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"Pregnant women need to be protected against COVID-19, and our study provides a safe and readily available prevention strategy for mother and baby."
SAN FRANCISCO, CA, January 27, 2021 /24-7PressRelease/ -- COVID-19 has been linked to severe complications in pregnancy including preterm delivery, fetal demise, respiratory failure and maternal death. A peer-reviewed report published in the prestigious International Journal of General Medicine examines a safe and effective way to avoid these maternofetal complications. The study is available at https://www.dovepress.com/articles.php?article_id=61495.
The report entitled "Pre-Exposure Prophylaxis for COVID-19 in Pregnant Women" was written by nurse practitioner Melissa Fesler and internist Raphael Stricker from the Alan E. Beer Medical Center for Reproductive Immunology in Los Gatos, CA, and Union Square Medical Associates in San Francisco, CA. The authors have extensive experience treating patients with recurrent miscarriages and recently published a proposal for prevention of SARS-CoV-2, the viral agent of COVID-19, using pre-exposure prophylaxis (PrEP) (https://www.dovepress.com/articles.php?article_id=58280).
The PrEP approach to prevent COVID-19 focuses on hydroxychloroquine (HCQ). This antimicrobial agent was originally promoted for treatment of severe SARS-CoV-2 infection using high daily doses in combination with other medications. HCQ appeared to have antiviral efficacy based on reports from France and the United States, but larger studies showed limited efficacy in patients who were already infected with or exposed to SARS-CoV-2. The fact that HCQ treatment became politicized added to the controversy over its value for COVID-19 therapy.
In the latest report, the authors emphasize that HCQ works best if given prior to viral infection or exposure. The medication is approved by the FDA and safe for use in pregnancy, and it has been a mainstay of malaria prophylaxis for decades in limited weekly dosing. It is also cheap and readily available if dosing is kept to a minimum. Other potential PrEP medications such as ivermectin are not considered safe for use in pregnancy. Although protective COVID-19 vaccines have been developed, the safety and efficacy of these novel vaccines has not been tested in pregnant women.
"We realized that HCQ could be safely used to prevent viral complications in pregnancy," says Fesler. "We may not be able to avoid infection completely with this approach, but in the absence of a vaccine we hope to prevent severe maternofetal problems caused by COVID-19."
A weekly dose of HCQ is effective for malaria prevention in pregnancy, and the authors postulate that a similar regimen would prevent COVID-19 in pregnant women. Six international cohort studies covering almost 400,000 people support this approach for HCQ PrEP, and two randomized controlled trials in the United States found that 1,053 healthcare workers using HCQ PrEP had no hospitalizations, no deaths and no cardiac complications. Furthermore, once-weekly HCQ dosing appeared to work as well as twice-weekly or daily dosing. Unfortunately the studies were terminated prematurely because of the controversy over HCQ.
"Although COVID-19 vaccines would be great for pregnant women, the safety and efficacy of these new vaccines in pregnancy is unknown," says Stricker. "Pregnant women need to be protected against COVID-19, and weekly HCQ PrEP provides a safe and readily available prevention strategy for mother and baby."
The Alan E. Beer Medical Center for Reproductive Immunology is a medical specialty practice that treats women with recurrent pregnancy loss and pregnancy failure. Union Square Medical Associates is an internal medicine practice that specializes in the treatment of tick-borne diseases.
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