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Covid-19 and Pregnancy
So you're pregnant and worried about the vaccine? It's only natural. Dr. Spencer Kuper explores the correlation between the COVID-19 vaccine and pregnancy, therapies, and what to anticipate if you get the virus.
Featuring:
Learn more about Spencer Kuper, MD, FACOG
Spencer Kuper, MD, FACOG
Spencer Kuper, MD, FACOG is a Maternal Fetal Medicine Specialist at Tri-State Perinatology.Learn more about Spencer Kuper, MD, FACOG
Transcription:
Deborah Howell: So you're pregnant and concerned about the COVID-19 virus. It's only natural. So let's talk about vaccination therapies and what to anticipate if you get the virus. I'm Deborah Howell, and our guest today is Dr. Spencer Kuper, a maternal fetal medicine specialist at Tri-State Perinatology. Welcome, Dr. Kuper.
Dr. Spencer Kuper: Thank you. It's good to be here.
Deborah Howell: Such a pleasure. So, you know, you hear so much in the news and online and everyone in the world wants to know the truth, should pregnant women get the COVID-19 vaccine?
Dr. Spencer Kuper: Absolutely. This is something that we all maternal fetal medicine subspecialists in our field as well as in our practice and our OB-GYN providers all believe strongly that all pregnant women should receive the COVID-19 vaccine.
Deborah Howell: And I noticed that you said all.
Dr. Spencer Kuper: Absolutely. There are very few, if any, contraindications to the vaccination. Anyone that has concerns about a potential medical condition, we would love to talk to them further. But I can tell you that nearly all women should receive the COVID-19 vaccine.
Deborah Howell: Got it. Now, does the vaccine actually cross the placenta?
Dr. Spencer Kuper: That's a really good question. And that was the initial concern. And I think that led to hesitancy of some people of avoiding the vaccine during pregnancy. But studies have shown and expert societies have agreed that the vaccine does not cross the placenta and therefore does not reach the baby.
Deborah Howell: That is awesome news. This vaccine just keeps getting better and better, right?
Dr. Spencer Kuper: Correct. We're lucky.
Deborah Howell: Exactly. Now, is there a best time during pregnancy to get the COVID-19 vaccine?
Dr. Spencer Kuper: I have that conversation with my patients often. And I tell them the earliest, the better. Certainly, if someone's considering pregnancy, they should get the vaccine before pregnancy, so that they're protected. The vaccine has been shown not to affect fertility and therefore they don't have to worry about potential infertility being a concern of the vaccine. But if they're in the first trimester and they're not vaccinated, I would recommend the patient receive the vaccine as soon as possible.
Deborah Howell: Okay. And which brand of vaccine should a pregnant woman choose?
Dr. Spencer Kuper: Really, it comes down to which one they're most comfortable with. The Moderna or Pfizer are the vaccine brands that I typically discuss with my patients. The Johnson & Johnson initially was paused by the Food and Drug Administration for a short period of time for concern of a rare blood clotting disorder and this was mainly in reproductive age women. While this was only 30 cases out of 6 million, it was cause for concern. This is exceedingly rare. And if your only option is Johnson & Johnson, I would say get the Johnson & Johnson. If you're given all three options, because of that exceedingly rare complication and because that can be a big deal, I would tell my patients that they have the option of Moderna or Pfizer, to pick one of those two. But again, any vaccine is better than no vaccine. And if a patient's only option is Johnson & Johnson, I would tell them to receive that vaccine.
Deborah Howell: Understood. Now, if a pregnant woman understands that the vaccine is recommended, but wants to wait to receive the vaccine until after delivery, how can she protect herself and her family in the meantime?
Dr. Spencer Kuper: So the best way is to use for family to cocoon around her and really form that cocoon and protect her. So every family member should be vaccinated so that therefore any contact point that she has is going to be vaccinated and decrease her risk of being exposed to the virus. Additionally, mask wearing at all times when she's out in public or around anyone potentially that is not in that cocooning family member to decrease her risk of being exposed to the virus.
Deborah Howell: I know the vaccine is one thing. What about the booster?
Dr. Spencer Kuper: So I think the booster is something for all pregnant women who are eligible. So what that means is six months from their initial vaccine completion series, that they're eligible for the booster. The reason they should get that, and I do recommend that for all eligible pregnant women to receive that, the reason is that studies have shown that we lose our protection against getting infected to the COVID-19 vaccine.
So while the vaccines are still incredibly effective at preventing severe disease, we lose that effectiveness against actually being infected. So I do recommend that pregnant women receive the booster as soon as they're eligible. So that would be six months from completion of their dose so that they're protected against not getting the COVID-19 infection.
Deborah Howell: And this is because, you know, our ability to fight the disease wanes after a certain amount of time. Correct?
