We thank Dr Al-Lami and colleagues for their interest regarding our work. In our case series of 54 pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we aimed to report the impact of coronavirus disease 2019 (COVID-19) on pregnancy and neonatal outcomes.1 However, our data are limited to answer the specific comments made by Dr Al-Lami and colleagues.
Correspondingly, we agree with the hypothesis that SARS-CoV-2 may induce specific placental vascular diseases and spontaneous prematurity. As our paper has been published online, 2 systematic reviews, including mainly retrospective and case reports studies, found an association of COVID-19 cases with meaningful rates of miscarriage, preterm birth, premature prelabor rupture of membranes, fetal growth restriction, perinatal death, and preeclampsia.2 , 3 Clinical evidence pointed to a correlation between COVID-19 and preeclampsia. Several papers published since January 2020 specifically reported cases of hypertensive disorders and/or preeclampsia associated with COVID-19 or even cases of patients that developed these pathologic conditions during the course of infection, leading to the concept of preeclampsia-like syndrome associated with COVID-19.4 Further studies are needed to confirm whether the hypothesis suggested by Dr Al-Lami and colleagues explains these complications.
At the initial phase of the epidemic, concerns about the use of corticosteroids, including antenatal administration of corticosteroids, have emerged as stated by Dr Al-Lami and colleagues but were not confirmed. In response to new data supporting the possible benefit of treatment with corticosteroids in patients with COVID-19, the American College of Obstetricians and Gynecologists guideline recommends that SARS-CoV-2 status should not alter decision-making regarding antenatal corticosteroid administration.5 Thus, without evidence suggesting adverse effects of antenatal glucocorticoids administration, we assume that their benefits overweight any theoretical risks.
Footnotes
L.S. carried out consultancy work and was a lecturer for Ferring Laboratories in the previous 3 years. The other author reports no conflict of interest.
No funding was received for this work.
References
- 1.Sentilhes L., De Marcillac F., Jouffrieau C., et al. Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Am J Obstet Gynecol. 2020;223:914.e1–914.e15. doi: 10.1016/j.ajog.2020.06.022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dashraath P., Wong J.L.J., Lim M.X.K., et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020;222:521–531. doi: 10.1016/j.ajog.2020.03.021. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Di Mascio D., Khalil A., Saccone G., et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2:100107. doi: 10.1016/j.ajogmf.2020.100107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Mendoza M., Garcia-Ruiz I., Maiz N., et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG. 2020;127:1374–1380. doi: 10.1111/1471-0528.16339. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.American College of Obstetricians and Gynecologists COVID-19 FAQs for obstetrician-gynecologists, obstetrics. https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics Available at: