Transcription:
COVID-19 Vaccine and Pregnancy: What You Need to Know

Prakash Chandran: This UAMS Health Talk COVID-19 podcast was recorded on February 25th, 2022.

Many people prioritize their health, especially during pregnancy. When a new baby is developing, the last thing any parent wants to do is to become sick for fear of causing any sort of complications or harm to their newborn. So when it comes to new diseases being treated with new drugs, such as COVID-19 and the accompanying vaccines, there is understandably conflict and concerns about what type of risks both might pose during pregnancy.

Here to help us demystify those risks and tell us what we need to know about the COVID-19 vaccine and pregnancy is Dr. Nirvana Manning, an obstetrician-gynecologist and Chair and Associate Professor in the Department of Obstetrics and Gynecology at UAMS.

This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So Dr. Manning, really great to have you here. Thank you so much for your time here today. You know, I find this topic to be pretty interesting just because it has evolved so quickly in terms of the information that we have and the decisions that people have made. So my son, for example, was born seven months ago during the pandemic. And, at that time, there just wasn't enough information for my wife and I to feel comfortable, so she ended up getting vaccinated after my son was born. My sister chose to wait to get the vaccine before becoming pregnant. And I have friends that got it right away and just, you know, read the information out there that it was completely safe. So now though, a little bit more time has passed, and I imagine that we have more data, I'm curious to maybe get started in asking you, you know, what are the general statistics surrounding complications of the vaccine with those who are pregnant?

Nirvana Manning, MD: Well, thank you again for having me. I think this topic has evolved since the beginning of the pandemic quite a bit. I think you're right in that, at the beginning of all of this, there was very little to know, and I think the first takers of the vaccine were largely healthcare professionals that really had a different understanding of some of the mechanisms with which this vaccine was working. And now, we have the luxury of 13 plus months of data on these vaccines with which to kind of speak to.

What we had seen, and I will speak predominantly of the messenger RNA ones and those being the Pfizer and the Moderna, which are the most highly utilized in pregnancy and really with all populations in the United States, we see very little in the way of complications. And what I mean by that, you know, that the big scary things that we were worried about. And with any new disease, with any new vaccine, with any new treatment, I think the unknown is probably the scariest thing. And then you throw into it you're pregnant and you're not thinking about yourself, you're thinking more about this unborn child, all kinds of emotions come into play.

I think now what we see and you asked me about statistics, I think a lot of the initial fears have been debunked. We have considerable numbers of pregnant women that have been vaccinated. And with regard to complications with the vaccine, what we're seeing is no different than anybody else in the population. And those being just, you know, the common, injection site soreness, some fevers, some muscle pain, some joint pain, headaches, fatigue, you know, those things that I think we're seeing with anybody that gets the vaccine. It's become no more pronounced with pregnant patients than it is with the general public.

Prakash Chandran: Yeah, I think that's really reassuring to hear. And I think another thing that is important to note is a lot of the fear and concern before was around, "If I get this vaccine, it's going to affect my baby or it's going to somehow, you know, change their genetic makeup." And from everything that I've read, especially with the messenger RNA, is that those vaccines actually don't necessarily change the DNA and therefore can't change the DNA of a baby. Is that correct?

Nirvana Manning, MD: Yes, you're absolutely correct. You know, the messenger RNA, without getting very technical, it has no way of changing the DNA in there. Actually, the actual vaccine is kind of, if you imagine surrounded by a big fat globule and it can't go over to the placenta, it can't get over to the baby. So the actual vaccine that kind of we give, and it's that vector with which we mount an immune response, it doesn't go to the baby in any way, shape or form. What we've learned is that those antibodies that we create in our bodies are able to go over to the baby and that, in no way by definition, it can't change the DNA. It's just giving those antibodies and some of that resilience that we have built on any vaccine, that's going then to the baby.

Prakash Chandran: Now, I know that there are people that are concerned that there haven't been any true longitudinal studies on vaccinated mothers and their children. You know, because how could there be? You know, this is still relatively new. I know we have 13 plus months of data now, but what might you say to people that are still hesitant because of a lack of longitudinal data that's out there?

Nirvana Manning, MD: So, what I would say is that messenger RNA vaccines are not in fact new. We have been working on these since probably 2003 is what I was looking at. The problem with them was that we had not created a safe mechanism for transportation on mass scale, meaning their integrity required them to be at this below zero, very cold temperature or else it lost some of the integrity of that vaccine.

So being that, you know, push came to shove and we were forced to kind of come up with some solutions, we have now kind of catapulted in the future and then able to develop these mechanisms with which we can keep them. There's been significant studies on messenger, RNA vaccines for years. And I know it seems as though, you know, "Goodness, it was all rushed. It was this and that," I will say the scrutiny with which these vaccines have been held to is unlike any other vaccine that we have ever seen. And, you know, it's the talk of the town, we're all talking about it, but none of the vaccines that we have that we don't think twice about, the hepatitis B, the measles, mumps, and rubella, the other vaccines that we can get, did not even come close to the amount of scrutiny that this has done, meaning it's been under a much more watchful eye. And if we haven't seen, you know, the complications, that's pretty amazing.

