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Melanie Cole (Host): This is UAB Med Cast. I'm Melanie Cole. Today we're discussing COVID-19 vaccines in women and during pregnancy. Joining me is Dr. Akila Subramaniam. She's a specialist in Maternal and Fetal Medicine and an Associate Professor at UAB Medicine. Dr. Subramaniam, thank you so much for joining us today. A lot of confusion surrounding the vaccines, everything that's changing seems like it's always changing. So what precautions first are we suggesting pregnant individuals and their families take during this pandemic, we're almost kind of through it, but you never know. There's always these variants popping up. So tell us a little bit about what we know now about couples that are planning to have children or that are already pregnant, what you want them to know about vaccination and even protecting themselves with masks and distancing.

Akila Subramaniam, MD (Guest): Yeah. So, we've had the opportunity to learn quite a bit now, over two years of the COVID-19 pandemic. And there is a significant amount of data that is available that suggests that pregnant women are particularly susceptible to severe illness and when I mean severe illness, so while, the majority of people may be asymptomatic and mild compared to non-pregnant individuals, pregnant individuals tend to have or require more ICU visits, intubations, we've seen an increased number of deaths among women when you compare the same age, but just one group is pregnant and not.

And so when you look at this, in the sense of how much more at risk pregnant women are, there are important strategies that we need to take to protect these women. And because they're pregnant, they're infants as well. Those strategies include masking. There's been changes in the masking policies, federally.

And so I would urge everyone to follow those policies. But masking does reduce transmission. And then the other thing that we can really do is vaccinate. So the vaccines that are widely available, there are three different types. Two are, of an mRNA type and one is a different type. They're all generally very safe in pregnancy. And if you look at the studies and I'm sure we'll talk about this more in the segment, they not only protect moms, but they protect their infants and they protect their young children as well. And so the simple sort of take-home point that we'll start with today is that pregnancy puts women at risk for becoming potentially very sick with COVID. Despite all of the different waves and the different surges and the variants, pregnant women are a more susceptible population. And so different types of interventions to reduce their risk are very important. One being vaccines, which are safe and effective, and one being masking in the appropriate settings as endorsed by CDC guidelines.

Host: So Doctor, ACOG is now supporting the COVID vaccine. What does that mean for pregnant women? When you are counseling and advising your patients and for other providers that are doing the same, are you receiving questions, push back. What is it they are asking you. And then how do you respond? Because now ACOGs on board. So that sort of changes it for you guys a little bit, doesn't it?

Dr. Subramaniam: Yeah, I will say that ACOG and the Society for Maternal Fetal Medicine, so the SMFM started endorsing vaccination for pregnant healthcare workers very early on. So really, as soon as the vaccination came out. For the public, which has a lower risk group of individuals, as opposed to healthcare workers, the endorsement of vaccination has actually been out for quite some time. I think that, you know, you have to put this in focus of a pregnant individual. Pregnant patients very concerned with their infants and their neonates. And so we see this very frequently in pregnant patients where let's say they have an underlying medical condition, like high blood pressure. We all know we should treat high blood pressure, but they get a little bit worried about the risks of that medicine to their infant. And there's a lot of different medications that are safe for the infant. So we frequently will see patients come in, who have just learned that they are pregnant, who have stopped some of their medications for chronic illnesses as a result of wanting to protect their unborn babies.

So the hesitancy to take medications, receive vaccinations. That's really nothing new when it comes to pregnant individuals. And if we look at that in the scope of COVID, that continues. So, I'll talk about another vaccine that's, very widely recommended for all pregnant individuals, which is the flu vaccination.

