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Ep. 131 - LiveWell Talk On...COVID-19 Vaccines and Pregnancy (Dr. Stephen Pedron)

episode 131

Ep. 131 - LiveWell Talk On...COVID-19 Vaccines and Pregnancy

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Host: 
Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Stephen Pedron, physician, UnityPoint Clinic Maternal Fetal Medicine

Dr. Arnold:
This is LiveWell Talk On...COVID-19 Vaccines and Pregnancy. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital in Cedar Rapids, Iowa. Joining me today is Dr. Stephen Pedron, maternal fetal medicine specialist at UnityPoint Clinic. Dr. Pedron, the Center for Disease Control has recommended that pregnant women receive the COVID-19 vaccine. However, there is a lot of fear with the possibility of fertility, possibly of being pregnant and receiving vaccine, whether or not breastfeeding. I'd like to answer some of those questions today and dispel some of the myths. First, what do we know about how COVID-19 effects pregnancy?

Dr. Pedron:
It affects pregnant patients as hard or harder than it does other patients. It's hard to tell whether those pregnant women get sicker, or whether we treat them more avidly, whether we're more aggressive with them because they're pregnant. They have that second passenger in there, and so everybody's a little bit more vigilant with pregnancy. But at least as sick as non-pregnant patients.

Dr. Arnold:
Let's go through the basic, kind of, concerns. If I'm considering getting pregnant. Has there been any evidence that fertility is affected by the vaccine?

Dr. Pedron:
No, not at all. There's been a lot of misinformation, a lot of voodoo out there, but there's not a shred of evidence that it affects fertility. Reproductive endocrinologists, the infertility specialists, they recommend that their patients get vaccinated. There was some misinformation early on about the vaccine antibody affecting a particular protein in the placenta. That got blown out of proportion. That is just flatly incorrect, and people became concerned that if you had this antibody that was affecting the placenta early in pregnancy, it could cause miscarriage. That just isn't true.

Dr. Arnold:
Let me ask this general question, related topic, and I know you're not a fertility specialist, but I know you're pretty smart, so you'll know the answer. Are there any vaccines that you take that affect your fertility?

Dr. Pedron:
No, none that I'm aware of. There are some vaccines, live vaccines, that are contraindicated in early pregnancy. It's all just theory, because they really haven't demonstrated birth defects as a cause of these vaccines. It's just super caution, but anything preventing or affecting fertility, I can't think of one, no.

Dr. Arnold:
With pregnancy, obstetrics, your specially, there's always the lack of randomized placebo controlled trials because who's going to be the pregnant patient who says yeah, I'll enroll my kid in the control group, you know? Just, there's not a lot of willing participants naturally because we're talking newborns, right. So it's hard, a lot of it is theoretical in your specialty, for the most part.

Dr. Pedron:
I wish that I could put that down to the pregnant patients not wanting to participate in the study because they're worried about their baby, but the bigger problem is the system. The bigger problem is the provider side, the clinical side, the research side, not wanting to do the research. Why is that? I don't know, Dustin. It's complex, it's political, it's liability. Nobody wants to get sued if something goes sideways. But if you look at, because of that dynamic, because medications just aren't studied in pregnancy. I was trying to think this morning, racking my brain, what's a medication that has a greater track record than the COVID-19 vaccine. I can't think of any medication that I'm using for my pregnant patients right now, whether it's hypertension or diabetes or cancer therapy or heart disease, I can't think of a thing that's got the volume of data that COVID-19 vaccine has. There's a huge amount of data that just tells me. Man, I know so much more about the safety of this than I do these other medications that patients are already taking. It just seems very straightforward to me. Gosh, we know that this is safer than other things that we're using.

Dr. Arnold:
Yeah. This was on a podcast of recent, 4 billion doses have been delivered, over 4 billion. That's billion with a B. I mean, that is a huge n for any study. I mean, I'm happy when I see a thousand patients enrolled in a study and I say, okay, that's a decent number. You know, now we can draw some conclusions, but 4 billion is huge.

Dr. Pedron:
Yeah. And I'm blown away by the by the sophistication of the data collection V-safe and what the CDC both have done together, as far as data collection for this vaccine and pregnancy. There's a lot of information out there.

Dr. Arnold:
Think some people don't understand that the V-safe is intended as a screening tool. Everybody volunteered to report everything and then we'll sort out whether or not it's related. So when they say that, oh, there's been more reactions reported with COVID than any other vaccine combined, all the other vaccines. That's probably true because they're over-reporting as a screening tool. And then the CDC will narrow it down and say, okay, this is a real side effect and we need to counsel on that. And I don't think people understand that it's not intended as a know all be all, but it's intended to find a pattern or a side effect that is predominant, and then go confirm or discount that it's true and related.