Dr. Spencer Kuper: That's exactly right. So we lose our antibody response. So if we're exposed to the virus, the ability of our body to say, "This doesn't belong, I need to fight this and remove it from my body," so if we lose that ability, our body still remembers how to fight the virus. We still remember how to mount that immune response and prevent the severe disease. But ultimately, we want to prevent ourselves from getting sick and that's what the booster is going to allow us to do.
Deborah Howell: Okay. So now you've gotten a positive test, what are the current treatment strategies being used for pregnant women who are infected with COVID-19?
Dr. Spencer Kuper: So if you have a positive test, what I would recommend, even if you're feeling well, I would recommend notifying your obstetrical provider, so that your obstetrical provider can be aware that you're positive and that his or her office can be checking in on you and to make sure you're doing okay.
Additionally, in our office, we do start patients on a certain vitamin cocktail that to hopefully boost their immune. Additionally, there's now the use of monoclonal antibodies. And the name of that, the commonly used is called Regeneron or Regen-COV and the monoclonal antibodies help prevent severe disease, so help prevent hospitalization. For those patients that are infected within 14 days of symptom onset, we do recommend that pregnant patients receive the monoclonal antibody to decrease the risk of hospitalization.
Deborah Howell: This is probably one of the only cocktails you would recommend to pregnant women, right?
Dr. Spencer Kuper: One-hundred percent. You know, you read a lot in the media on social media of ivermectin or hydroxychloroquine. I cannot express to you strongly enough that we strongly advise against pregnant women receiving ivermectin or hydroxychloroquine.
Deborah Howell: All right, the big day is finally here. What strategies are being used to keep pregnant women and their babies safe when they're admitted for delivery?
Dr. Spencer Kuper: We take this exceedingly serious at The Women's Hospital here at Deaconess. We have a universal mask mandate, so that every single provider and every single support person that you come in contact to here will be wearing a mask at all times to protect you. And in that same manner, we ask you and your support person to also wear a mask to help protect us and help protect the other patients. We also have a vaccine mandate among our staff so that our staff is fully vaccinated against COVID-19 to protect you, your care person and also your baby.
Deborah Howell: And are all women who are being admitted being tested for COVID-19?
Dr. Spencer Kuper: No, there are some centers that initially started that in the beginning of the pandemic. Our center does not test women unless they're symptomatic. If you're symptomatic, that certainly is something that we would discuss with you. But we do not universally test all women if they're admitted to The Women's Hospital.
Deborah Howell: Okay. Now, should pregnant women be tested before a scheduled admission?
Dr. Spencer Kuper: That's a good question and a good thought. We don't traditionally recommend that people be tested before they come in for a scheduled admission for obstetrics. However, if you're more comfortable being tested, you and your care person, certainly that's something that we would support and we could help you find a location that could help you be tested.
Deborah Howell: Okay, so you have your baby, you're in the hospital. You have a million things going through your mind, you know, so many tasks with your new child. Can a newly postpartum woman be given the COVID-19 vaccine before discharged, so she doesn't have to worry about that?
Dr. Spencer Kuper: We can make this easy for you. Just like your flu vaccine, before you leave the hospital, we can give you the COVID-19 vaccine.
Deborah Howell: Awesome. That's so good. Now, can a mom who just received the vaccine breastfeed?
Dr. Spencer Kuper: Absolutely. There is thought that the vaccine, as you make the antibodies to the COVID-19 virus, that your antibodies are going to cross through your breast milk to the baby so that your baby's going to get protection just like baby does. And that's why you get the Tdap shot at 28 weeks, so you make that immune response and you protect your baby against the whooping cough. You will protect your baby against COVID-19 as well.
Deborah Howell: Great. Now what's something you wish pregnant women understood about COVID-19?
Dr. Spencer Kuper: The number one thing that I wish pregnant women understood about COVID-19 that this is an exceedingly serious virus that affects pregnant women disproportionately to the non-pregnant population.
In our nearly two years of the pandemic, we have admitted nearly 80 women with COVID-19. These women were exceedingly sick and the vaccine is something that could have prevented hospitalization and also prevented severe disease in these women. We have a way to prevent women from getting sick and potentially babies from being exposed to complications. And I would strongly encourage women to receive the vaccine.
Deborah Howell: Boy, you sound like a wonderful advocate for women. What's the best part about your job, Dr. Kuper?
Dr. Spencer Kuper: The best part is that I get invited into the most special time of a person's life. And that I can help that person to just enjoy this special time to deliver safe care and to just be a part of this joyous occasion.
Deborah Howell: Well, I've just really loved being a part of this conversation. Just wonderful. Excellent information, Dr. Kuper. Thanks for your expertise and for being with us today.
