanguinetti M, et al. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol 2020; 37(8): 869-72.
[http://dx.doi.org/10.1055/s-0040-1710541] [PMID: 32359227]
[34]
Eastin C, Eastin T. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. J Emerg Med 2020; 58: 710-1.
[http://dx.doi.org/10.1016/j.jemermed.2020.04.003]
[35]
Fan C, Lei D, Fang C, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis 2020; 72(5): 862-4.
[http://dx.doi.org/10.1093/cid/ciaa226] [PMID: 32182347]
[36]
Wang S, Guo L, Chen L, et al. A case report of neonatal 2019 coronavirus disease in China. Clin Infect Dis 2020; 71(15): 853-7.
[http://dx.doi.org/10.1093/cid/ciaa225] [PMID: 32161941]
[37]
Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med 2020; 14(2): 193-8.
[http://dx.doi.org/10.1007/s11684-020-0772-y] [PMID: 32285380]
[38]
Li Y, Zhao R, Zheng S, et al. Lack of vertical transmission of severe acute respiratory syndrome Coronavirus 2, China. Emerg Infect Dis 2020; 26(6): 1335-6.
[http://dx.doi.org/10.3201/eid2606.200287] [PMID: 32134381]
[39]
Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol 2020; 19(3): 141-54.
[http://dx.doi.org/10.1038/s41579-020-00459-7] [PMID: 33024307]
[40]
Mackenzie JS, Smith DW. COVID-19: a novel zoonotic disease caused by a coronavirus from China: what we know and what we don’t. Microbiol Aust 2020; 41: MA20013.
[http://dx.doi.org/10.1071/MA20013] [PMID: 32226946]
[41]
Olival KJ, Cryan PM, Amman BR, et al. Possibility for reverse zoonotic transmission of SARS-CoV-2 to free-ranging wildlife: A case study of bats. PLoS Pathog 2020; 16(9): e1008758.
[http://dx.doi.org/10.1371/journal.ppat.1008758] [PMID: 32881980]
[42]
Rozycki HJ, Kotecha S. Covid-19 in pregnant women and babies: What pediatricians need to know. Paediatr Respir Rev 2020; 35: 31-7.
[http://dx.doi.org/10.1016/j.prrv.2020.06.006] [PMID: 32709462]
[43]
Wu X, Sun R, Chen J, Xie Y, Zhang S, Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynaecol Obstet 2020; 150(1): 58-63.
[http://dx.doi.org/10.1002/ijgo.13165] [PMID: 32270479]
[44]
Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150(1): 53-7.
[http://dx.doi.org/10.1002/ijgo.13188] [PMID: 32350871]
[45]
Wong TC, Lee ZY, Sia TLL, Chang AKW, Chua HH. Miscarriage Risk in COVID-19 Infection. SN Compr Clin Med 2020; 2: 1-4.
[http://dx.doi.org/10.1007/s42399-020-00443-5] [PMID: 32838193]
[46]
Vlachodimitropoulou KE, Vivanti AJ, Shehata N, et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost 2020; 18(7): 1648-52.
[http://dx.doi.org/10.1111/jth.14856] [PMID: 32302459]
[47]
Ryan GA, Purandare NC, McAuliffe FM, Hod M, Purandare CN. Clinical update on COVID-19 in pregnancy: A review article. J Obstet Gynaecol Res 2020; 46(8): 1235-45.
[http://dx.doi.org/10.1111/jog.14321] [PMID: 32500549]
[48]
Omer S, Ali S, Babar ZUD. Preventive measures and management of COVID-19 in pregnancy. Drugs Ther Perspect 2020; 36: 1-4.
[http://dx.doi.org/10.1007/s40267-020-00725-x] [PMID: 32292265]
[49]
Corbett GA, Milne SJ, Hehir MP, Lindow SW, O’connell MP. Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 249: 96-7.
[http://dx.doi.org/10.1016/j.ejogrb.2020.04.022] [PMID: 32317197]
[50]
Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, et al. Maternal death due to COVID-19. Am J Obstet Gynecol 2020; 223(1): 109.e1-109.e16.
[http://dx.doi.org/10.1016/j.ajog.2020.04.030] [PMID: 32360108]
[51]
McFee DRB. COVID-19 Laboratory Testing/CDC Guidelines. Dis Mon 2020; 66(9): 101067.
