Deborah Howell (Host): Welcome. You know, we read and hear so much about vaccines these days, and it's something that expecting parents should be thinking about. I'm Deborah Howell. And my guest is Dr. Barton Staat, a retired Air Force Colonel and Doctor of Maternal-Fetal Medicine here at Deaconess. And today, we'll discuss what parents need to know about vaccinations during pregnancy. Welcome, Dr. Staat.

Dr Barton Staat: Hi. Thank you for having me. I'm excited to share some information about vaccinations both before, during and after pregnancy to make sure we optimize health for moms and babies.

Host: Yep, that is the plan for today. And I'm going to jump right in with my first question. Are vaccines safe during pregnancy?

Dr Barton Staat: Yeah. Some are safe and actually some are considered not to be recommended. So, there are vaccines that we do encourage pregnant women to get. And then, there are some that we would defer to outside of pregnancy.

Host: Okay. Let's go over the types of vaccines.

Dr Barton Staat: There are some that are called inactive vaccines. These mean that they have no live components of a virus or anything living in the vaccine. This includes the flu shot as well as hepatitis A. There are some that are called live attenuated. That means that they're a weakened version of the virus. These types of vaccines typically aren't recommended during pregnancy, and this includes the MMR or measles, mumps, rubella, or the varicella vaccination. As far as the other types include toxoid vaccines, this would be your tetanus, and your pertussis vaccination, and these can be given. There's also some called messenger RNA vaccines. Two of the COVID vaccines are messenger RNA vaccines. And these, we think, are safe for pregnancy. And then, there's some others that are called recombinant or polysaccharide or conjugate vaccines. And these typically are not always recommended, but can be on a case by case. So, this would be the pneumococcal, meningococcal, hepatitis B, and the HPV vaccines.

Host: So, obviously, discuss all of this with your primary care physician, right?

Dr Barton Staat: Correct. And then, if you are pregnant, most of the OB-GYNs or obstetric providers can also help guide your decision-making on whether a vaccine should be given during a pregnancy or not.

Host: Sounds good. I think probably the number one question women who, you know, they're in their early stages of pregnancy, can a vaccine harm my developing baby?

Dr Barton Staat: Sure. When vaccines are being considered to be safe or not safe, there actually is one of the more well-studied treatments or interventions that we do have both inside and outside of pregnancy. We usually look at theoretical risks. I mentioned the various types of vaccines. So even though I mentioned the inactive vaccines that includes flu shot and hepatitis, they've not been shown to cause problems, even some of the live attenuated virus that has a weakened version. These are not typically recommended. However, they've actually not been shown to cause any problems. So, in general, we tend to err on the side of safety. And unless we're very certain that there's not going to be a concern or a problem of harming a baby, we tend to not recommend it unless we are sure that the risks of getting the disease outweighs any risk to the baby.

Host: And which vaccines should I get if I'm pregnant?

Dr Barton Staat: So as far as the CDC, as well as ACOG, there are a couple that are definitely recommended. One is the whooping cough or the other name of it's called Tdap. And that's something that's recommended during each pregnancy, typically around 32 weeks of pregnancy. That's something that does help give the baby some protection or immunity to whooping cough. And if you wait until after you deliver or try to vaccinate the baby, there can be a period of time that the baby's not protected and can have troubles with whooping cough.

Also, the flu shot, if you are pregnant during the flu season, we would recommend a flu shot. Pregnant women aren't necessarily more likely to get the flu, but they are more susceptible to severe disease. And that's similar to COVID-19, whereas if you get COVID-19 while you're pregnant, you are more likely to end up needing hospitalization or have severe disease from COVID, in cases where you actually even have to deliver prematurely due to COVID-19. So if you're not up-to-date on your vaccinations, it would be one that we would recommend.

And then, the newest one is actually called RSV vaccine, and that's just been recently approved by the FDA. Currently, ACOG is recommending giving it between 32 to 36 weeks if you're that gestational age during the RSV season, which is September to January. If you don't get the vaccine and your baby's at risk for RSV, they may give baby something called monoclonal antibody after delivery.

Host: So, now, which vaccines should I definitely not get if I'm pregnant?

Dr Barton Staat: As I alluded to earlier, there's a few vaccines called live attenuated, and that means it has a weakened version of the virus, and they're usually not recommended during the pregnancy. The main ones include MMR and varicella.

Host: Now, during what part of gestation should a pregnant person receive these vaccines?

Dr Barton Staat: I would start with, if you're planning a pregnancy, it would be great to be up-to-date on your vaccines. Prior to conceiving, because as we mentioned, there's a couple that we would avoid while you're pregnant. As far as the flu shot or the COVID vaccine can be given, when you're most susceptible or vulnerable to getting it. So, we're getting into the flu season, so it would be important to have your flu shot. Other ones, such as the Tdap or whooping cough vaccine, that's usually given around 32 weeks of pregnancy to time it correctly for the baby's protection. The RSV vaccine is, again, newer, and it's something that is typically timed between 32 to 36 weeks and only given during the most susceptible time during September to January.

Host: Got it. Now, I'm sure you've had many a patient ask you this question. Can I wait until after pregnancy to get vaccinated?

Dr Barton Staat: And my answer would be depending on why you're getting the vaccine. If it's something to protect the baby, such as the whooping cough, then It would be best given during the pregnancy to allow the immunity for the baby to develop before baby's born. If it's something like Rubella or the MMR shot or varicella, then it actually would be recommended. Some of the vaccines are given primarily for the baby's benefit and some maternal benefit, and then there's some that may benefit both.

Deborah Howell (Host): You touched on this earlier, Dr. Staat, are there vaccines I should get prior to getting pregnant?

Dr Barton Staat: Depending on any comorbidities or complications that the mother may carry going into the pregnancy, we do recommend in general the MMR, measles, mumps, rubella, if the mother has not already had immunity or the varicella vaccine if the mother has not previously had varicella, is just another name for chicken pox. If she can complete the COVID-19 vaccine series prior to pregnancy, then that may also improve or reduce the chances that she would have COVID.

Host: And I guess we can't stress enough to really have this discussion with your doctor while you're planning your family, correct?

Dr Barton Staat: Yes, that's correct. I gave some general guidance, but there are unique scenarios where we didn't necessarily get into some of the international travels or some people that need, additional counseling because they have additional medical complications that may increase the risk of certain diseases. And the vaccine recommendations may expand or may include other vaccines that we didn't cover here today.

Host: Or just fears in general because there's so much in the news and, you know, various sources about vaccines these days.

Dr Barton Staat: Yes. That is correct. And, I think the most reliable sources of information would either be the Centers for Disease Control that does have a wonderful site on vaccines during and after pregnancy, or the American College of OBGYN.

Host: Well, this is such excellent information, Dr. Staat. Is there anything else you'd like to add to our conversation?

Dr Barton Staat: I do appreciate the time to discuss the vaccines during pregnancy, it's something that I'm passionate about because we love to provide preventive medicine instead of actually treating disease. So if there's ways that we can keep mothers out of the hospital if they don't need to be for preventable disease, then that's the best medicine of all.

Host: Absolutely. Thank you so much for being with us today to help us understand more about vaccines during pregnancy. It was really great to have you on the podcast.

Dr Barton Staat: Great. Thank you for your time.

Host: That wraps up this episode of the podcast series from Deaconess, the Women's Hospital, a place for all your life. For more information, visit deaconess.com/twh. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. For more health tips and updates, follow us on your social channels. This is the Women's Hospital, a place for all your life. I'm Deborah Howell. Thanks for listening and have yourself a great day.