Dr. Spencer Kuper: Thank you.
Deborah Howell: This is The Women's Hospital, a place for all your life. For more information, head on over to deaconess.com/tsp. Please remember to subscribe, rate and review this podcast and all the other Deaconess Women's Hospital podcasts. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.
Deborah Howell: So you're pregnant and concerned about the COVID-19 virus. It's only natural. So let's talk about vaccination therapies and what to anticipate if you get the virus. I'm Deborah Howell, and our guest today is Dr. Spencer Kuper, a maternal fetal medicine specialist at Tri-State Perinatology. Welcome, Dr. Kuper.
Dr. Spencer Kuper: Thank you. It's good to be here.
Deborah Howell: Such a pleasure. So, you know, you hear so much in the news and online and everyone in the world wants to know the truth, should pregnant women get the COVID-19 vaccine?
Dr. Spencer Kuper: Absolutely. This is something that we all maternal fetal medicine subspecialists in our field as well as in our practice and our OB-GYN providers all believe strongly that all pregnant women should receive the COVID-19 vaccine.
Deborah Howell: And I noticed that you said all.
Dr. Spencer Kuper: Absolutely. There are very few, if any, contraindications to the vaccination. Anyone that has concerns about a potential medical condition, we would love to talk to them further. But I can tell you that nearly all women should receive the COVID-19 vaccine.
Deborah Howell: Got it. Now, does the vaccine actually cross the placenta?
Dr. Spencer Kuper: That's a really good question. And that was the initial concern. And I think that led to hesitancy of some people of avoiding the vaccine during pregnancy. But studies have shown and expert societies have agreed that the vaccine does not cross the placenta and therefore does not reach the baby.
Deborah Howell: That is awesome news. This vaccine just keeps getting better and better, right?
Dr. Spencer Kuper: Correct. We're lucky.
Deborah Howell: Exactly. Now, is there a best time during pregnancy to get the COVID-19 vaccine?
Dr. Spencer Kuper: I have that conversation with my patients often. And I tell them the earliest, the better. Certainly, if someone's considering pregnancy, they should get the vaccine before pregnancy, so that they're protected. The vaccine has been shown not to affect fertility and therefore they don't have to worry about potential infertility being a concern of the vaccine. But if they're in the first trimester and they're not vaccinated, I would recommend the patient receive the vaccine as soon as possible.
Deborah Howell: Okay. And which brand of vaccine should a pregnant woman choose?
Dr. Spencer Kuper: Really, it comes down to which one they're most comfortable with. The Moderna or Pfizer are the vaccine brands that I typically discuss with my patients. The Johnson & Johnson initially was paused by the Food and Drug Administration for a short period of time for concern of a rare blood clotting disorder and this was mainly in reproductive age women. While this was only 30 cases out of 6 million, it was cause for concern. This is exceedingly rare. And if your only option is Johnson & Johnson, I would say get the Johnson & Johnson. If you're given all three options, because of that exceedingly rare complication and because that can be a big deal, I would tell my patients that they have the option of Moderna or Pfizer, to pick one of those two. But again, any vaccine is better than no vaccine. And if a patient's only option is Johnson & Johnson, I would tell them to receive that vaccine.
Deborah Howell: Understood. Now, if a pregnant woman understands that the vaccine is recommended, but wants to wait to receive the vaccine until after delivery, how can she protect herself and her family in the meantime?
Dr. Spencer Kuper: So the best way is to use for family to cocoon around her and really form that cocoon and protect her. So every family member should be vaccinated so that therefore any contact point that she has is going to be vaccinated and decrease her risk of being exposed to the virus. Additionally, mask wearing at all times when she's out in public or around anyone potentially that is not in that cocooning family member to decrease her risk of being exposed to the virus.
Deborah Howell: I know the vaccine is one thing. What about the booster?
Dr. Spencer Kuper: So I think the booster is something for all pregnant women who are eligible. So what that means is six months from their initial vaccine completion series, that they're eligible for the booster. The reason they should get that, and I do recommend that for all eligible pregnant women to receive that, the reason is that studies have shown that we lose our protection against getting infected to the COVID-19 vaccine.
So while the vaccines are still incredibly effective at preventing severe disease, we lose that effectiveness against actually being infected. So I do recommend that pregnant women receive the booster as soon as they're eligible. So that would be six months from completion of their dose so that they're protected against not getting the COVID-19 infection.
Deborah Howell: And this is because, you know, our ability to fight the disease wanes after a certain amount of time. Correct?
Dr. Spencer Kuper: That's exactly right. So we lose our antibody response. So if we're exposed to the virus, the ability of our body to say, "This doesn't belong, I need to fight this and remove it from my body," so if we lose that ability, our body still remembers how to fight the virus. We still remember how to mount that immune response and prevent the severe disease. But ultimately, we want to prevent ourselves from getting sick and that's what the booster is going to allow us to do.
