Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review

The treatment of COVID-19 is particularly critical in pregnant women, considering the potential teratogenic effects of antiviral agents and the immune-depression related with pregnancy. The aim of this review is to systematically examine the current evidence on the clinical use of convalescent plasma during pregnancy. The electronic databases Medline PubMed Advanced Search Builder, Scopus, Web Of Science and Google Scholar were searched (until 1 January 2021). Inclusion criteria were pregnant women with COVID-19 (or SARS-CoV-2 infection), in whom convalescent plasma (or hyperimmune plasma) was used as treatment. We searched clinical trial registries (censored 5 January 2021) for eligible studies under way. After elimination of duplications, the initial search yielded 79 potentially relevant records, of which 67 were subsequently excluded. The 12 remaining records were case reports involving 12 pregnancies. Six of the mothers were reported to be well, two were reported to have preeclampsia, and in one case each the maternal outcome was described as survival, clinical improvement, discharged with oxygen and rehabilitation. With regard to the neonates, two were declared to be well, four had transient morbidity, two were critically ill and one died; normal ongoing pregnancies, but no post-delivery information, were reported for the remaining three cases. Clinical trials under way or planned to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. This is the first systematic review of the literature regarding the treatment of COVID-19 in pregnancy. The published literature data seem to indicate that convalescent plasma administered to pregnant women with severe COVID-19 provides benefits for both the mother and the fetus. The quality of the available studies is, however, very limited since they are all case reports and thus suffer from relevant reporting bias

Adipose tissue inflammation during acute colitis.

<p>(A) Colons and adipose tissue [mesenteric (MAT), epididymal (EAT), and subcutaneous (SAT)] from mice sacrificed at Day 0 and Day 7 (<i>n</i> = 4 per timepoint) were analyzed for relative mRNA expression of TNF-α, IL-1β, and IL-6. Target gene expression was normalized to HPRT gene expression; fold change was calculated relative to mean SAT expression at Day 0. Data represent mean ± SD. ***<i>P</i><0.001, **<i>P</i><0.01, *<i>P</i><0.05 vs. Day 0 of the same tissue; †††<i>P</i><0.001, ††<i>P</i><0.01 vs. EAT and SAT at Day 7; ###<i>P</i><0.001 vs. MAT at Day 7. (B) H&E stained sections of formalin-fixed MAT, EAT, and SAT from Day 0 and Day 7 of experimental colitis were compared (<i>n</i> = 5 per time point). Representative images are shown (original magnification × 400; arrowhead  =  mononuclear infiltrates; thick arrow  =  fibrotic connective tissue; thin arrow  =  adipocytes).</p

Development and progression of experimental colitis.

<p>Male, 6 month-old C57BL/6 mice (<i>n</i> = 20) were exposed to 2% DSS in drinking water for up to 5 days. Mice were sacrificed at Day 0, 3, 7, and 14 of the experimental period (<i>n</i> = 5 per time point). (A) Daily body weight of mice sacrificed at Day 14; mice sacrificed at earlier time points followed a similar pattern. <i>*P</i><0.05 compared to initial body weight on Day 0. (B) Disease Activity Index (DAI) was calculated at the time of sacrifice based on weight loss, stool blood, and stool consistency. (C) Colons were excised and measured lengthwise. (D) H&E stained sections were graded for Histologic Severity Score. (E) Representative images of colon histology on Day 0, 3, 7, and 14 (original magnification × 100; arrowhead  =  mononuclear infiltrates, thick arrow  =  mucosal ulceration, thin arrow  =  epithelial hyperplasia). Data represent mean ± SD, <i>***P</i><0.001, <i>*P</i><0.05 vs. Day 0.</p