(304) Prevalence of medication use for COVID-19 treatment in pregnancy: a two-stage individual patient data meta-analysis combining international registries.

Background: Pregnant women infected with SARS-CoV-2 are at higher risk of severe maternal comorbidities and mortality than nonpregnant women. There are few data on the real-world utilization of medications to treat COVID-19 in pregnancy.

Objectives: To estimate the prevalence of use of medications for COVID-19 treatment in pregnancy stratified by trimester, hospitalization and country.

Methods:

Design: Two-stage individual patient data meta-analysis using primary data on medications used for COVID-19 in pregnancy.
Setting: Nine study sites covering 27 countries with data on pregnant inpatients and outpatients with COVID-19 between February 2020 and October 2022 were included: Centers for Disease Control and Prevention (Surveillance for Emerging Threats to Pregnant People and Infants; SET-NET), COVI-PREG, five study sites centralized by George Washington University and two Saudi Arabian sites.
Exposure: Any pregnant women with at least one medication administered to treat COVID-19 were considered to be exposed.
Main outcome measures: Prevalence of medication use for COVID-19 treatment was defined as the proportion of patients exposed during pregnancy to one medication divided by the total number of included pregnancies.
Statistical analysis: A common data model was used to pool the data from the nine datasets in a meta-analysis of proportions using a random effects model. The fraction of variance due to heterogeneity was estimated by the statistic I^2.

Results: Among 24,937 pregnant women, the pooled proportions of medications received to treat COVID-19 were as follows: 9.8% antibiotics (95% confidence interval [95%CI] 3.7-23.7%; I2=99%), 2.2% antivirals (95%CI 0.8-6.5%; I2=99%), 0.8% antimalarials (95%CI 0.5-1.4%; I2=81%), 4.9% corticosteroids (95%CI 0.2-11.8%; I2=99%), 34.7% heparin (95%CI 28.0-42.1%; I2=99%), 0.18% immunosuppressants (95% CI 0.02-1.35%; I2=90%), 0.26% convalescent plasma (95%CI 0.02-2.72; I2=97%), and 0.02% monoclonal antibodies (95%CI 0.01-0.10; I2=42%). Prevalence was much higher in inpatients than in outpatients: 26.9% versus 5.8% for antibiotics, 10.3% versus 0.3% for antivirals, 4.5% versus 0.1% for antimalarials, 17.5% versus 0.1% for corticosteroids and 58.4% versus 22.3% for heparin. The prevalence of use of any medication was lower in the first trimester of pregnancy. The proportions of medication use differed widely across countries.

Conclusions: Medications to treat COVID-19 were used more frequently in pregnant women hospitalized for COVID-19 as primary diagnosis. However, the prevalence of use was low in the first trimester of pregnancy. The disparity in use between countries is a cause for concern, as it could reflect uneven management during the pandemic.