Dr. Pedron:
Yes. And that data collection, that volume of data that's been collected, it's just, I don't want to beat a dead horse here, but it's just entirely reassuring for pregnancy.

Dr. Arnold:
Now, breastfeeding. Any concerns there?

Dr. Pedron:
Perfectly safe. Doesn't affect breast milk production. Doesn't decrease breast milk production. Antibodies, immunity is passed to the baby in breast milk. This has been demonstrated, I have literature for this. And anything else that a listener wants, just give them my email and have them contact me because I have the background literature on all of this. It's very safe.

Dr. Arnold:
So, I mean, there really is not a contraindication for pregnancy.

Dr. Pedron:
No, there is not a contraindication for pregnancy, period. It we haven't talked about this yet, but these antibodies that are produced cross the placenta and give the baby some newborn immunity. Now, newborns haven't yet, with the variants that we have, been severely affected. However, they can be infected, they can get severe disease and they certainly can transmit. So to have some of that immunity transmitted across the placenta, safe antibodies to coronavirus, cross placenta, and have the baby born with that immunity, that's amazing.

Dr. Arnold:
Wow. Can I ask you this scenario then? So if a woman comes to the hospital, she delivers, we could vaccinate them before they went home, correct?

Dr. Pedron:
Yes, absolutely. There is no stipulation about the timing of the vaccine, pregnancy, postpartum, period.

Dr. Arnold:
So if a mom says I'm a little concerned about my baby, we can still hit them before they go out the door.

Dr. Pedron:
Absolutely.

Dr. Arnold:
That's interesting. Do you recommend one vaccine over another? mRNA versus the viral analog? Pfizer versus Moderna?

Dr. Pedron:
No, I don't. If you can get a vaccine, take a vaccine. Now having said that, I love the mRNA vaccines. Just the technology, the biology, the potential for mRNA vaccines and just certain safety of that vaccine of the Moderna or the Pfizer, I love them. And J&J, as you know, has this pesky little uptick in risk for clotting and thrombocytopenia. And so, yeah, it's there, but compared to the alternative, and that is getting coronavirus disease—which the rate of deaths from coronavirus disease is, I don't know, one in 100, one in 200, something like that for patients who acquire the disease, it's high. The odds are so much in the favor that if you have an opportunity to get the J&J, go for it. I'm perfectly comfortable with it.

Dr. Arnold:
Okay. And then, so you would also be comfortable with the booster?

Dr. Pedron:
Oh yes, strongly recommend it. The moment it comes out and the patient becomes a candidate for it, absolutely get it.

Dr. Arnold:
I tell you, Steve, I'm worried about the booster, the encouragement for people to get vaccinated, and seasonal flu shots, all coming due in October. I think it's going to put a huge strain on the system. And if you ask me, what's keeping Dustin up at night, it's the logistics of delivering those vaccines when it rolls around.

Dr. Pedron:
Yeah. I think it's all going to hit at once, right. And what's going to happen as far as logistics, you got me. But I did just do a little research yesterday and found out that there's no contraindication to having them both on the same day. Did you know that you can get your influenza and your coronavirus booster, or vaccine on the same day?

Dr. Arnold:
Just not in the same arm, yeah.

Dr. Pedron:
Yup, right.

Dr. Arnold:
Well, they are working on trying to get one shot, lifetime shot, for influenza. That work was being done by, I can't think of his name, but prior to the pandemic. So it will be interesting what he learned during that if that work continues during the pandemic.

Dr. Pedron:
I don't know that research, that's fascinating, but I do know that the mRNA biology, just you watch over the next six months, year, five years, 10 years, it's going to explode our treatment of cancer, other immune disorders. I think it's just going to blow people away, genetic disorders, cystic fibrosis. I think it's just going to change the landscape of what we're doing, Dustin.

Dr. Arnold:
Yeah, I think in any disease process that is a result of some deficiency of either protein building or enzyme production. You don't want to use this term very often in medicine because you don't want to provide false hope, but you're really talking cures for some diseases.

Dr. Pedron:
Yeah, that's going to be something.

Dr. Arnold:
I mean, you really might be able to get a shot and be cured of your thyroid condition, cured of your rheumatoid arthritis. mRNA technology is one of those things in medicine, where I look at it and I go, man, I'm glad they weren't dependent on me to come up with this because this is brilliant. You know, whoever thought of that and worked it up, wow.

Dr. Pedron:
Oh yeah, these guys are Wiz kids.

Dr. Arnold:
Well, once again this is Dr. Pedron, maternal fetal medicine specialist and all things pregnant. He is always on top of things. He's always a pleasure to have on the podcast. If you would like more information regarding a UnityPoint Clinic - Maternal Fetal Medicine, please visit UnityPoint.org.

Dr. Pedron:
Pleasure to be here. Thanks, Dustin.

Dr. Arnold:
Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.