- Hey, y'all welcome back.
I'm Mama Doctor Jones, a board-certified OB-GYN.
And today I'm talking about COVID-19 vaccine in pregnancy
and breastfeeding.
Is it safe? Do we know anything?
And also a little bit about how the vaccine itself works.
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get the information and bring it up with your own doctor.
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This information is up to date to the best of my knowledge
and ability as of November 30th, 2020.
Things could change.
We will definitely be getting more information,
but this is what we know now.
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The ones I'm talking about today are the mRNA vaccines
that are currently under review and expect it to be approved
by the FDA sometime in the coming weeks.
mRNA vaccines are really interesting to me
because instead of taking a whole live virus vaccine,
like the MMR vaccine or a whole dead virus vaccine,
like the influenza shot,
we have taken a tiny piece of messenger RNA or mRNA
from a dead virus of SARS-CoV-2
and use that for the vaccine.
So how does mRNA work in the vaccine?
I want to specify I am an OB-GYN.
I am not an epidemiologist or an immunologist,
but I'll explain it to you to the best of my understanding
in a way that hopefully you can understand too
because I actually think it's really cool.
mRNA is messenger RNA.
And what that mRNA does in SARS-CoV-2
is create the spike protein.
The spike protein is basically the key that SARS-CoV-2
uses to get into your body.
A protein on the outside of the virus
that allows a virus to gain entry
into your respiratory system.
When we take that piece of mRNA out
and put it in a vaccine
your body starts making that protein.
It's kind of like if you sent a message to your printer
to print out a, I don't know, a picture
and that's what your printer would do.
So basically the mRNA is the message that you're sending
to your body to make some of the spike protein,
which is the key the virus uses
to get into your respiratory system.
Even though your body's making it,
your body recognizes it as not being the typical thing
that should be in your body.
So immediately your immune system kicks into gear
and starts making antibodies that fight that protein off.
Your body is actually doing all the work here.
So once your body starts making those spike proteins
and then starts making the antibodies,
your body has an ability to recognize that spike protein
if it ever interacts with it again, out in the wild.
So when you go out and you're exposed to SARS-CoV-2,
if you've had this mRNA vaccine,
when that virus gets close to your respiratory system
your body goes, oh, we know that key.
That's a key we don't want SARS-CoV-2 using
to get into our body.
So it protects against that spike protein
being able to be used as the key to get into your body.
And then if the virus does get into your body
you're better able to fight it off
because your body and your immune system
already recognize it.
I hope that that made sense.
That's the way that my brain understands it.
And I hope that it helps you understand
a little bit of how the vaccine works as well.
And again, there's a couple of different types of vaccines
that they're developing.
These are the mRNA vaccines that are currently under review.
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So unfortunately, despite many OB-GYNs like myself
yelling about this for a long time,
people who are pregnant were excluded
from every vaccine trial
and people who are breastfeeding were excluded
from most vaccine trials.
This is really unfortunate
because it puts us in a very difficult place
as far as counseling what you should do.
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First off,
I want to say this video should not supplement
medical advice that your doctor gives you.
You should talk to your own OB-GYN
and make this decision in conjunction with them.
That being said, I do want to give you some information,
so that you have some talking points
to bring up with your doctor.
We can kind of extrapolate a little bit of information
from other vaccines.
However, since we've never had an mRNA vaccine,
we can't predict super accurately how it will behave
in your body.
We can use biologic plausibility and history
to give us a little information.
This vaccine being a portion of a dead virus
will most likely react most similarly
to other dead virus vaccines
because it's more similar to take a dead piece of virus
and compare it to a dead virus
than it would be to take a dead piece of virus
and compare it to a live virus.
Does that make sense?
So we should look at what vaccines have been traditionally
contraindicated or recommended against in pregnancy.
And most of those are going to be
things that either can wait safely
until you're not pregnant,
like HPV vaccine
or they're going to be live virus vaccines,
like the MMR vaccine.
Most dead virus vaccines,
like influenza shot and Tdap shot
are safe to use in pregnancy.
We would expect based on that,
that hopefully this one will be safe in pregnancy,
but again,
I don't have any data at this point to base that on.
So why have live vaccines been traditionally not given
in pregnancy?
This is because people who are pregnant
tend to react more strongly to these
and have worse side effects.
And so we choose not to give those because of that.
There are things like the HPV vaccine,
which can safely wait until after pregnancy.
So we just recommend that you wait until you're not pregnant
anymore to get that one as well.
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Over the next six or 12 months,
we will start to get a little bit of data on this
from post-licensure data
and any post-licensure scientific studies that are done,
but they probably won't be randomized controlled trials
because once a vaccine is approved
it's really hard to do a randomized control trial.
Most people aren't going to want to be randomized
once we have the data for them to make that decision.
If that makes sense.
So probably what we're going to have is post-licensure data,
where people who are currently pregnant
and opt to get the vaccine
are followed to see if they have any bad outcomes
or side effects that might be related to the vaccine itself.
We will continue to follow these post-licensure events
in all people who get the vaccine for a long period of time.
But specifically,
I'm hoping that in the next six to 12 months,
we do have information on people
who chose to get the vaccine while they were pregnant.
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We know that COVID in pregnancy might be more dangerous
than COVID outside of pregnancy.
And we do know that there are some associated
poor fetal outcomes that are looking more and more likely
to be associated with COVID-19 infection in pregnancy.
I have a video on this. I need to do an update.
That's kind of the general understanding
is that although pregnant people
don't seem more likely to get infected.
They might have a higher likelihood
of being admitted to the ICU
and they might have a higher likelihood
of having pregnancy complications,
like preterm labor, miscarriage, stillbirth,
preterm delivery, and things like that.
That would mean that if someone has weighed,
you know, we don't have any information on the risks,
but we know the benefit of it being very effective
against preventing COVID-19.
And if you get the vaccine and you still get COVID
it seems like your COVID is much less severe.
So that would make us lean towards,
okay, well, if COVID in pregnancy can be dangerous
and have pregnancy complications associated with it
and the vaccine based on biologic plausibility and history,
seems like it should be safe and effective.
Then some people may choose to get the vaccine
without that data.
I think it's really important to acknowledge
if there are people who choose not to get the vaccine
because they don't want to be,
you know, getting it before the data's there.
I really think that is completely reasonable.
When I evaluate it in my head
if I were the person who was pregnant,
I think I would probably choose to get the vaccine.
Knowing my own risk, benefit analysis
and my own risk aversion.
That's what I would choose.
But, I think this is a situation
where it's really, really reasonable to get this information
and choose whichever way you think is best for you.
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Breastfeeding has been excluded
in most of the vaccine trials.
Although there are a couple out there
that have a little bit of information on it.
We don't have any evidence to suggest that,
I don't think any vaccine,
I can't think of any vaccine
that is completely contraindicated
in someone who is breastfeeding.
And we know that there's probably some conferred immunity
from getting the vaccine either while pregnant
and those antibodies go through the placenta
and help protect the baby when the baby's born
and in creating antibodies
that go through the breast milk to the baby.
So there probably is a benefit there.
The risk is likely to be minimal,
but again, we don't have that data yet.
And hopefully we'll have more in the next six to 12 months.
I want to one more time say I think a reasonable decision
is whichever one sounds the best for you
after hearing this information
and talking with your own doctor or midwife.
I hope this gave you some information
to chat with them about
and made you feel a little more empowered.
If you have any more questions about the COVID vaccine
in pregnancy or breastfeeding,
please feel free to leave them in the comments below.
And I will update you guys
as soon as we have more information on this topic.
Be kind to yourself, to each other, to me,
in the comments be kind, and I will see you next time.