Available medications used as potential therapeutics for COVID-19: What are the known safety profiles in pregnancy.
Identifieur interne : 000716 ( Main/Exploration ); précédent : 000715; suivant : 000717Available medications used as potential therapeutics for COVID-19: What are the known safety profiles in pregnancy.
Auteurs : Anick Bérard [Canada, France] ; Odile Sheehy [Canada] ; Jin-Ping Zhao [Canada] ; Evelyne Vinet [Canada] ; Caroline Quach [Canada] ; Behrouz Kassai [France] ; Sasha Bernatsky [Canada]Source :
- PloS one [ 1932-6203 ] ; 2021.
Abstract
BACKGROUND
Medications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source.
METHODS
Using the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998-2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations.
RESULTS
Of the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine (0.05%), 6,206 to azithromycin (2.70%), 230 to oseltamivir (0.10%), and 114 to HIV medications (0.05%). Adjusting for potential confounders, we observed an increased risk of prematurity related to dexamethasone (aOR 1.92, 95%CI 1.11-3.33; 15 exposed cases), anti-thrombotics (aOR 1.58, 95%CI 1.31-1.91; 177 exposed cases), and HIV medications (aOR 2.04, 95%CI 1.01-4.11; 20 exposed cases) use. An increased risk for LBW associated with anti-thrombotics (aOR 1.72, 95%CI 1.41-2.11; 152 exposed cases), and HIV medications (aOR 2.48, 95%CI 1.25-4.90; 21 exposed cases) use were also found. Gestational exposure to anti-thrombotics (aOR 1.20, 95%CI 1.00-1.44; 176 exposed cases), and HIV medications (aOR 2.61, 95%CI 1.51-4.51; 30 exposed cases) were associated with SGA. First-trimester dexamethasone (aOR 1.66, 95%CI 1.02-2.69; 20 exposed cases) and azithromycin (aOR 1.10, 95%CI 1.02-1.19; 747 exposed cases) exposures were associated with MCM.
CONCLUSIONS
Many available medications considered as treatments for COVID-19 are associated with adverse pregnancy outcomes. Caution is warranted when considering these medications during the gestational period.
DOI: 10.1371/journal.pone.0251746
PubMed: 34010282
Affiliations:
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Quach</name><affiliation wicri:level="1"><nlm:affiliation>Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Research Center, CHU Sainte-Justine, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Medicine, University of Montreal, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Kassai, Behrouz" sort="Kassai, Behrouz" uniqKey="Kassai B" first="Behrouz" last="Kassai">Behrouz Kassai</name><affiliation wicri:level="3"><nlm:affiliation>Faculty of Medicine, Université Claude Bernard, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Faculty of Medicine, Université 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Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Pharmacy, University of Montreal, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:affiliation>Faculty of Medicine, Université Claude Bernard, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Faculty of Medicine, Université Claude Bernard, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Sheehy, Odile" sort="Sheehy, Odile" uniqKey="Sheehy O" first="Odile" last="Sheehy">Odile Sheehy</name><affiliation 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Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Medicine, McGill University, Montreal, Quebec</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Quach, Caroline" sort="Quach, Caroline" uniqKey="Quach C" first="Caroline" last="Quach">Caroline Quach</name><affiliation wicri:level="1"><nlm:affiliation>Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Research Center, CHU Sainte-Justine, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Medicine, University of Montreal, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Kassai, Behrouz" sort="Kassai, Behrouz" uniqKey="Kassai B" first="Behrouz" last="Kassai">Behrouz Kassai</name><affiliation wicri:level="3"><nlm:affiliation>Faculty of Medicine, Université Claude Bernard, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Faculty of Medicine, Université Claude Bernard, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Bernatsky, Sasha" sort="Bernatsky, Sasha" uniqKey="Bernatsky S" first="Sasha" last="Bernatsky">Sasha Bernatsky</name><affiliation wicri:level="4"><nlm:affiliation>Faculty of Medicine, McGill University, Montreal, Quebec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Medicine, McGill University, Montreal, Quebec</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author></analytic><series><title level="j">PloS one</title><idno type="eISSN">1932-6203</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Medications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Using the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998-2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine (0.05%), 6,206 to azithromycin (2.70%), 230 to oseltamivir (0.10%), and 114 to HIV medications (0.05%). Adjusting for potential confounders, we observed an increased risk of prematurity related to dexamethasone (aOR 1.92, 95%CI 1.11-3.33; 15 exposed cases), anti-thrombotics (aOR 1.58, 95%CI 1.31-1.91; 177 exposed cases), and HIV medications (aOR 2.04, 95%CI 1.01-4.11; 20 exposed cases) use. An increased risk for LBW associated with anti-thrombotics (aOR 1.72, 95%CI 1.41-2.11; 152 exposed cases), and HIV medications (aOR 2.48, 95%CI 1.25-4.90; 21 exposed cases) use were also found. Gestational exposure to anti-thrombotics (aOR 1.20, 95%CI 1.00-1.44; 176 exposed cases), and HIV medications (aOR 2.61, 95%CI 1.51-4.51; 30 exposed cases) were associated with SGA. First-trimester dexamethasone (aOR 1.66, 95%CI 1.02-2.69; 20 exposed cases) and azithromycin (aOR 1.10, 95%CI 1.02-1.19; 747 exposed cases) exposures were associated with MCM.