In the decision to utilize corticosteroids during the COVID-19 pandemic for pregnant women, the maternal risks and fetal benefits must be carefully weighted. Corticosteroids have been proven to have many neonatal benefits, and therefore have become common place for women at risk of premature delivery (23 to 36 weeks gestation). 

Hamilton College

The most commonly used drugs for immunomodulatory therapy are corticosteroids, which in COVID-19 patients can suppress the host immune system and delay viral clearance. Through the findings of two recent patient studies, it is now believed that corticosteroid usage is beneficial in severe cases of COVID-19 (particularly in patients with ARDS), not in patients with mild cases of COVID-19. Therefore, corticosteroids are only recommended for patients in critical conditions. 

The decision must still be made carefully even in critical cases of COVID-19 due to their potential negative side effects. There is no available data illustrating the success of corticosteroids in SARS-CoV or MERS. 

Corticosteroids and COVID-19

McIntosh J. J. (2020). Corticosteroid Guidance for Pregnancy during COVID-19 Pandemic. American journal of perinatology, 37(8), 809–812. https://doi.org/10.1055/s-0040-1709684
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356057/

Corticosteroid Guidance for Pregnancy during COVID-19 Pandemic 

- Glucocorticoids may help in preventing damage to the lungs from cytokine storms
- Glucocorticoids suppress the immune system
- Genomic and non genomic mechanisms
- GC, in the nucleus, prevents the transcription of white blood cells → lowers inflammation due to cytokines (genomic mechanism)
- GC → GC receptor → inhibits the function of phospholipase A2 → increase in lipocortin-1 → decreased production of lipids that aid in inflammation (non-genomic mechanism)
- However, they can negatively affect the formation of lymphocytes and take longer to get rid of the virus 
- Glucocorticoids can also increase the chances of a secondary infection

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