Potential Side Effects of Covid-19 Medicines on Mother and Baby (Fetus)
Pregnancy is a state when the woman’s immune system is partially suppressed and hence is more vulnerable to infections. Even mild influenza possesses a high risk of morbidity. Despite a year to the first incidence of coronavirus disease in Wuhan, there is little research available on the effects of covid on pregnant women's health and fetal development. No relation between pregnancy and increased susceptibility to covid has been drawn till now. However, contracting the disease during your pregnancy can increase the risk of severe illness, and pregnant women are likely to develop respiratory complications that require intensive care and ventilators. Some studies also claim that covid19 can cause premature birth and increase the risk of miscarriages. In this article, we shall look at six drugs commonly used for the disease’s treatment and their side effects.
Medication Used on Covid-19 Patients and Their Side Effects 1. REMDESIVIR ● ● ● ●
This was the first drug approved by the FDA to be used as an investigational anti-viral medication for SARS-CoV-2. It is a broad-spectrum anti-viral sold under the brand name Veklury and is given as an IV injection. Studies show it to inhibit the replication of other coronaviruses associated with high morbidity in human tissue cultures. It was studied under clinical trials to treat Ebola but showed a limited improvement, and the study was discontinued mid-way after morbidity of patients increased with use.
General side effects:
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Nausea and vomiting Chills or shivering Increased sweating Increased serum concentration of ALT or AST or both. Increased bilirubin
Rare side effects: ● ● ●
Increased hepatic enzymes Increased liver function tests Seizures
Side effects during pregnancy: ● ●
No studies have been done to show the effect of remdesivir on pregnancy and fetus. Pregnant patients who have been treated using remdesivir show no signs of increased birth defects or malformations or miscarriages.
2. DEXAMETHASONE ●
This is a corticosteroid that is used for its anti-inflammatory and immune suppressant effects. ● Severe covid-19 diseases occur due to the overreaction of our immune system leading to an exaggerated inflammatory response – the cytokine storm. ● This severe inflammatory response can be reduced by corticosteroids like dexamethasone and help improve symptoms. ● An interim guideline released by WHO in September 2020 recommends the use of corticosteroids either orally or given by IV for patients with severe or critical COVID19. General side effects: ● Swelling at the site of injection ● Vision changes ● Acne or dry skin ● Insomnia ● Slower wound healing ● Dizziness ● Nausea ● Stomach pain and bloating Rare side effects: ● Anaphylaxis (severe allergic reactions) ● Cushing syndrome (high levels of cortisol produced) ● Decreased calcium in the blood ● Myopathy ● Fat embolism Side effects during pregnancy: ● All the above-mentioned side effects can occur in pregnant women who are administered corticosteroids. ● Reduction in fetal movement ● Slower growth of fetus on prolonged and continuous use ● Affects osteogenesis
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Reduced birth weight on prolonged use
3. TOCILIZUMAB ●
This drug was originally developed to treat rheumatoid arthritis and systemic juvenile idiopathic arthritis. ● It was first approved by the FDA to be tested in phase 3 randomised, double blinded control trial called COVACTA in March and later also recommended by the ICMR for emergency COVID patients. General side effects: ● Runny nose ● Sore throat ● Sinus infection ● High blood pressure ● Headache ● Pain or swelling with itching at the site of injection Rare side effects: ● Gastrointestinal perforation ● Severe allergic reactions (anaphylaxis) ● Nervous system disorders ● Increased risk of cancer and heart stroke Side effects during pregnancy: ● All the above-mentioned side effects can be faced by a pregnant woman on tocilizumab. ● Lower birth weight of a baby ● Increased chances or preterm labour ● Pre-eclampsia ● Some studies claim that long-term use during pregnancy can cause slower brain development and behavioural problems in babies.
4. FAVIPIRAVIR ● ● ● ●
This is an oral antiviral drug used basically in Japan to treat influenza. It is usually used for the more severe form of influenza, not the seasonal infection. It acts by inhibiting the RNA Polymerase that is necessary for viral replication. It has been approved to be used for covid-19 treatments in some countries including India, Italy, Japan, etc. ● Not much research has been published about its general effects and other side effects. ● The only data available is about animal trials. Side effects during pregnancy: ● Teratogenicity ● Embryotoxic effects
5. CASIRIVIMAB AND IMDEVIMAB ● ●
Marketed as REGN- COV2, this is an antibody cocktail as it is made of a combination of two monoclonal antibodies. It has been reported to reduce viral load and relieve covid19 symptoms sooner than normal.
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Major benefit has been noticed in patients who had not yet developed their own antibodies. ● FDA issued a EUA for the joint use of casirivimab and imdevimab in moderate to mild covid patients in November 2020. They are given by IV injection. ● Due to the lack of sufficient data, the NIH has stated to consider neither of the above drugs as the standard treatment of COVID19. General side effects: ● Nausea and dizziness ● Headache ● Myalgia ● Vomiting ● Dyspnoea ● Hyperglycaemia ● Fever and chills Rare side effects: ● Pneumonia ● Intestinal obstructions ● Anaphylaxis ● Severe dizziness and trouble in breathing Side effects during pregnancy: ● All the side effects mentioned above can occur to a pregnant woman. ● There is insufficient data available to evaluate the risks of major birth defects, miscarriages or any other fetal outcomes. ● Advised to be avoided during pregnancy or practice as directed by the physician.
6. HYDROXYCHLOROQUINE AND CHLOROQUINE ● It is commonly used to treat or prevent malaria. Other uses include treatment for rheumatoid arthritis, lupus in patients whose condition has not been improved by routine treatments. ● FDA approved the emergency use of hydroxychloroquine and chloroquine on March 2020 for the treatment of adults and adolescents who are hospitalised by covid-19. ● Both FDA and NIH state that the drug should be used only under clinical settings and in the hospital. ● It might be working by reducing the immune system activity for lupus patients. This was expected to work for COVID19 as well. General side effects: ● Headache ● Dizziness ● Loss of appetite ● Nausea ● Diarrhea or stomach pain ● Vomiting ● Rash Rare side effects: ● Irregular heartbeats ● Drowsiness ● Difficulty in reading
● Blurred vision and sensitivity to light ● Difficulty in breathing or hearing ● Hair loss ● Convulsions Side effects during pregnancy: ● All the above-mentioned side effects can occur to the pregnant mother. ● It has been associated with increased fetal malformation. ● Increased risk of miscarriage. ● Ophthalmologic and otic toxicity has also been reported. ● Can pass to a suckling infant via breast milk and cause slower development and behavioural change.
Clearly, covid19 is going to take a long time to be eradicated and completely avoiding the disease is an impossible task. All we can do is to follow all the guidelines and take adequate precautions. None of the above-mentioned drugs are free of side effects or approved for standard use as a treatment. No information is yet available about the effects of COVID vaccines on pregnant women/ mom and baby. Hence, we recommend you to always discuss in detail about a treatment method before adopting it with your doctor. Reference: ● ● ● ● ● ● ● ● ●
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284138/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178925/ https://pubmed.ncbi.nlm.nih.gov/14613284/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305505/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599121/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750542/ https://www.ncbi.nlm.nih.gov/books/NBK564279/ https://pubmed.ncbi.nlm.nih.gov/33176367/ https://pubmed.ncbi.nlm.nih.gov/32417899/
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