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Abigail Chitwood, M.D. (Guest): Hi, I'm Dr. Abigail Chitwood. I am an OB-GYN with BJC Medical Group. I work out of Missouri Baptist and in conjunction with St. Louis Children's Hospital. And I'm a MomDoc.

Melanie Cole (Host): Hey, welcome to MomDocs, the podcast from St. Louis Children's Hospital. Today, we're talking about pregnancy and COVID-19. Dr. Chitwood, I'm so glad to have you with us. And as we get going in this, I just want the listeners to know because you are right there in the thick of exactly what we're talking about. You are pregnant during this time of COVID. So, can you tell us a little bit about COVID-19 and what you've seen during this pandemic? And if COVID affects pregnancy and fetus, tell us a little bit about what we know now.

Dr. Chitwood: So, I think it's an interesting time to be pregnant. Of course, it's always interesting to be pregnant, but, in the middle of a pandemic and when we're gathering information still and still things are unknown, I think it's an interesting time to be navigating all this. And as a pregnant OB-GYN, you know, even more so. So, ultimately, just a little bit about my journey with COVID and pregnancy, is that I had my first COVID vaccine on December 28th. I had a positive pregnancy test on January 4th and then I tested positive for COVID on January 8th. And so I've run the gamut of COVID, COVID vaccination and pregnancy. And so I think, I have felt that stress that a lot of pregnant women and moms feel about what does this mean for my pregnancy?

What's going on? Is this safe? Is this going to have any long-term effects, et cetera. So, I feel that, and I empathize with that completely. The good news, I think, and the reassuring thing is that yes, while studies are still ongoing and things are coming out, you know, it's hard because this sort of started, what 15, 16 months ago for us.

And so I don't know that we fully have a lot of knowledge in terms of like long-term things, but in terms of pregnancy specifically, the good news thus far is that COVID vaccination specifically has had very reassuring pregnancy outcomes in terms of no increased risk of negative aspects to pregnancy.

And then I think ultimately what we know thus far, is that COVID in pregnancy seems to have a greater effect. And I think this sort of makes logical sense on mom than baby thus far. And so just in terms of, if you think about pregnancy itself, you are growing a human inside of you and it's squishing all of your insides and making it harder to breathe and function. And then if you put a disease that affects the lungs on top of it, as you can imagine, it becomes harder to breathe and it can significantly affect women, especially further in pregnancy.

Host: Wow. That was quite an introduction Dr. Chitwood. You've been through a lot, but that was really encouraging and hopeful. And as an OB-GYN, tell us a little bit about how prenatal and postpartum care have changed due to the pandemic. What are you telling moms about their care, vaccinations, delivery. I mean, that's a big worry for a lot of couples. Is my partner going to be able to be in the room with me? Tell us a little bit about how this pandemic has changed this time of life for women.

Dr. Chitwood: Yeah, there is no doubt that it has. I think when in years past, and like when I was in residency, you would be in a delivery room and someone would have 10 family members in there. And, um right. Exactly, exactly. And for bett or for worse, there were way fewer rules on who could be there. And then, you know, this happens and hospital rules sort of flipped on their heads as people were trying to navigate these new waters and keep people safe. And I think that is the important thing to remember as a patient, as a mom, as a pregnant person, as a doctor, like nobody through this whole thing has been trying to punish everyone.

It is everyone just navigating new waters and really trying to keep people safe. And I think, in terms of support people during labor and delivery, every hospital is different, which is important to remember because someone delivering at Missouri Baptist versus Barnes versus Mercy versus St. Luke's versus wherever, and that's just the St. Louis area hospitals, there will be different rules. But, at least in my experience, the good thing is that they have found a way on maternity floors to at least, always allow a support person. And I think that that is important in the labor and delivery process if you can't have 10 people, at least you can have one person because having a baby is a life-changing event.

And so, that has changed and things are, as vaccinations are coming out, the rules are changing with hospitals. So, of course, always talking to your doctor about the hospital rules and things is important, but certainly like at Missouri Baptist, for instance, you can now have two support people during labor, which I think is great because oftentimes people bring the father of the baby and a sister or the father of the baby and mom or whomever.

And then in terms of prenatal care, I think that what has changed a lot for people is the level of anxiety one has with prenatal care. I think that it's just gotten more stressful. Is it safe to go to the doctor? People wanting to not go to the doctor, but still check on their baby. And are we going to get COVID from being there? I think that that has made prenatal care a little bit more stressful for people. And I think it's part of our jobs as OB-GYNs to do our best to keep our patients safe and also do our best to make everybody feel calm and comfortable in your office.

It's part of the reason I became an OB-GYN. You're taking women through some of the best and hardest times of their life from adolescence to potential pregnancy and motherhood and menopause. And you get to sort of see women through all of that. And part of it is, rolling with the punches of what happens in the world. And right now that happens to be COVID-19. And so, I think that prenatal care has changed, but the basis has stayed the same and certainly finding a doctor to take care of you that you feel comfortable with is so important, especially now.