[http://dx.doi.org/10.1016/j.disamonth.2020.101067] [PMID: 32883517]
[52]
Sidiq Z, Hanif M, Dwivedi KK, Chopra KK. Laboratory diagnosis of novel corona virus (2019-nCoV)-present and the future. Indian J Tuberc 2020; 67(4S): S128-31.
[http://dx.doi.org/10.1016/j.ijtb.2020.09.023] [PMID: 33308658]
[53]
Li C, Zhao C, Bao J, Tang B, Wang Y, Gu B. Laboratory diagnosis of coronavirus disease-2019 (COVID-19). Clin Chim Acta 2020; 510: 35-46.
[http://dx.doi.org/10.1016/j.cca.2020.06.045] [PMID: 32621814]
[54]
Ng MY, Lee EYP, Yang J, et al. Imaging profile of the Covid-19 infection: Radiologic findings and literature review. Radiol Cardiothorac Imaging 2020; 2(1): e200034.
[http://dx.doi.org/10.1148/ryct.2020200034] [PMID: 33778547]
[55]
Marietta M, Ageno W, Artoni A, et al. COVID-19 and haemostasis: a position paper from Italian Society on Thrombosis and Haemostasis (SISET). Blood Transfus 2020; 18(3): 167-9.
[http://dx.doi.org/10.2450/2020.0083-20] [PMID: 32281926]
[56]
Poon LC, Yang H, Kapur A, et al. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. Int J Gynaecol Obstet 2020; 149(3): 273-86.
[http://dx.doi.org/10.1002/ijgo.13156] [PMID: 32248521]
[57]
Gynaecologists 2. Royal College of Obstetricians and. Coronavirus (COVID-19) infection and pregnancy. 2020.
[58]
Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. Am J Obstet Gynecol MFM 2020; 2(2): 100106.
[http://dx.doi.org/10.1016/j.ajogmf.2020.100106] [PMID: 32363335]
[59]
D’Souza R, Malhamé I, Teshler L, Acharya G, Hunt BJ, McLintock C. A critical review of the pathophysiology of thrombotic complications and clinical practice recommendations for thromboprophylaxis in pregnant patients with COVID-19. Acta Obstet Gynecol Scand 2020; 99(9): 1110-20.
[http://dx.doi.org/10.1111/aogs.13962] [PMID: 32678949]
[60]
Khoiwal K, Kapur D, Gaurav A, Chaturvedi J. Management of pregnant women in times of Covid-19: A review of current literature. J Obstet Gynaecol India 2020; 70(4): 262-6.
[http://dx.doi.org/10.1007/s13224-020-01342-4] [PMID: 32760170]
[61]
Allotey J, Stallings E, Bonet M, et al. for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370: m3320.
[http://dx.doi.org/10.1136/bmj.m3320] [PMID: 32873575]
[62]
Schwartz DA, Graham AL. Potential maternal and infant outcomes from coronavirus 2019-NCOV (SARS-CoV-2) infecting pregnant women: Lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12(2): E194.
[http://dx.doi.org/10.3390/v12020194] [PMID: 32050635]
[63]
Qi H, Luo X, Zheng Y, et al. Safe delivery for pregnancies affected by COVID-19. BJOG 2020; 127(8): 927-9.
[http://dx.doi.org/10.1111/1471-0528.16231] [PMID: 32219995]
[64]
Sichitiu J, Desseauve D. Intrapartum care of women with COVID-19: A practical approach. Eur J Obstet Gynecol Reprod Biol 2020; 249: 94-5.
[http://dx.doi.org/10.1016/j.ejogrb.2020.04.018] [PMID: 32307204]
[65]
Singhal T, Sanabria AJ, Rigau D, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 47: 48-55.
[66]
Knight M, Bunch K, Vousden N, et al. UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107.
[http://dx.doi.org/10.1136/bmj.m2107] [PMID: 32513659]
[67]
Salvatore CM, Han JY, Acker KP, et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. Lancet Child Adolesc Health 2020; 4(10): 721-7.
[http://dx.doi.org/10.1016/S2352-4642(20)30235-2] [PMID: 32711687]
[68]
Boscia C. Skin-to-Skin Care and COVID-19. Pediatrics 2020; 146(2): e20201836.