Prakash Chandran: Absolutely. And I think you raised an important point, right? Like there are so many things that we ingest on a daily basis or even my wife was ingesting during pregnancy that we really don't know that much about. Like sometimes we'll go to the market and we'll get a supplement or something that we have no idea how long it's been studied for. But this has really been under a magnifying glass because it is new and, obviously, it's being distributed on mass. And so yeah, I definitely understand what you're saying.

Nirvana Manning, MD: I think, you know, pregnancy is such a unique period in a person's life where truly we can make so many differences for the good, for the bad, for all the things. You know, if I have a patient that's a smoker, I have the best chance of getting them to quit smoking during pregnancy. But the flip side of that is that you would do anything kind of for this unborn child. And I think that, to a degree, the news kind of just throws so much data at us and it's hard without having a trustful source to kind of sort through that. And I truly think parents are doing the best I can. It's just finding what amounts of the data are real and what are not.

Prakash Chandran: And you mentioned trustful source, but what does that mean? You know, and I think it's so hard because you look on the internet, you look on YouTube, and you look at a lot of these opinion pieces, or you're watching the news, like you kind of hear so many different things across these different distribution channels. Where do you feel like parents should be going to get that trusted, accurate, resourceful information about the vaccine and about pregnancy?

Nirvana Manning, MD: I think one of the easiest and most trusted sites would be places that nationally advocate for women. So for me, that's the American College of Obstetrics and Gynecology, ACOG. It's main purpose is to support women in pregnancy and make sure that we are making the best decisions that we can. And so going to trusted sites rather than blogs or, you know, the Facebook, TikTok, all the places where we get so much information that seems real because they can throw statistics to it, but yet it has no basis with which it's kind of being said. So that's what we've ran across.

You know, one tiny bit of misinformation takes 10 times longer for me to convince someone otherwise once it's already out there. And kind of the beauty and the detriment is how much information we have out there. So I think places like ACOG, CDC, places that you know they're going to put the research into it, American Pediatric Society, places where they're not going to promote things if they don't feel it's in the best interest of the group with which they serve.

Prakash Chandran: Okay, understood. So I want to move on to, let's say, you know, a parent or a soon-to-be parent is doing research and they've decided, "Okay. You know, I think that it is safe for me to get this vaccine," let's talk about these dynamics. Now, you mentioned before you were focused more on the mRNA vaccines, which is the Pfizer and Moderna, are you saying that they're more efficacious to get as a pregnant person versus the Johnson & Johnson?

Nirvana Manning, MD: Yeah. You know, if we're talking data and the number of patients that have gotten it such that we can see what any potential complications are and downstream, we have seen significantly more patients that have had the Moderna and the Pfizer vaccine. So those are the ones that we can speak the most to.

Prakash Chandran: Okay, I got it. And is there any condition or circumstance where a pregnant woman or a woman who is thinking about becoming pregnant should not get any sort of vaccine?

Nirvana Manning, MD: I mean, I think the only situation would be if you are directly allergic or have a reaction to one of the components that were in it. But I cannot think of another reason to not.

Prakash Chandran: Now, how about for a woman who may have a chance of facing other complications in their pregnancy, you know, such as having endometriosis or something like that, is it better or worse to get the vaccine? Are there factors that women need to consider? If there are other, I guess, comorbidities or things that they should be aware of?

Nirvana Manning, MD: I think remembering that pregnancy in and of itself puts women at risk of more severe COVID infection. We know this is a fact. We see increased admissions to the intensive care unit. We see increased need for mechanical ventilation. We see increased number of deaths with the same age, same demographics, same comorbidities. More of these are getting significantly more sick with COVID infection than without. The vaccine is the only mechanism that we have to decrease that severity. And we've seen it. We've seen it in the last 13 months that women may get the COVID infection. We've seen that even more so with this last variant in the Omicron, but the severity of that disease has been significantly less.

Prakash Chandran: So just as we start to close here, Dr. Manning, I know that you have seen hundreds, if not thousands of women that are either in the throws of their pregnancy or they're thinking about becoming pregnant. In all of your experience and everything that you have learned regardless of this vaccine or otherwise, what is one thing that you know to be true that you wish more women knew before they came to see you?

Nirvana Manning, MD: You know, going into pregnancy, it is a life-changing event. Maximizing your health prior to making that decision can only help you. That means, if we have diabetes, making sure that's well-controlled. If it means if we have chronic hypertension, making sure that's well-controlled. If it means, you know, gaining some weight, losing some weight, you know, going into pregnancy with that increased level of understanding, I think can be helpful. And talking to your healthcare provider. They're not there to shove information down your throat.

Myself and my patients. I really want this to be a dialogue. I want us to talk about what those fears are and some of them are completely warranted. This is, you know, a conversation to be had and there's no one right answer. It's just really making that right decision for your family.

Prakash Chandran: I love that, Dr. Manning, and I think that is a perfect place to end this conversation. Thank you so much for your time today.

Nirvana Manning, MD: Thank you so much. I appreciate it.

Prakash Chandran: That was Dr. Nirvana Manning, an Obstetrician Gynecologist, Chair and Associate Professor in the Department of Obstetrics and Gynecology at UAMs. Thanks for checking out this episode of UAMS Health Talk.

For more information on this topic and to access the resources mentioned, you can visit obgyn.uams.edu. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks again for listening. My name is Prakash Chandran, and we'll talk next time.