Deborah Howell: Okay. So now you've gotten a positive test, what are the current treatment strategies being used for pregnant women who are infected with COVID-19?
Dr. Spencer Kuper: So if you have a positive test, what I would recommend, even if you're feeling well, I would recommend notifying your obstetrical provider, so that your obstetrical provider can be aware that you're positive and that his or her office can be checking in on you and to make sure you're doing okay.
Additionally, in our office, we do start patients on a certain vitamin cocktail that to hopefully boost their immune. Additionally, there's now the use of monoclonal antibodies. And the name of that, the commonly used is called Regeneron or Regen-COV and the monoclonal antibodies help prevent severe disease, so help prevent hospitalization. For those patients that are infected within 14 days of symptom onset, we do recommend that pregnant patients receive the monoclonal antibody to decrease the risk of hospitalization.
Deborah Howell: This is probably one of the only cocktails you would recommend to pregnant women, right?
Dr. Spencer Kuper: One-hundred percent. You know, you read a lot in the media on social media of ivermectin or hydroxychloroquine. I cannot express to you strongly enough that we strongly advise against pregnant women receiving ivermectin or hydroxychloroquine.
Deborah Howell: All right, the big day is finally here. What strategies are being used to keep pregnant women and their babies safe when they're admitted for delivery?
Dr. Spencer Kuper: We take this exceedingly serious at The Women's Hospital here at Deaconess. We have a universal mask mandate, so that every single provider and every single support person that you come in contact to here will be wearing a mask at all times to protect you. And in that same manner, we ask you and your support person to also wear a mask to help protect us and help protect the other patients. We also have a vaccine mandate among our staff so that our staff is fully vaccinated against COVID-19 to protect you, your care person and also your baby.
Deborah Howell: And are all women who are being admitted being tested for COVID-19?
Dr. Spencer Kuper: No, there are some centers that initially started that in the beginning of the pandemic. Our center does not test women unless they're symptomatic. If you're symptomatic, that certainly is something that we would discuss with you. But we do not universally test all women if they're admitted to The Women's Hospital.
Deborah Howell: Okay. Now, should pregnant women be tested before a scheduled admission?
Dr. Spencer Kuper: That's a good question and a good thought. We don't traditionally recommend that people be tested before they come in for a scheduled admission for obstetrics. However, if you're more comfortable being tested, you and your care person, certainly that's something that we would support and we could help you find a location that could help you be tested.
Deborah Howell: Okay, so you have your baby, you're in the hospital. You have a million things going through your mind, you know, so many tasks with your new child. Can a newly postpartum woman be given the COVID-19 vaccine before discharged, so she doesn't have to worry about that?
Dr. Spencer Kuper: We can make this easy for you. Just like your flu vaccine, before you leave the hospital, we can give you the COVID-19 vaccine.
Deborah Howell: Awesome. That's so good. Now, can a mom who just received the vaccine breastfeed?
Dr. Spencer Kuper: Absolutely. There is thought that the vaccine, as you make the antibodies to the COVID-19 virus, that your antibodies are going to cross through your breast milk to the baby so that your baby's going to get protection just like baby does. And that's why you get the Tdap shot at 28 weeks, so you make that immune response and you protect your baby against the whooping cough. You will protect your baby against COVID-19 as well.
Deborah Howell: Great. Now what's something you wish pregnant women understood about COVID-19?
Dr. Spencer Kuper: The number one thing that I wish pregnant women understood about COVID-19 that this is an exceedingly serious virus that affects pregnant women disproportionately to the non-pregnant population.
In our nearly two years of the pandemic, we have admitted nearly 80 women with COVID-19. These women were exceedingly sick and the vaccine is something that could have prevented hospitalization and also prevented severe disease in these women. We have a way to prevent women from getting sick and potentially babies from being exposed to complications. And I would strongly encourage women to receive the vaccine.
Deborah Howell: Boy, you sound like a wonderful advocate for women. What's the best part about your job, Dr. Kuper?
Dr. Spencer Kuper: The best part is that I get invited into the most special time of a person's life. And that I can help that person to just enjoy this special time to deliver safe care and to just be a part of this joyous occasion.
Deborah Howell: Well, I've just really loved being a part of this conversation. Just wonderful. Excellent information, Dr. Kuper. Thanks for your expertise and for being with us today.
Dr. Spencer Kuper: Thank you.
Deborah Howell: This is The Women's Hospital, a place for all your life. For more information, head on over to deaconess.com/tsp. Please remember to subscribe, rate and review this podcast and all the other Deaconess Women's Hospital podcasts. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.