Therapeutic opportunities for improving the course of coronavirus disease and reducing the frequency of gestional complications

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.62.8-13

Keywords:

coronavirus disease, COVID-19, gestational complications, progesterone, respiratory support, pregnancy

Abstract

Research objective: to study the clinical efficacy of the proposed treatment complex in pregnant women with coronavirus disease (COVID-19).
Materials and methods. 60 pregnant women with a moderate COVID-19 who were treated at the Kyiv City Center for Reproductive and Perinatal Medicine were examined and selected to assess the effectiveness of the proposed treatment. Pregnant women were divided into 2 clinical groups: the main group (n = 30) were prescribed treatment complex with progestin, the comparison group consisted of 30 pregnant women with COVID-19, who did not differ in age, sex, body mass index and received only standard drug therapy. Given the immunomodulatory effect, micronized progesterone was administered orally 200 mg three times a day immediately after hospitalization for 2 weeks, regardless of gestational age. Clinical manifestations, laboratory and instrumental indicators, duration of oxygen therapy and respiratory support, duration of hospital stay and intensive care were analyzed to assess the treatment complex.
Results. Therapeutic complex with progesterone helps to reduce the severity of respiratory disorders in pregnant women with COVID-19, the general condition of pregnant women improves faster and inflammatory changes in
the lungs regress. The positive dynamics of pulse oximetry indicators was noted. The frequency of the additional methods of respiratory support and transfer to the intensive care unit were lower, and a more rapid normalization of laboratory parameters was noted. Incidence of gestational complications (threats of pregnancy termination, placental insufficiency, fetal growth retardation and distress, oligohydramnios, premature birth and premature rupture of membranes) was lower against the background of treatment with progesterone, children status was better at birth. The need for oxygen therapy, the length of stay in the intensive care unit and the total length of hospitalization are significantly reduced when progesterone was prescribed for pregnant women with COVID-19.
Conclusions. The use of progesterone in pregnant women with coronavirus disease has a stabilizing effect, has no negative side effects which is significantly expands the scope of the proposed therapy in pregnant women at different stages of gestation.

Author Biographies

V.V. Kaminskyi, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine, head of the Obstetrics, Gynecology and Reproductology Department

R.O. Tkachenko, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, head of the Course of Obstetric Anesthesiology and Resuscitation, Department of Obstetrics, Gynecology and Reproductology

A.V. Kaminskyi, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, Department of Obstetrics, Gynecology and Reproductology

O.I. Zhdanovych, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, Department of Neonatology

L.I. Vorobei, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, associate professor, Department of Obstetrics, Gynecology and Reproductology

T.V. Kolomiichenko, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

PhD, chief researcher, Department of Obstetrics, Gynecology and Reproductology

O.I. Gervaziuk, P.L. Shupyk National Healthcare University of Ukraine; KNE “Kyiv City Center for Reproductive and Perinatal Medicine”, Kyiv

PhD, senior researcher, Department of Obstetrics, Gynecology and Reproductology;
Head of the Infectious Obstetrics Department

R.R. Tkachuk, P.L. Shupyk National Healthcare University of Ukraine; KNE “Kyiv City Center of Reproductive and Perinatal Medicine”, Kyiv

PhD, researcher, Obstetrics, Gynecology and Reproductology Department;
Head of the Obstetrical Department

S.I. Mudryi, “KROK” University of Economics and Law; KNE “Kyiv City Center of Reproductive and Perinatal Medicine”, Kyiv

PhD, associate professor, Department of State and Legal Disciplines;
Head of the Organizational and Methodological Department

