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Prakash Chandran (Host): Since COVID-19, questions surrounding the value of vaccination for those who are pregnant have cropped up. This is understandable since pregnancy can be a very delicate stage of life for mothers and babies. But what can we learn from past information that has been collected on vaccines and pregnancy? Here to talk to us about it is Dr. Lisa Oldham, an OBGYN for AMITA Health. This is AMITA HealthCast, the podcast from AMITA Health. I'm your host, Prakash Chandran. So first of all, Dr. Oldham, really great to have you on today. You know, we've been hearing so many things in the news and the media about vaccines and pregnancy. So, I wanted to start with a foundational question really. Is it safe to get a vaccine of any type for a woman that is pregnant or thinking of becoming pregnant?

Lisa Marie Oldham, MD (Guest): You know, Prakash, thank you for having me. And I really do appreciate that question because, while I do want everyone to understand that all vaccinations are safe, more or less, it's true that there are certain vaccinations that we should not give patients while they're pregnant. It's important to wait to get certain vaccinations or to get certain vaccinations before you're pregnant.

But there are some that shouldn't be given during pregnancy, and those tend to be the ones that are live attenuated vaccinations, or very new vaccinations that haven't really been studied or necessary in pregnancy.

Host: Okay. So I'm going to pick up off of that last thing that you said, relatively new vaccinations. Now, obviously we know this COVID-19 vaccine had that emergency use authorization. And so there has been a lot of hesitancy from people that are either pregnant or thinking about becoming pregnant for taking it just because of the reason that you just mentioned, what might you say to them?

Dr. Oldham: I would say that it's very important for us to remember that most of these vaccinations that we're concerned about that are most certainly, a vaccination that could cross the placenta, harm a baby, or those vaccinations that have a little live particle of a virus that's in the vaccination that could theoretically maybe harm a baby.

Most of the vaccinations that we have now, are not live attenuated vaccinations and very safe, not going over to the placenta and harm the baby and infect the baby, but rather just allows for antibodies of mom to cross over to our unborn babies. So, it's very important for us to recall that, coronavirus, the novel coronavirus is incredibly deadly, and incredibly infectious and it is absolutely worth taking this moment to know what we know is, most assuredly safe in the way that these vaccinations are made for pregnant women, in order to prevent more morbidity and mortality for pregnant women and their unborn children as well to help the greater community.

So, unfortunately in times like this, where we have pandemics. And we're trying to allow for herd immunity and to protect our communities and for our most vulnerable, it's these times where we actually have to use our science the way we should use our science. When we know something's going to be safe and it's going to be useful, it's important to do it now. On the flip a vaccination that prevents, for example, cervical cancer that doesn't need to be given during pregnancy. It can be given just after pregnancy. We can wait and administer that after pregnancy, because that's not an imminent danger or threat to us community-wide.

Host: I think that's very well said. One of the other things I wanted to move on to and ask you about is when someone who is pregnant receives a vaccination, are they just protecting themselves or is there actually benefit for the baby as well?

Dr. Oldham: All of the vaccinations that we request that our pregnant moms get during pregnancy are given for the protection of both mom and unborn child and newborn child, because if we recall, newborns, don't get vaccinations until two months and not all vaccinations. So if we can give, for example, mom a flu vaccination, or we really do recommend every pregnancy for moms to get also the Tdap, which includes tetanus, diptheria, and pertussis, every single pregnancy. Those all cause an immune response that allows for antibodies to be generated that do cross over to the baby, through the placenta. So yes, protection for both mom and baby with the vaccinations that we recommend during pregnancy, including what we think is going to be beneficial to newborn babies, with the COVID-19 vaccinations, same as true for them, we believe.

Host: Yeah. So Dr. Oldham, just speaking more generally about vaccinations. You also hear mixed things in the media about them, like, are they truly efficacious? Is it really needed? Obviously, we have this COVID-19 vaccine going on, that's obviously protecting people, but there are so many types of different vaccines. So I was wondering if you could just address or talk about vaccines in general.