[http://dx.doi.org/10.1542/peds.2020-1836] [PMID: 32430442]
[69]
Ortiz EI, Herrera E, De La TA. Coronavirus (Covid-19) infection in pregnancy. Colomb Med (Cali) 2020; 51(2): e4271.
[http://dx.doi.org/10.25100/cm.v51i2.4271] [PMID: 33012886]
[70]
Royal college of Paediatrics and Child Health. COVID-19-Guidance for paediatric services. 2020.
[71]
Centers for Disease Control and Prevention Centers for Disease Control and Prevention Pregnancy & Breastfeeding 2020.
[72]
Public Health England. Health chiefs encourage more pregnant women to get their COVID-19 vaccine 2021.
[73]
Covid-19 statistical report (Scotland), Coronavirus (COVID-19): Daily data for Scotland 2021.
[74]
COVID-19: The green book chapter 14a. Coronavirus (COVID-19) vaccination information for public health professionals. Public Health England.
[75]
Collier AY, McMahan K, Yu J, et al. Immunogenicity of COVID-19 mRNA vaccines in pregnant and lactating women. JAMA 2021; 325(23): 2370-80.
[http://dx.doi.org/10.1001/jama.2021.7563] [PMID: 33983379]
[76]
Shimabukuro TT, Kim SY, Myers TR, et al. CDC v-safe COVID-19 pregnancy registry team. Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med 2021; 384(24): 2273-82.
[http://dx.doi.org/10.1056/NEJMoa2104983] [PMID: 33882218]
[77]
Gray KJ, Bordt EA, Atyeo C, et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol 2021; 225(3): 303.e1-303.e17.
[http://dx.doi.org/10.1016/j.ajog.2021.03.023] [PMID: 33775692]
[78]
ARCS. CPD - association of reproductive and clinical scientists. Available from: https://www.arcscientists.org/
[79]
Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506: 145-8.
[http://dx.doi.org/10.1016/j.cca.2020.03.022] [PMID: 32178975]
[80]
Gavillet M, Rolnik DL, Hoffman MK, Panchaud A, Baud D. Should we stop aspirin prophylaxis in pregnant women diagnosed with COVID-19? Ultrasound Obstet Gynecol 2020; 55(6): 843-4.
[http://dx.doi.org/10.1002/uog.22063] [PMID: 32349165]
[81]
Thevathasan I, Said JM. Controversies in antenatal corticosteroid treatment. Prenat Diagn 2020; 40(9): 1138-49.
[http://dx.doi.org/10.1002/pd.5664] [PMID: 32157719]
[82]
Rosen T. Corticosteroids in the management of pregnant patients with coronavirus Disease (COVID-19). Obstet Gynecol 2021; 137(2): 378-9.
[http://dx.doi.org/10.1097/AOG.0000000000004272] [PMID: 33481518]
[83]
Horby P, Landray M, Haynes R, et al. Randomised evaluation of Covid-19 therapy (RECOVERY). EudraCT 2020; 6: 1-35.
[84]
McIntosh JJ. Corticosteroid guidance for pregnancy during COVID-19 pandemic. Am J Perinatol 2020; 37(8): 809-12.
[http://dx.doi.org/10.1055/s-0040-1709684] [PMID: 32274772]
[85]
Saito J, Yakuwa N, Takai C, et al. Tocilizumab concentrations in maternal serum and breast milk during breastfeeding and a safety assessment in infants: a case study. Rheumatology (Oxford) 2018; 57(8): 1499-501.
[http://dx.doi.org/10.1093/rheumatology/key091] [PMID: 29635528]
[86]
Nakajima K, Watanabe O, Mochizuki M, Nakasone A, Ishizuka N, Murashima A. Pregnancy outcomes after exposure to tocilizumab: A retrospective analysis of 61 patients in Japan. Mod Rheumatol 2016; 26(5): 667-71.
[http://dx.doi.org/10.3109/14397595.2016.1147405] [PMID: 26873562]
[87]
Hoeltzenbein M, Beck E, Rajwanshi R, et al. Tocilizumab use in pregnancy: Analysis of a global safety database including data from clinical trials and post-marketing data. Reprod Toxicol 2016; 46(2): 238-45.
[http://dx.doi.org/10.1016/j.reprotox.2010.05.061] [PMID: 27346577]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy