Pregnancy and COVID Q&A with UNC gynecologist

Pregnancy and COVID Q&A with UNC gynecologist


NC Health News asked a UNC gynecologist questions about fertility, pregnancy and vaccination during the time of COVID.

The Centers for Disease Control and Prevention recently doubled down on its recommendation that pregnant people get vaccinated to help combat the Delta variant.

Pregnant people are more at risk for serious illness from COVID-19, which could lead to hospitalization, intensive care or a ventilator. We sat down with Lisa Rahangdale, associate professor of general obstetrics and gynecology at UNC Chapel Hill School of Medicine to answer common questions about fertility, pregnancy and vaccination in the times of COVID. (Answers have been edited for brevity and continuity.)

North Carolina Health News: Will a vaccine impact people’s fertility, both women and men?

Lisa Rahangdale, MD: We don’t have any data that would support that it would impact fertility. There’s a biological plausibility to it as well. We give vaccines to women preconception, in order to prevent different illnesses, in pregnancy and beyond. That’s always been a standard practice and has not been associated with any fertility issues. I am not an infertility doctor, but I know that there have been studies looking at women undergoing IVF, in-vitro fertilization, that have also not shown any impact on outcomes.

NCHN: Does the COVID vaccine affect your menstrual cycle?

Rahangdale: Women who actually had COVID infection were found to have changes to their menstrual cycle, and now we’re also learning more that women who are vaccinated have had changes. Generally, it’s short term, like, maybe one to two cycles, and it actually biologically makes sense because the lining of the uterus, or the endometrium, has immune cells in it, and if the immune system gets activated in your body, whether it’s from getting natural infection or for getting the vaccine, it’s going to impact all the immune cells in your body, potentially, and having an irregular period is not a surprise. Women who’ve gotten vaccinations in the past have also reported such things. Stress, changes in the health status, have always triggered women to have changes in their period.

NCHN: What kind of vaccines do people normally get pre-conception?

Rahangdale: They can update it if they need the MMR vaccine or the varicella vaccine. Sometimes people need a tetanus booster or pertussis, [those are] the ones that we mostly think about.

It’s a normal thing that even in normal times those are vaccines that you get. That’s what I was trying to emphasize — that this whole concept of vaccination in reproductive-age women, we give them preconception, in pregnancy, postpartum, so it’s not like a new thing that women of reproductive age need to be vaccinated for something — and flu shots of course, flu shots.

NCHN: Is it safe to get a vaccine if you’re pregnant or if you’re expecting to be pregnant?

Rahangdale: Yes. Based on the information we have, it is safe. I think that there’s no concern for people who are planning pregnancy or, postpartum or lactating. Of course in pregnancy, in general, we’ve always talked to our patients about avoiding exposure if they don’t need to, so if you don’t need to take a medication or something, we don’t recommend it.

Over 147,000 pregnant women have been vaccinated. And there are three different surveillance systems that the CDC is using in order to track these women with thousands of women who are in those surveillance systems, and there haven’t been outcomes that have been seen. I can’t answer long term, I can’t answer all the what-ifs, but vaccines don’t work as long term players. They are in the body, the body reacts to them and then they’re gone. So just biologically, the way vaccines work, we wouldn’t expect lingering long-term continued effects.

NCHN: Is there any research that has shown the risks that being unvaccinated and pregnant and getting the virus could show to someone’s health?

Rahangdale: So [COVID during] pregnancy can lead to a three-fold increase in risk of ICU admission and a 2.4 fold increased risk of needing ECMO — that’s where you are put on a machine to sort of support your heart and lungs — and a 1.7-fold increased risk of death, compared to symptomatic non-pregnant women.

Even pre-COVID, pregnant women who got respiratory viruses, with the flu, for example, had worse outcomes than non-pregnant women, and that means being hospitalized, maybe needing a breathing support ventilation, death.

When COVID came around, we of course were worried that this would be the same issue for pregnant women. And we have now found that there is [evidence to] support that pregnant women are twice as likely to have a worse outcome than a non-pregnant woman. The additional thing is that if you get sick in pregnancy, you need to have a healthy mom to have a healthy baby, that can increase your risk of adverse outcome in pregnancy so there is an increased risk of premature birth, if you get sick from COVID. And so, that of course impacts the child long term.

Between the significant health risks, and the increase in safety data that we have in pregnant women, and particularly, how the Delta variant has spread so rapidly, and had younger people getting sick, I support pregnant women getting vaccinated.

I don’t want pregnant women to be … living in fear. I think there are things that you can do to stay safe: vaccines, masking, living your bubble, and you can be safe, and have a healthy pregnancy. So my goal in sharing all that is not to fill everybody with anxiety, it’s just it’s also why we advocate for the vaccine.

NCHN: If you are pregnant, you get a vaccine, is there any evidence to show if the baby will also acquire that immunity?

Rahangdale: Regardless of the vaccine or infection, if you get sick when you’re pregnant, … get a vaccine and you’re pregnant, women produce antibodies and those antibodies cross the placenta to the baby. It’s not that the vaccine itself is passing to the baby. It’s the antibodies, I just want to clarify that. And there is evidence that those antibodies cross to the baby, both in pregnancy and breastfeeding.

NCHN: So that could be possibly an incentive to people, especially since children that young can’t get vaccinated that there is an opportunity for them to get those antibodies.

Rahangdale: Right, it is an opportunity. Your baby will not be in a bubble. If your child has older siblings who also can’t be vaccinated, and other caretakers and things like that, that could be a potential benefit to the newborn.

NCHN: Is there a particular timing that research has shown is best to get a vaccine while you’re pregnant?

Lisa Rahangdale: No, I don’t think that there have been any data showing the vaccine associated with miscarriages, that’s early pregnancy, or with adverse outcomes later in pregnancy, so the ideal time is as soon as possible.

NCHN: Do pregnant women count as “immune compromised” when it comes to getting a booster shot?

Rahangdale: Pregnant women are going to be relatively immunocompromised compared to non-pregnant women, but they are not so immunocompromised that they’re in the category of moderate to severe immune compromised and need a booster shot at this time.

NCHN: Even before COVID, there’s been an effort to make sure that pregnant women are protected from respiratory diseases. Back in 2009 during the swine flu pregnant women also did significantly worse when they caught that virus. What lessons have we learned from the past that we can apply to COVID?

Rahangdale: That’s why we had increased vigilance with COVID because of those lessons and of course, what we learn from this yearly flu. And so I think that pregnant women need to do all the precautions of washing their hands, distancing, wearing a mask and vaccination is, of course, another very powerful tool to help protect them, but if somebody is unvaccinated, then masking is critical in order to prevent infection.

NCHN: What kind of masks should you be wearing, what social distancing protocols should you be following?

Rahangdale: I think that absolutely pregnant women should be masking and social distancing, limiting your bubble to what it needs to be. Masking in particular indoors if you’re not able to mask outdoors, but I think that even people who have been vaccinated have gotten infected, though their symptoms and the shedding, meaning the spread of the virus, has been less. I think that they need to use both of those tools in order to stay safe and healthy.

NCHN: And if someone who is pregnant gets sick with COVID, are they able to use the current treatments that are out there like the monoclonal antibody infusion?

Rahangdale: Yes, they are considered a high priority … to get on monoclonal bodies because of the risks of illness.

NCHN: Is there anything else you would like to add?

Rahangdale: I understand why this is so hard for women. They want to protect their health and they want to protect their ability to have the family they choose or to have healthy pregnancies. The fact that women are asking these questions is really great because I want women to be an advocate for themselves, but it’s also true that COVID is a serious illness. And particularly, waiting on vaccination is not necessary. We have increasing safety data, and I want to also provide reassurance that making the choice to get a vaccination is also making a choice to take good care of yourself and your baby.

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