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

Podcast Transcript

Cassandra Holloway:

Hi, thanks for joining us for the Health Essentials Podcast. My name is Cassandra Holloway and I'll be your host for today. Today, we're talking about getting the COVID-19 vaccine while you're pregnant, breastfeeding, or trying to conceive we're here with OBGYN, Dr. Oluwatosin Goje. Dr. Goje, thank you for taking the time to speak with us and welcome to the podcast.

Dr. Oluwatosin Goje:

Thank you for having me.

Cassandra Holloway:

So, many moms are debating if they should go ahead and get the coronavirus vaccine while they're pregnant or if they should wait until after they give birth. So, Dr. Goje, I want to first start off by asking if you'll talk to us a little bit about why are you more at risk for severe COVID-19 if you're pregnant? What makes pregnancy a risk factor?

Dr. Oluwatosin Goje:

Thank you very much, Cassandra. Pregnancy is a wonderful time, but at the same time, there is the decrease in immunity in the mother. There's down regulation of immunity in the mother, so that it does not reject the fetus. Also, there are changes in other physiology. There's change in the pulmonary physiology, there's change in the cardiovascular physiology. We know that COVID-19 affects this two areas, the lungs and the cardiovascular system. So, that puts a pregnant patient at high risk. Then if she has other comorbidities like diabetes or obesity, this even makes a even further high-risk.

Cassandra Holloway:

So I'm going to just ask you the million dollar question here. Should you get the vaccine if you're pregnant and what should you consider? Walk me through that thought process for this.

Dr. Oluwatosin Goje:

Excellent. I will recommend that pregnant patients discuss with their healthcare provider to discuss what their risks are. The fact that you're pregnant is one risk factor. The CDC categorizes pregnant patients as being at risk, but there are other risks that you want to discuss. What is the prevalence or the rate of COVID-19 infection in your community? What type of job do you have that may expose you to COVID-19? Do you interface with people? Do you take public transportation? You have to think about all that. Even your housing, are you living in a huge community with many people? Are there people in your house or your community that are in close relationship with you that have high risk jobs? It could be your partner that is having the high risk job. So you have to think about all that. That is number one.

              Number two. Do you have any other medical conditions? Sickle cell anemia, moderate to severe asthma, type two diabetes, which is pre-gestational before pregnancy, do you have a history of transplant of a solid organ? Are you taking some immunosuppressive medications? You have to consider all of those because those are high risk conditions for COVID-19 infection and this patient can have severe COVID infection. All this is crystallized by the CDC publication that showed that pregnant patients that develop symptomatic COVID infection had increased risk of hospitalization, increased risk of being admitted into the ICU, the intensive care unit, the need for respiratory support and death. There have been over 80 or 88 pregnant patients that have died from COVID-19 infection. So you have to look at all that to make your decision.

Cassandra Holloway:

What about if you have a high risk pregnancy already? I know you mentioned gestational diabetes, but if you are a high risk pregnancy for other factors, does that up your need for the vaccine as well?

Dr. Oluwatosin Goje:

Exactly, that ups your need, because we don't want to go into all the levels of high risk, but that does up your need.

Cassandra Holloway:

So it sounds like you really need to have a personal one-on-one conversation with your OB to discuss, like you said, all of these risk factors, are you an essential worker, what is the risk of COVID in your community and really have that a conversation with your OB to come to a decision together, right?

Dr. Oluwatosin Goje:

Yes. I call it a shared medical decision because patients think, "Oh, I don't interface with people so I'm not at high risk," but you have to think about all the other things that make you a high risk, not just the interfacing with people outside your home.

Cassandra Holloway:

What about for those women who are going through fertility treatments? The medications, the procedures, would the vaccine had any effect on those sorts of treatments?

Dr. Oluwatosin Goje:

No. So let's talk about fertility. The vaccine has no effect on the treatment women go through or a couple goes through for fertility reasons. The American Society of Reproductive Medicine has categorically out to state it, that if you're going through fertility medication for a fertility procedure, that should not stop you from getting your vaccine. If you get the first dose and in-between you start the fertility treatment, or you get pregnant, you should go ahead to get your second dose if you have chosen to get the vaccine. The misinformation and all the news is unfortunate, but it's just pure misinformation.