And then the big vaccine question, I think is certainly a hot button topic. Now, especially as you hear of schools, hospitals and medical systems mandating it. And I think for me, it is important that number one, my patients know that I am vaccinated. I was vaccinated in pregnancy and I would do it a thousand times over. And if someone told me tomorrow to get a booster, because that would help my baby have antibodies, I would absolutely do it.

Everything has basically not supported what people are sometimes reading on the internet. You know, there's concerns about fertility and concerns about pregnancy outcomes. And there has been no evidence to suggest increased rates of miscarriages or pregnancy complications at all, or any bearing on future fertility. And so I think it's important to talk to your doctors and talk to people that you trust because the internet is a scary place and you can certainly find anything if you look hard enough.

So, you just have to be careful because certainly people smarter than I have developed these vaccines with years and research and research and development, and you know, at one point the HPV vaccine was brand new. Right? And now we know that that has decreased cervical cancer. And so, I think that, it is okay to be nervous, and to talk to people that you trust in, your doctors. And, I think it's important to also believe in science.

Host: Well, that's a key message here, Dr. Chitwood and also the mRNA, you know, that's been around for a long time. This is not new. They're just sort of repurposing it and finding other uses and boy, what a use. Right? And I'm right there with you as far as the vaccination. So, I'm glad that you made that point. Now what do we know? When we heard about HIV for a while and all of an HPV and all these things about transference during delivery from mom to fetus. So, can you tell us what we know about Coronavirus? Does it transfer from mom to baby if mom does test positive? What about breastfeeding? Tell us a little bit about what actually is going to happen during delivery if mom does test positive, how does that all work.

Dr. Chitwood: So, I think that's a hard question, especially because there is no current good rule about how we're testing things. I do know it has been shown that antibodies have been passed from mom to baby, either in utero or through breastfeeding. And so we certainly are very much encouraging women who have babies to breastfeed, even if they've had COVID in pregnancy and certainly, to be hopeful that both vaccination or infection with COVID can potentially give baby some antibodies. But it's hard because pregnancy is somewhere around 40 weeks long. Right. And so does my infection with COVID and vaccination at four weeks of pregnancy confer any protection or issue to my baby versus someone who is 30 weeks and vaccinated or getting infected.

And so, ultimately, given that we've only been at this for 16 months, I think certainly as we continue moving forward and there are more people, I absolutely plan when I deliver to have my obstetrician send the cord blood to wherever they'll test it, to see if my baby has antibodies. Just if anyone needs that for research or anything you know. As we continue moving and especially at big academic centers, like Barnes and the like, continuing to get this information to really see. And I think that there's an important role for the pediatric aspect of things moving forward as well, because, even if someone was infected with COVID in March of last year and had a baby in April, that baby is just over a year.

So, I think it's hard to say in terms of what does this mean long-term and also a lot of it is out of our hands. And so just taking care of ourselves because we know that if you get COVID in pregnancy and you got really sick, the risk to that is like needing a preterm delivery because you are sick. It's not necessarily that there's any fetal indication, but certainly moms have had to be delivered earlier because of respiratory distress, and then potentially that means something for the baby, because now you're talking about a preterm delivery. But not because of COVID in the baby.

So, I don't know that I can fully give good stats on transference of the disease itself. But I certainly know that we are seeing transference of antibodies in both vaccinated and infected individuals to the baby, which is good. I hope every day that my baby has antibodies against this.

Host: No, it's great. That's great news. And we've heard about how breastfeeding really transfers those antibodies on other things that we've heard about for so many years. So, hopefully the same is true for this, and we're learning more and more all the time. Before we wrap up, you've given us such an upbeat hopeful show and, how excited I am for you. You're pretty close to it now.

And any mother will know what an exciting time of life it is such an exciting. And as you said, doctor, sometimes a little bit scary, you know, it's a little frightening to be pregnant. However, you've given us a lot to think about. And a lot of encouragement. Wrap it up for couples listening, what would you like them to know about COVID-19 and pregnancy and really the facts and the importance of vaccination, the safety and efficacy and just what you'd like them to know.

Dr. Chitwood: I think the overarching message I would like to get across is number one, believe in science, number two, always feel free to talk to your doctors and reach out and do your own research, yes. But in a smart way, you know, not just on Google and making sure that we're not perpetuating things that are untrue because a vaccine, no one just closed their eyes and put it in a vial and put it in your body. There is years, like you said, of research and development and people who spend their whole lives to do this, who have developed this and everything that we have seen thus far has been very encouraging on safety of vaccination.

And certainly I never want anyone to leave my office thinking they're being forced to do anything, but like I said, I did it, I would do it again, and I strongly recommend it. And that feeling that yourself is important, but also trusting science, trusting your doctors and keeping yourself safe.

Host: So important and thank you. And I hope you'll join us again, Doctor and update us and good luck to you and your little baby girl. That's just so exciting. I love babies so much. Thank you again for joining us. That concludes another episode of MomDocs with St. Louis Children's Hospital. For more advice and articles, check out the MomDocs website at children'smd.org.

For more health tips, follow us on your social channels and be sure to share this show with friends and family, because that's how we are learning from the experts and the MomDocs at St. Louis Children's Hospital together. I'm Melanie Cole. Stay safe and thanks for listening.