References

  1. Alghamdi, I.G., Hussain, I.I., Almalki, S.S., et al. “The pattern of middle east respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health.” Int J Gen Med 7 (2014): 417–23. DOI: 10.2147/IJGM.S67061
  2. Alkhouli, M., Nanjundappa, A., Annie, F., et al. “Sex differences in case fatality rate of COVID-19: insights from a multinational registry.” Mayo Clin Proc 95.8 (2020): 1613–20.
  3. Breslin, N., Baptiste, C., Miller R., et al. “COVID-19 in pregnancy: early lessons.” Am J Obstet Gynecol 2.2 (2020): 100111. DOI: 10.1016/j.ajogmf.2020.100111
  4. Breslin, N., Baptiste, C., Gyamfi-Bannerman, C., et al. “COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.” Am J Obstet Gynecol MFM 2 (2020): 100118. DOI: 10.1016/j.ajogmf.2020.100118
  5. Chen, G., Wu, D., Guo, W., et al. “Clinical and immunological features of severe and moderate coronavirus disease 2019.” J Clin Invest 13.5 (2020): 2620–9.
  6. Chen, L., Li, Q., Zheng, D., et al. “Clinical characteristics of pregnant women with Covid-19 in Wuhan, China.” N Engl J Med 382.25 (2020): e100.
  7. Chousterman, B.G., Swirski, F.K., Weber, G.F. “Cytokine storm and sepsis disease pathogenesis.” Semin Immunopathol 39.5 (2017): 517–28.
  8. COVID-19 National Emergency Response Center, Epidemiology and Case Management Team, Korea Centers for Disease Control and Prevention. “Coronavirus disease-19: the first 7755 cases in the Republic of Korea.” Osong Public Health Res Perspect 11.2 (2020): 85–90. DOI: 10.24171/j.phrp.2020.11.2.05
  9. Ding, T., Zhang, J., Wang, T., et al. “Potential influence of menstrual status and sex hormones on female SARS-CoV-2 infection: a cross-sectional study from multicentre in Wuhan, China.” Clin Infect Dis 72.9 (2021): e240–8. DOI: 10.1093/cid/ciaa1022
  10. Docherty, A.B., Harrison, E.M., Green, C.A., et al. “Features of 16 749 hospitalised UK patients with COVID-19 using the ISARIC. WHO clinical characterisation protocol.” 369 (2020): 1985. DOI: 10.1136/bmj.m1985
  11. Gadi, N., Wu, S.C., Spihlman, A.P., Moulton, V.R. “What's sex got to do with COVID-19? Gender-based differences in the host immune response to coronaviruses.” Front Immunol 11 (2020): 2147.
  12. Gebhard, C., Regitz-Zagrosek, V., Neuhauser, H.K., et al. “Impact of sex and gender on COVID-19 outcomes in Europe.” Biology of Sex Differences 11.1 (2020): 29. DOI: 10.1186/s13293-020-00304-9
  13. Ghandehari, S., Matusov, Y., Pepkowitz, S., et al. “Progesterone in Addition to Standard of Care vs Standard of Care Alone in the Treatment of Men Hospitalized With Moderate to Severe COVID-19: A Randomized, Controlled Pilot Trial.” Chest 160.1 (2021): 74–84. DOI: 10.1016/j.chest.2021.02.024
  14. Global Health 50/50. “The COVID-19 Sex-Disaggregated Data Tracker.” Available from: [https://globalhealth5050.org/the-sex-gender-and-covid-19-project/the-data-tracker/].
  15. Grasselli, G., Zangrillo, A., Zanella, A., et al. “Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy.” JAMA 323.16 (2020): 1574–81.
  16. Guan, W.J., Ni, Z.Y., Hu, Y. “Clinical characteristics of coronavirus disease 2019 in China.” N Engl J Med 382.18 (2020): 1708–20.
  17. Hantoushzadeh, S., Shamshirsaz, A.A., Aleyasin, A., et al. “Maternal death due to COVID-19.” Am J Obstet Gynecol 223.1 (2020): 109.e1–16. DOI: 10.1016/j.ajog.2020.04.030
  18. Jin, J.-M., Bai, P., He, W., et al. “Gender Differences in Patients With COVID-19: Focus on Severity and Mortality.” Front Public Health 8 (2020): 152. DOI: 10.3389/fpubh.2020.00152
  19. Klein, S., Dhakal, S., Ursin, R., et al. “Biological sex impacts COVID-19 outcomes.” PLoS Pathog 16.6 (2020): e1008570.
  20. Mauvais-Jarvis, F., Bairey Merz, C.N., Barnes, P.J., et al. “Sex and gender: modifiers of health, disease, and medicine.” Lancet 396.10250 (2020): 565–82. DOI: 10.1016/S0140-6736(20)31561-0
  21. McGonagle, D., Sharif, K., O’Regan, A., Bridgewood, C. “The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease.” Autoimmun Rev 19.6 (2020): 102537.
  22. Mehta, P., McAuley, D.F., Brown, M., et al. “COVID-19: consider cytokine storm syndromes and immunosuppression.” Lancet 395.10229 (2020): 1033–4.
  23. Onder, G., Rezza, G., Brusaferro, S. “Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy.” JAMA 323.18 (2020): 1775–6.
  24. Petrilli, C.M., Jones, S.A., Yang, J. “Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study.” BMJ 369 (2020): 1966. DOI: 10.1136/bmj.m1966
  25. Richardson, S., Hirsch, J.S., Narasimhan, M., et al. “Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area.” JAMA 323.20 (2020): 2052–9.
  26. Tanaka, T., Narazaki, M., Kishimoto, T. “Immunotherapeutic implications of IL-6 blockade for cytokine storm.” Immunotherapy 8.8 (2016): 959–70.
  27. World Health Organization. WHO Coronavirus (COVID-19) Dashboard (2020). Available from: [https://covid19.who.int/].
  28. Wu, C., Wu, X., Yang, W., et al. “Clinical manifestation and laboratory characteristics of SARS-CoV-2 infection in pregnant women.” Virol Sin 35 (2020): 305–10.
  29. Ye, Q., Wang, B., Mao, J. “The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19.” J Infect 80.6 (2020): 607–13.

Published

2021-12-29

How to Cite

Kaminskyi, V., Tkachenko, R., Kaminskyi, A., Zhdanovych, O., Vorobei, L., Kolomiichenko, T., Gervaziuk, O., Tkachuk, R., & Mudryi, S. (2021). Therapeutic opportunities for improving the course of coronavirus disease and reducing the frequency of gestional complications. REPRODUCTIVE ENDOCRINOLOGY, (62), 8–13. https://doi.org/10.18370/2309-4117.2021.62.8-13

Issue

Section

Treatment of infertility and pregnancy

Most read articles by the same author(s)