              Two researchers or a researcher and a clinician actually thought that there was a relationship between some of the molecule of the messenger RNA vaccine, and some molecules that are needed in placentation and in placenta. There are a lot of articles out there, I actually read one yesterday, that clearly shows what that molecule in the vaccine is and how different it is from the molecule that we're talking about in placentation or in the placenta. People have looked at all the biological possibilities and have debunked that myth that these vaccines have no relationship to fertility, neither do they affect fertility medications.

Cassandra Holloway:

That's interesting. So that study you were talking about reading yesterday, does that talk about females and males? So across the board, if you and your husband both get it, that won't have any effect on your fertility in general, for both of you guys?

Dr. Oluwatosin Goje:

So the article looked at the female reproductive system in details, because what has been a false message is the placenta, that will attack a placenta the way the vaccine supposed to take care of COVID. So the article went into details about placenta and placentation in women. But having said, that they also talked in general about fertility, because I always want to use the word messenger RNA so that people understand what this vaccine is all about. This vaccine does not get incorporated into our DNA, neither does it leave behind genetic material. The vaccine is coated in a lipid, just to make sure it doesn't disintegrate very quickly before it can actually send its message. So once it's done its job, it gets rapidly disintegrated and leaves the system. So knowing that mechanism, it should not cause infertility in men or in women.

Cassandra Holloway:

Gotcha. I just want to reiterate for our listeners, does the vaccine affect ovulation or your cycle, even if you're not pregnant in any way?

Dr. Oluwatosin Goje:

Excellent question. That's another one we should talk about. I always like to talk about basic things so that our listeners understand what is going on. Stress can change your menstrual cycle. If you talk to athletes that have been practicing intensely for the Olympics or for anything, sometimes they don't have menstruation for months, just because of all the exercises and the training they go through. Sometimes change in diet, patients who develop bulimia or are unable to eat. Patients who have malignancy, they are unable to eat, their menstrual cycles change from the stress. Patients that suddenly become obese, or suddenly reduce their weight, or lose a lot of weight, their menstrual cycles change. These are all things we have seen over the years. During the COVID pandemic, it's not different.

              Some women might say, "Oh, my menstrual cycle has changed," but it's not related to the vaccine. There's still a lot of studies out there, people are doing research trying to understand why, but that's what I want to talk about, what we know about environmental and personal changes that influence our menstrual cycle. So it's possible that we've been in this pandemic for more than a year, that could play a role, but not the vaccine, the vaccine doesn't play a role.

Cassandra Holloway:

What would be your advice, or what would you tell a woman who is trying to conceive and she's debating if she should go ahead and get the vaccine right away, or she's nervous that she's going to conceive and then be in that in-between stage, like you said, between the first and second dose? So what would be your general advice to someone who's just trying to conceive right now and really debating the vaccine?

Dr. Oluwatosin Goje:

Based on the evidence we have, if she has elected to be vaccinated to protect herself, her family, her community, she should go ahead and still go ahead to take her vaccine and go ahead to continue to plan for her family.

Cassandra Holloway:

So can you talk a little bit about this myth that we're hearing, that the vaccine causes having a miscarriage if you're already pregnant, or it causes birth defects to the baby? Is that true and can you talk a little bit more about that?

Dr. Oluwatosin Goje:

Thank you. The vaccine does not increase our risk for miscarriage. There is a baseline of miscarriage that is seen in the community, that is seen in the country, and these are all accessible online. What is the baseline rate of miscarriage in any community in the country? The vaccine does not increase that baseline. The vaccine does not increase our risk of first or second trimester miscarriage or infertility. In fact, there is a study that came out looking at over 30,000 women who actually use the v-safe. So the v-safe is an app on your smartphone that pregnant patients on their own can actually check in. I have done it when I got my vaccine. After vaccination, you are encouraged to download the app and then put in your side effects, put in anything you think is associated with the vaccine. More than 30,000 to 35,000 women that are pregnant have actually included their data in this v-safe.

              Now, out of this women, about 1,700 by March agreed to join a registry that is like a sub shoot of that v-safe. The women in the registry actually go more in details, pregnancy outcome and all that. More than 800 women have completed their pregnancy from the v-safe. So we have data on these women and we know that there was no congenital anomaly that is different from the baseline. These are on CDC's documents that people can access. So we know that there is no safety signal from the messenger RNA vaccines that has been given to pregnant patients, at least up to the last time that data was analyzed in March.

