Is it possible to reduce the rate of vertical transmission and improve perinatal outcomes by inclusion of remdesivir in treatment regimen of pregnant women with COVID–19?

Background Coronavirus disease 2019 (COVID–19) is currently one of the world's most critical health issues so far. Given the importance of appropriate treatment in pregnancy and the controversies about Remdesivir effectiveness and complications, the present study aimed to evaluate the impact of Remdesivir on maternal, fetal, and perinatal outcomes in pregnant women with COVID–19 diseases. Methods A total of 189 pregnant women with positive polymerase chain reaction (PCR) results for SARS–COV–2, and oxygen saturation [SpO2] of < 95%) were admitted to 12 hospitals affiliated with the Iran University of Medical Sciences from March 1 st , 2020 to June 7 th , 2021, namely the first four COVID-19 Picks in Iran. They were enrolled in this retrospective cohort study by census method and categorized into case and control groups, based on the inclusion of Remdesivir in their treatment protocol. Demographics, clinical outcomes, and pregnancy-related complications of the mothers and the neonates were compared between the two study groups. Results A comparison of 54 mothers in the case and 135 in the control group showed no demographic and clinical characteristics difference. Neonates whose mothers did not receive Remdesivir had a higher rate of positive PCR (10.2%), compared to the Remdesivir group (1.9%) with a relative risk of 0.91 reported for Remdesivir (95% CI: 0.85–0.98, P = 0.04); besides, Remdesivir resulted in fewer neonatal intensive care unit admission rates in mild/moderate COVID–19 group (RR = 0.32, 95% CI: 0.105–1.02, P = 0.03). Although neonatal death between the two groups was not statistically significant, from the clinical point seems important; 1(1.9%) in the case vs. 9(7.2%) in the control group. Interestingly LOS (Length of Stay) in the hospital was longer in the case group (median of 7 vs. 3 days; P < 0.0001). Conclusion The inclusion of Remdesivir in the treatment protocol of pregnant women with COVID–19 may reduce vertical transmission and improve perinatal outcomes, thus being suggested to be considered.