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Many available medications considered as treatments for COVID-19 are associated with adverse pregnancy outcomes. Caution is warranted when considering these medications during the gestational period.</p></div></front></TEI><pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">34010282</PMID><DateRevised><Year>2021</Year><Month>05</Month><Day>21</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1932-6203</ISSN><JournalIssue CitedMedium="Internet"><Volume>16</Volume><Issue>5</Issue><PubDate><Year>2021</Year></PubDate></JournalIssue><Title>PloS one</Title><ISOAbbreviation>PLoS One</ISOAbbreviation></Journal><ArticleTitle>Available medications used as potential therapeutics for COVID-19: What are the known safety profiles in pregnancy.</ArticleTitle><Pagination><MedlinePgn>e0251746</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0251746</ELocationID><Abstract><AbstractText Label="BACKGROUND">Medications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source.</AbstractText><AbstractText Label="METHODS">Using the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998-2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations.</AbstractText><AbstractText Label="RESULTS">Of the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine (0.05%), 6,206 to azithromycin (2.70%), 230 to oseltamivir (0.10%), and 114 to HIV medications (0.05%). Adjusting for potential confounders, we observed an increased risk of prematurity related to dexamethasone (aOR 1.92, 95%CI 1.11-3.33; 15 exposed cases), anti-thrombotics (aOR 1.58, 95%CI 1.31-1.91; 177 exposed cases), and HIV medications (aOR 2.04, 95%CI 1.01-4.11; 20 exposed cases) use. An increased risk for LBW associated with anti-thrombotics (aOR 1.72, 95%CI 1.41-2.11; 152 exposed cases), and HIV medications (aOR 2.48, 95%CI 1.25-4.90; 21 exposed cases) use were also found. Gestational exposure to anti-thrombotics (aOR 1.20, 95%CI 1.00-1.44; 176 exposed cases), and HIV medications (aOR 2.61, 95%CI 1.51-4.51; 30 exposed cases) were associated with SGA. First-trimester dexamethasone (aOR 1.66, 95%CI 1.02-2.69; 20 exposed cases) and azithromycin (aOR 1.10, 95%CI 1.02-1.19; 747 exposed cases) exposures were associated with MCM.</AbstractText><AbstractText Label="CONCLUSIONS">Many available medications considered as treatments for COVID-19 are associated with adverse pregnancy outcomes. Caution is warranted when considering these medications during the gestational period.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bérard</LastName><ForeName>Anick</ForeName><Initials>A</Initials><Identifier Source="ORCID">0000-0001-7535-5517</Identifier><AffiliationInfo><Affiliation>Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Faculty of Medicine, Université Claude Bernard, Lyon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sheehy</LastName><ForeName>Odile</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhao</LastName><ForeName>Jin-Ping</ForeName><Initials>JP</Initials><AffiliationInfo><Affiliation>Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vinet</LastName><ForeName>Evelyne</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, McGill University, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Quach</LastName><ForeName>Caroline</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kassai</LastName><ForeName>Behrouz</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, Université Claude Bernard, Lyon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bernatsky</LastName><ForeName>Sasha</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, McGill University, Montreal, Quebec, Canada.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>05</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS One</MedlineTA><NlmUniqueID>101285081</NlmUniqueID><ISSNLinking>1932-6203</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>12</Month><Day>21</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>04</Month><Day>30</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>5</Month><Day>19</Day><Hour>17</Hour><Minute>34</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>5</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>5</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34010282</ArticleId><ArticleId IdType="doi">10.1371/journal.pone.0251746</ArticleId><ArticleId IdType="pii">PONE-D-20-40139</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Canada</li><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Québec</li><li>Rhône-Alpes</li></region><settlement><li>Lyon</li><li>Montréal</li></settlement><orgName><li>Université McGill</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Berard, Anick" sort="Berard, Anick" uniqKey="Berard A" first="Anick" last="Bérard">Anick Bérard</name></noRegion><name sortKey="Berard, Anick" sort="Berard, Anick" uniqKey="Berard A" first="Anick" last="Bérard">Anick Bérard</name><name sortKey="Bernatsky, Sasha" sort="Bernatsky, Sasha" uniqKey="Bernatsky S" first="Sasha" last="Bernatsky">Sasha Bernatsky</name><name sortKey="Quach, Caroline" sort="Quach, Caroline" uniqKey="Quach C" first="Caroline" last="Quach">Caroline Quach</name><name sortKey="Quach, Caroline" sort="Quach, Caroline" uniqKey="Quach C" first="Caroline" last="Quach">Caroline Quach</name><name sortKey="Sheehy, Odile" sort="Sheehy, Odile" uniqKey="Sheehy O" first="Odile" last="Sheehy">Odile Sheehy</name><name sortKey="Vinet, Evelyne" sort="Vinet, Evelyne" uniqKey="Vinet E" first="Evelyne" last="Vinet">Evelyne Vinet</name><name sortKey="Zhao, Jin Ping" sort="Zhao, Jin Ping" uniqKey="Zhao J" first="Jin-Ping" last="Zhao">Jin-Ping Zhao</name></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Berard, Anick" sort="Berard, Anick" uniqKey="Berard A" first="Anick" last="Bérard">Anick Bérard</name></region><name sortKey="Kassai, Behrouz" sort="Kassai, Behrouz" uniqKey="Kassai B" first="Behrouz" last="Kassai">Behrouz Kassai</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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