ritonavir and Stillbirth

To analyze the susceptibility of SARS-CoV-2 in pregnancy and the drugs that can be used to treat pregnancy with COVID-19, so as to provide evidence for drug selection in clinic. By reviewing the existing literature, this paper analyzes the susceptibility of pregnant women to virus, especially to SARS-CoV-2, from the aspects of anatomical, reproductive endocrine and immune changes during pregnancy and screens effective and fetal-safe treatments from the existing drugs. The anatomical structure of the respiratory system is changed during pregnancy, and the virus transmitted by droplets and aerosols is more easily inhaled by pregnant women and is difficult to remove. Furthermore, the prognosis is worse after infection when compared with non-pregnancy women. And changes in reproductive hormones and immune systems during pregnancy collectively make them more susceptible to certain infections. More importantly, angiotensin-converting enzyme (ACE)-2, the SARS-CoV-2 receptor, has been proven highly increased during pregnancy, which may contribute to the susceptibility to SARS-CoV-2. When it comes to treatment, specific drugs for COVID-19 have not been found at present, and taking old drugs for new use in treating COVID-19 has become an emergency method for the pandemic. Particularly, drugs that show superior maternal and fetal safety are worthy of consideration for pregnant women with COVID-19, such as chloroquine, metformin, statins, lobinavir/ritonavir, glycyrrhizic acid, and nanoparticle-mediated drug delivery (NMDD), etc. Pregnant women are susceptible to COVID-19, and special attention should be paid to the selection of drugs that are both effective for maternal diseases and friendly to the fetus. However, there are still many deficiencies in the study of drug safety during pregnancy, and broad-spectrum, effective and fetal-safe drugs for pregnant women need to be developed so as to cope with more infectious diseases in the future.

Topics: Angiotensin-Converting Enzyme 2; Anti-Inflammatory Agents; Antimalarials; Antiviral Agents; Basal Metabolism; Betacoronavirus; Cardiovascular Physiological Phenomena; Chloroquine; Congenital Abnormalities; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Disease Susceptibility; Drug Combinations; Drug Delivery Systems; Female; Functional Residual Capacity; Glycyrrhizic Acid; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypoglycemic Agents; Interferon Type I; Lopinavir; Metformin; Nanoparticles; Oxygen Consumption; Pandemics; Peptidyl-Dipeptidase A; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Progesterone; Prognosis; Respiratory Physiological Phenomena; Ritonavir; SARS-CoV-2; Spike Glycoprotein, Coronavirus; Stillbirth; Ventilation-Perfusion Ratio

Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period.. This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection.. This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection.

Topics: Acute Kidney Injury; Amphetamine-Related Disorders; Antiviral Agents; COVID-19; Drug Combinations; Erythrocyte Transfusion; Female; Hemoglobins; Humans; Hydroxychloroquine; Intensive Care Units; L-Lactate Dehydrogenase; Lopinavir; Methamphetamine; Plasmapheresis; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Purpura, Thrombotic Thrombocytopenic; Renal Dialysis; Ritonavir; SARS-CoV-2; Stillbirth; Tomography, X-Ray Computed; Young Adult

Angiogenic processes in the placenta are critical regulators of fetal growth and impact birth outcomes, but there are limited data documenting these processes in HIV-infected women or women from low-resource settings.. We sought to determine whether angiogenic factors are associated with adverse birth outcomes in HIV-infected pregnant women started on antiretroviral therapy.. This is a secondary analysis of samples collected as part of a clinical trial randomizing pregnant women and adolescents infected with HIV to lopinavir/ritonavir-based (n = 166) or efavirenz-based (n = 160) antiretroviral therapy in Tororo, Uganda. Pregnant women living with HIV were enrolled between 12-28 weeks of gestation. Plasma samples were evaluated for angiogenic biomarkers (angiopoietin-1, angiopoietin-2, vascular endothelial growth factor, soluble fms-like tyrosine kinase-1, placental growth factor, and soluble endoglin) by enzyme-linked immunosorbent assay between: 16-<20, 20-<24, 24-<28, 28-<32, 32-<36, 36-<37 weeks of gestation. The primary outcome was preterm birth.. In all, 1115 plasma samples from 326 pregnant women and adolescents were evaluated. There were no differences in angiogenic factors according to antiretroviral therapy group (P > .05 for all). The incidence of adverse birth outcomes was 16.9% for spontaneous preterm births, 25.6% for small-for-gestational-age births, and 2.8% for stillbirth. We used linear mixed effect modelling to evaluate longitudinal changes in angiogenic factor concentrations between birth outcome groups adjusting for gestational age at venipuncture, maternal age, body mass index, gravidity, and the interaction between treatment arm and gestational age. Two angiogenic factors-soluble endoglin and placental growth factor-were associated with adverse birth outcomes. Significantly higher concentrations of soluble endoglin throughout gestation were found in study participants destined to deliver preterm [likelihood ratio test, χ. An antiangiogenic state in the second or third trimester is associated with adverse birth outcomes, including stillbirth in women and adolescents living with HIV and receiving antiretroviral therapy.

Topics: Adult; Alkynes; Angiopoietin-1; Angiopoietin-2; Anti-HIV Agents; Benzoxazines; Biomarkers; Cyclopropanes; Drug Combinations; Endoglin; Female; HIV Infections; Humans; Infant, Newborn; Infant, Small for Gestational Age; Lopinavir; Neovascularization, Physiologic; Placenta Growth Factor; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Premature Birth; Ritonavir; Stillbirth; Uganda; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1