Dr. Oldham: Sure. Many people who are anti-vaccination proponents believe that our own personal immunity is better than vaccinations. Believe that sanitation measures are better than vaccinations. But science has proven over and over again, that at the exact moment that a vaccination is introduced, the rates of those infectionsplummet. And it has just been seen through the centuries, that this is what happened. So while we want sanitation, while we want our own immunity to kick in, our own natural immunity is generally not better than vaccinations and science has proven that. So, it's hard change certain people's minds, but if you look at the science, the science tells the facts. So in terms of efficacy, I think they're efficacious. I think that they are absolutely necessary. And we have to remember, that this isn't just about local herd immunity. This is about populations and two to 3 million deaths are prevented worldwide each year with vaccinations, and if people actually took all recommended vaccinations, it's believed that like we'd probably prevent somewhere around 1.5 million deaths every single year. It would be important to remember that 33,000 kids would probably live every year if they were given the vaccinations worldwide, had access to the vaccinations worldwide, than die.

So, I'm a huge proponent of vaccinations. I think world health has changed significantly because of it and pregnant women are very vulnerable. So, it's really important that we get the word out that vaccinations are safe. Vaccinations should absolutely be used during pregnancy. And when we look at newborn babies, they're so vulnerable, just take, for example, pertussis, there's a resurgence of pertussis or whooping cough, and we can't explain all reasons why that is, but we do know that if we give the Tdap vaccination between 27 and 36 weeks, ideally, but really at any time, especially if mom is going to breastfeed, we can reduce the risk of pertussis, which is so deadly to newborns. They are so vulnerable to whooping cough until about six months, until they're fully vaccinated.

So these are just things that are really pretty simple that we can do to offer our populations, our pregnant moms and our baby's safety.

Host: So I want to expand on that a little bit. You mentioned obviously the Tdap vaccine and the prevention of whooping cough, or pertussis. What are the vaccine, I guess, programs or regimens that a pregnant woman should consider getting?

Dr. Oldham: So every pregnancy, the CDC, the American College of OBGYN and the American Association of Family Physicians recommend flu, influenza virus vaccination, not the nasal. The nasal is a live attenuated vaccine. So we don't give live attenuated vaccinations to pregnant women. So, the regular injection and the Tdap, which is tetanus, diptheria and pertussis.

And we're giving that because of the pertussis component of it. It doesn't come as a single vaccination. So this is the way we get it. And because of antibodies, pertussis, and once a person is immunized against pertussis, the antibodies drop gradually over time. So we feel in order to protect our babies, moms should get Tdap for the pertussis component of it, the whooping cough component, every single pregnancy.

And then lastly, of course, as you know, we do highly recommend that pregnant women get the COVID-19 vaccination and the booster.

Host: Okay, that's helpful. And I think you touched on this earlier, but can women get their vaccines at any time, like while they're pregnant or do you recommend that they get it beforehand?

Dr. Oldham: Okay. So it is really important that ideally, if a patient can talk with her obstetrician before she's pregnant to determine if she's behind in any of her vaccinations. Like for example, the MMR, a lot of people received their MMR when they were children. May not have gotten their booster and that measles component, potentially the Rubella component, which is German measles, which is highly problematic infection in pregnancy causes, birth defects, et cetera, et cetera.

If that vaccination, for example, has worn off, it should ideally be given at least six weeks before a woman tries to get pregnant because you can't get it during pregnancy. You can't take it during pregnancy. And we want the protection to baby and mom during and after pregnancy. So, MMR at least six weeks beforehand.

Okay. No chicken pox vaccinations during pregnancy. So she has not had chickenpox. She could certainly have a varicella vaccine, and we have ways of testing antibodies to see if a patient is immune or not, to these things. And then of course, if a patient is at risk for hepatitis B and she would like to be vaccinated for that prior to pregnancy, that would be acceptable too.

There's certain travel vaccinations, yellow fever, typhoid fever, Japanese encephalitis. Those are certain things that we generally wouldn't give during pregnancy. So again, beforehand or after. And only if at very high risk for these infections, would an obstetrician likely recommend that during pregnancy.

And that's pretty much it. If you have an opportunity to sit down and have preconceptual counseling with your obstetrician and you determine that you want to catch up on your vaccinations before trying, that's the best way. Otherwise, we often will recommend that, that these vaccinations can wait until after delivery.