Cassandra Holloway:

It sounds like if you are pregnant, or if you're trying to conceive and you do get the vaccine, would you encourage people to participate in this v-safe just to track their symptoms and to help gather that bigger picture about the vaccine in pregnancy?

Dr. Oluwatosin Goje:

Absolutely. Transparency has been one of the things that we've encouraged during this vaccination process and the v-safe actually is one way to actually put in your own personal data without any coercion.

Cassandra Holloway:

So, I feel like we've all heard these varying answers about when in your pregnancy it's safe or safest to get the vaccine. Where do we stand with the timing? Are there certain trimesters where it's considered safe? Is it the first versus the third? Where do we stand with the timing of the vaccine, if you are pregnant?

Dr. Oluwatosin Goje:

All trimesters are safe for you to get your vaccine. The best time to get your vaccine to protect yourself is now. If you have spoken with your provider and you have chosen, after knowing the risks and the benefits to get your vaccine, the best time to get your vaccine is now, regardless of the trimester. There is a study that came out in March, it's in the American Journal of OBGYN. They actually had a cohort of more than 100 women who got the messenger RNA vaccines, and a little amount, I think like 11 patients, which was 13%, were in their first trimester when they got the first dose and the rest were in their second and third trimester. Majority were in their second trimester.

              What that data shows is that there is a robust generation of immunity in this group of women. There was a woman who did not have a lot of IgG, which is the humoral immunity. They discovered that she was delivered of her baby in between both vaccines, in between the two doses. So, that shows that getting both doses is better. The second dose is almost like a booster. Another lady that had low immunity actually had the baby shortly after she got her second dose, so that shows that you need some time after your vaccine to get the maximum development or a robust immunity that you can transfer to the baby. So if you look at everything, the safest time is now, but if you were to think about generating immunity to transfer, we might be talking about the second trimester.

Cassandra Holloway:

What about expecting moms who already had a COVID-19 infection? Maybe slightly before they conceived or while they were pregnant, should they still get the vaccine at that point?

Dr. Oluwatosin Goje:

Absolutely they should. The same study actually compared pregnant patients, lactating mothers who got the vaccine, and pregnant patients who had a COVID infection and not the vaccine. The women who were vaccinated had a more robust immunity to SARS-CoV-2 than women who had immunity from an infection, that is clear.

Cassandra Holloway:

Yeah. Wow, so the vaccine is providing better protection-

Dr. Oluwatosin Goje:

Correct.

Cassandra Holloway:

... than a regular infection would?

Dr. Oluwatosin Goje:

Correct. I know the more immunity you generate, looking at how pregnancy is, we transfer immunity to babies transplacental, the more you will be able to transfer, to my knowledge.

Cassandra Holloway:

So when a pregnant woman gets the vaccine, it sounds like it protects the baby. Is it always, or does it vary slightly by when you get it?

Dr. Oluwatosin Goje:

So, there's a lot of research is still needed. The first thing that is good news is that this immunity, especially the IgG, is transferred through the transplacental and in breast milk. Now how efficient that transfer is to the baby, how effective it is, is more for research, we need to delve deeper to see but it's just good, that when you get the vaccine, you're generating immunity like a non-pregnant patient, which is good. So it's not like you're just going through the routine, you're actually generating immunity. The fact that you transfer to the baby is good news. Now, we need to know how efficient that transfer is and how much of it benefits the baby. I'm sure as we keep going through this pandemic and vaccinating everyone in the country, we'll get more data.

Cassandra Holloway:

Yeah. As we continue to analyze these numbers and this data, like you're saying, we'll see how long was the baby breastfed for? And what level are the antibodies being passed on, via that breast milk, I imagine?

Dr. Oluwatosin Goje:

Absolutely, absolutely.

Cassandra Holloway:

Obviously, prenatal care is already a very personal topic and journey for every expecting mom or family, and so is making the decision to get the vaccine. What should you do if you and your OB or doctor are in different pages about the vaccine? How do you navigate that situation or that conversation?

