Heilongjiang University of Chinese Medicine, Harbin, 150040, China.
Zhejiang Chinese Medical University, Hangzhou, 310053, China.
Eur J Clin Microbiol Infect Dis. 2020 Jul;39(7):1209-1220. doi: 10.1007/s10096-020-03897-6. Epub 2020 Apr 23.
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.
分析 SARS-CoV-2 在妊娠中的易感性以及治疗 COVID-19 妊娠的可用药物，为临床药物选择提供依据。通过回顾现有文献，从妊娠期间解剖学、生殖内分泌和免疫变化方面分析孕妇对病毒（尤其是 SARS-CoV-2）的易感性，并从现有药物中筛选有效且对胎儿安全的治疗方法。妊娠期间呼吸系统的解剖结构发生变化，飞沫和气溶胶传播的病毒更容易被孕妇吸入且难以排出。此外，感染后的预后较非妊娠女性更差。妊娠期间生殖激素和免疫系统的变化使她们更容易受到某些感染。更重要的是，已证实妊娠期间血管紧张素转换酶（ACE）-2 即 SARS-CoV-2 受体大量增加，这可能导致对 SARS-CoV-2 的易感性。在治疗方面，目前尚未发现 COVID-19 的特定药物，用治疗 COVID-19 的新药治疗旧病已成为应对大流行的紧急方法。特别值得考虑对 COVID-19 孕妇使用具有优越母婴安全性的药物，如氯喹、二甲双胍、他汀类药物、洛匹那韦/利托那韦、甘草酸和纳米颗粒介导的药物递送（NMDD）等。孕妇易感染 COVID-19，应特别注意选择既对母体疾病有效又对胎儿友好的药物。然而，妊娠期间药物安全性的研究仍存在许多不足，需要开发广谱、有效且对胎儿安全的孕妇用药，以应对未来更多的传染病。