Host: Now, one of the things that I wanted to move into was misconceptions that might be floating around out there. We hear so many different things and it's hard to know what to believe. You know, there are different media sources and just different things that we see on the internet. So, can you talk to maybe some of the most popular and damaging misconceptions and address them for us?

Dr. Oldham: So about vaccinations overall particularly. Well, there have always been anti-vaxxers ever since 1796 and Edward Jenner created the first well-known vaccine for smallpox. But the biggest American push away from vaccinations was I'd say, in the mid 1990s, where there was this concern over preservatives in certain vaccinations that many people felt were causing autism. And since then, no science really supports that association, but there were many campaigns against vaccinations, risk of autism in the mid to late 1990s, early 2000s. So that's one misconception that was very large in the United States, probably worldwide, but pretty, pretty big here. Another one is that there's certain preservatives that can cause toxicity of various different kinds, in addition to autism, just toxic to the body. There's really no risk of toxicity. Yes, there are some patients who very rarely can develop Guillain-Barré syndrome, which is a neurologic auto-immune issue. But it's very, very rare and the benefits of vaccination really outweigh the very rare risk of this occurring.

And so it's not widespread. I'm hearing a lot of COVID-19 related misconceptions, almost daily from pregnant and non-pregnant patients. Things like it can change my DNA. Did it make my period irregular? I feel like it's made my cramps worse. So, pretty serious concerns all the way down to, just sort of day to day is it causing me aches and pains? Am I getting headaches because of my COVID-19 vaccination? I wish I didn't get it. I'm hearing that all the time about the COVID-19 vaccination.

Host: Well, that kind of leads me to one of the final questions that I wanted to ask you, because there are so many misconceptions floating around. It almost feels scary to question your health provider about some of these concerns that you might have, because even if it is a misconception that you're hearing, you might take it as truth. And that it's a real concern for yourself. So, should you address that with your healthcare provider and how do you go about doing that?

Dr. Oldham: I think it's important that we do. I think that's one of the biggest tips that I can provide for patients all the time. We don't always have to have the exact same opinion about things when we meet in the exam room. It's important sometimes that we don't. There are times that patients will ask me questions that force me to educate myself more on a topic, because it may be that I just need to look more deeply into something, read a research paper, talk to colleagues, so on and so forth.

So I think the comfort zone comes in the conversation in elucidating all of the facts that we know to be true, because sometimes patients don't know facts. They may read something, they may see a blog. There's a lot of wrong information out there. So, I always ask patients to bring me what they're reading so I can see and kind of distill how they're processing something.

Because more than likely it's a legitimate fear, but we just need to talk about it. Where does it come from? What does it connect to? If a patient, for example, has a clotting disorder and they have questions about whether or not they should receive a J and J Janssen vaccine that has a very, very rare risk of clotting. Well, we should talk about that. Maybe we will come to a shared decision making moment where we agree that maybe Johnson and Johnson isn't going to be the one. So, there's different options for that particular patient. But I think that patients just really need to be bold and be very comfortable with communicating specifically what their concerns are so that we can kind of talk about what's facts, what may be fiction. And quite frankly, yes, there's certain things that we don't know.

Host: You know, I love the way you frame that comfort comes through conversations, especially respectful discussion. So Dr. Oldman, I really appreciate all your time here today. This has been a really informative conversation, I know for myself. Is there anything else that you wanted to leave our audience with today before we close?

Dr. Oldham: Well, the overwhelming success of certain vaccinations has made certain diseases rare. And that is the truth. And so, what I'm wondering and hoping that we will see that even COVID-19 is rare one day too. We just have to keep at it and we have to keep doing what we think is best to protect everybody, our neighbors, but also worldwide.

Host: Well, Dr. Oldman, I think that's the perfect place to end. Thank you so much for your time today.

Dr. Oldham: You're very welcome.

Host: Thanks for listening to AMITA HealthCast, the podcast from AMITA Health.

Prakash Chandran (Host): To learn more about Amita health, prenatal care, visit Amita health.org/baby. You can also find a primary care provider or OB GYN near you@ametahealth.org slash doctor.

Host: I'm Prakash Chandran. Stay well and we'll talk next time.