Dr. Oluwatosin Goje:

This is a very, very important topic because as you alluded to, obstetric is quite personal. It's me and my doctor, me and my midwife. If you and your provider on different pages regarding vaccination, you should ask yourself, what are your risk? I'll keep going back to it because not everybody is low risk pregnancy, not everybody is high risk pregnancy and our jobs, our families, for example, there are people who live multi-generational in their homes. They have grandparents that are frail, they have cousins that had solid organ transplant, like a kidney transplant. You want to consider, if you as a pregnant patient gets infected, you get symptomatic and you infect those people that you love in your family. So not everybody's risk is the same. You have to consider your personal risk and your family risk. If your provider is on a different page, you can actually reach out to another provider and reach out to your department of health if you want to get the vaccine.

              As of today, there are a lot of places where you can get your vaccine, pharmaceutical companies, pharmacists, department of health, the Cleveland Clinic as an enterprise. So you can reach out and I can assure you that we'll still have the conversation with you before we go ahead to administer the vaccine.

Cassandra Holloway:

So it's well known that most COVID-19 vaccine side effects are experienced after that second dose. So if you're pregnant and you receive the second dose and you find that you aren't feeling well, maybe you have a small temperature, or you're feeling just not like yourself, what advice do you have for expecting moms to work through those second dose side effects?

Dr. Oluwatosin Goje:

Excellent. So the first good news is the CDC analyze the data from that v-safe, and the commonest side effects that the pregnant patient complained about was pain at injection site. So that is good because pain at injection site, we also see it with Tdap, the tetanus shot. Ice pack to the area, acetaminophen for the pain, and you're good. Pregnant patients have always taken acetaminophen as needed. It is safe in pregnancy, and you can ask your provider or any of the health care providers how much you can take, as long as you have no allergies to it. You start with ice packs.

              The other thing is fever. If your patient may have an increase in temperature, you stay hydrated, you use acetaminophen to try to decrease the temperature. If you're unable to do that, you reach out to your provider. Body aches, we can do the same thing, rest, hydrate. Most pregnant patients already told me, "If I have a slight contraction, I just need to hydrate more and rest." So hydration, taking antipyretics, reach out to your doctor. If you have nausea or vomiting, pregnant patients can take over-the-counter Unisom. They stay hydrated. If you think you can't keep enough fluid in, you reach out, you call your provider and we will take care of you. Most of the things we need to ameliorate the side effects of the vaccine are safe in pregnancy, are readily available.

Cassandra Holloway:

So I know we touched on this a little bit in your previous answers to some of my questions, but I just want to reiterate for listeners who are interested in getting the vaccine and they are pregnant. How do they go about this? What should they do? I know in certain circumstances you need a letter from your doctor giving you that special permission, but what would be your advice for getting the rolling with getting this vaccine, if you are pregnant?

Dr. Oluwatosin Goje:

So officially, you don't need a letter from your provider. What you need is a form of discussion with your provider to say, "I have discussed my risk of COVID-19 infection with my provider. I have discussed the benefit of vaccination and the side effects, and I'm ready to do it." So the CDC and ACOG encourage pregnant patients to discuss with their provider, because that way you can tease out your risk and you can ask questions about the side effects of the vaccine. So that is really what you need, not necessarily a formal letter to get the vaccine. You can go to any of the pharmacies that offer the vaccine, or you can go to the department of health if your doctor's office is further away or there's no opening.

Cassandra Holloway:

Excellent. So Dr. Goje, the last thing I want to ask you about today, all expecting moms obviously want to protect their growing baby. So do you have any parting advice for listeners who are really just debating getting the vaccine while pregnant and they're on the fence? What would you tell them?

Dr. Oluwatosin Goje:

I have three things to say. One, the COVID-19 infection is real, and if you're listening to the news, globally it's still there. This COVID-19 infection has been shown to have a severe infection or a severe consequence in pregnant patients when they are symptomatic. Pregnant patients want to stay healthy for their unborn baby and for their newborn. So you don't want to get very sick and be intubated or hospitalized. Also, most pregnant patients know that when a pregnant mother is sick, she might have a preterm delivery. That has been documented, that there was a slight increase in preterm birth in symptomatic COVID-19 infected mothers. I'm sure no pregnant patient wants a preterm birth. So think about all the ways you want to protect your baby and consider that this vaccine is one step, a major step in protecting that baby and yourself.

Cassandra Holloway:

Wonderful advice to end on. Dr. Goje, thank you for being here today and sharing your insight with our listeners.

Dr. Oluwatosin Goje:

Thank you for having me.

Cassandra Holloway:

To learn more about the COVID-19 vaccine, visit clevelandclinic.org/covidvaccine.