The flu vaccination has been recommended, during flu season for all pregnant individuals, because they do get more severe illness. But when you look at how many pregnant patients decide to take the flu vaccine, it's not very high because there is some concern. So we see that same sentiment being echoed, in terms of the COVID-19 virus and vaccination. What I will say is that when we approach our patients who have this hesitancy, what has been resounding from these bodies, so ACOG or SMFM is that vaccination is safe. They have multiple huge databases out there that show, no untoward effects in terms of birth defects, in terms of fertility, but we do know it's protective and really what these bodies are recommending is vaccinations when before you try to get pregnant, as soon as you get pregnant, during the pregnancy, even postpartum and in breastfeeding. So there's, never an ideal time. So there are certain medications that we use in pregnancy where we say, hey, don't take them in the first trimester. You can take them later. But when it comes to COVID-19 vaccination, there's no best time. Anytime is the best time to be vaccinated because it does not just protect moms, but it protects their newborns. And a lot of studies have shown that if you get that vaccine, especially in the third trimester, so close to delivery, that passive immunity and what I mean, passive immunity, mom develops a robust antibody response. Those then cross to the baby and provides a vulnerable new infant with some protection against this virus as well. So, usually this is a discussion that we have with our patients as to the risks and the benefits. The risks are essentially none, some mild side effects of actual the vaccine. So like, arm hurting or feeling some fatigue or malaise, but the benefits really are pretty significant, not just to the pregnant patient, but also their newborn as soon as that infant is born.

Host: Well, thank you. That was a very comprehensive answer. And doctor, I'm glad that you mentioned the flu vaccine. What about other vaccines? Like T-DAP. If a woman got that as a child, does she need it in pregnancy? What are you recommending when it comes to those other vaccines?

Dr. Subramaniam: There's really three vaccines, that are routinely recommended in pregnancy. We've just talked about the COVID-19 vaccine and really the story is not completely unfolded as to how long we will continue to be recommending that potentially yearly or boosters, we just sort of touched on the flu vaccine.

So, the flu vaccine is recommended, to all pregnant patients during flu season. So talking about, late fall, winter, early spring, and then you have T-DAP is, as people may or may not know, protects against tetanus, diptheria and pertussis, but pertussis being the most important one to consider when we're talking about vaccination and pregnancy.

But pertussis causes whooping cough. And so it is recommended, by ACOG, and all the pregnancy bodies that pregnant women in their third trimester, so really after 27 weeks get vaccinated with the T-DAP to protect themselves and really their infants from the whooping cough. So just like what we talked about with COVID, a patient gets the vaccine, they have a robust antibody response, and those antibodies passively go to the baby to protect a newborn vulnerable baby that doesn't have a very robust immune system.

It gives them the antibodies to potentially fight pertussis because there has been an increase in rates of pertussis or whooping cough, in this country. So we routinely recommend the T-DAP vaccination after about 27 weeks up til delivery, to protect those newborn infants.

Host: Yeah. I had a son that had pertussis and I'm telling you right now, it was not fun. And even though he was vaccinated, he got that whooping cough, and it was a very scary time. So what else would you like us to know? Because there are new variants coming out. And so you've talked about vaccination and masking, according to the CDC, what else would you like families and families that are in planning or even in fertility treatments to know about some other things that they can do, whether it's boosting their immune system, continuing to do some physical distancing. What else do you counsel your patients to keep them healthy as they are planning pregnancy and beyond?

Dr. Subramaniam: So I think when it comes to what's happening with the COVID pandemic, I think all of us are hopeful, or maybe it's wishful thinking that we're sort of maybe nearing the tail end of this, but the question is who really knows, right. There's a variant running through Europe right now, that has really sort of taken over as the dominant variant. It's a variant of the Omicron, string. So, I think all of us are hoping that we're nearing the tail end of it, but, we don't really know. And so I would say, that we should all still be cautious and not let our guard down completely because then we could be back where we were about a year ago. So taking precautions such as, good hygiene.

So hand-washing, taking care of using soap and water to wash your hands, masking in places that there's a lot of people or there's a high rate of COVID that's still in the community. I think those are some important strategies. They just, reported that patients over 50 years of age should get a second booster.

So I think following CDC guidelines is really important and if you haven't gotten boosted, potentially getting boosted. There's some good data that suggests that there's waning immunity in some individuals. So I think just continuing to be abreast of the recommendations and following those is really important.

Host: I agree with you and thank you so much, Dr. Subramaniam for joining us today and sharing your expertise. And a physician can refer a patient to UAB Medicine by calling the mist line at 1-800-UAB-MIST. Or by visiting our website at UABmedicine.org/physician. That wraps up this episode of UAB Med Cast. For the latest on medical advancements, breakthroughs and research, please follow us on your social channels. I'm Melanie Cole.