- The COVID-19 vaccines, pregnancy,
breastfeeding, and infertility.
We're talking about each one of those subjects
because you requested it.
Let's bring in the special guest, Mama Doctor Jones.
Welcome to the channel.
Today, I'd like to talk with you
specifically surrounding the COVID-19 vaccines
and their effects on pregnancy,
breastfeeding, and infertility.
Three subjects that you're an absolute expert on.
I'm a patient, I walk into your office,
"Hey Dr. Jones, I am pregnant.
Should I get the vaccine?"
What's your response?
- This is not a yes or no answer for any of my patients.
This is, "All right, I'm so glad that you asked that.
Let's sit down and let's talk about it."
We know that this vaccine is safe and effective
in adults at preventing severe COVID symptoms.
We know that it is probably effective
in pregnant people as well
because they generally wrap pretty similarly
as far as safety and effectiveness of non-live vaccines
which this is not a live vaccine.
What we don't know is what is the evidence
of fetal safety or fetal harm?
We can't tell you that.
We can talk about the biologic plausibility,
meaning is it likely to cause harm to a fetus?
And I would say that is pretty unlikely,
but I can't tell you for sure
because I don't have that data.
At the end of the day,
I think it's really important to say,
we don't have any reason to think
that this would be harmful
and we know that COVID-19 is harmful
in people who are pregnant
and does increase rates of pregnancy complications.
- When we were doing the initial research
on COVID-19 and vaccines,
we did not include pregnant patients.
Do you think that was the right move?
Not including pregnant patients in the initial research?
- I don't.
And we've been talking about this as obstetricians
since before the trials got started.
Like, please do not exclude people who are pregnant.
This will cause major issues with uptake
and with also how we counsel our patients
when we get the vaccine available.
But, now here we are with no way
to really have specific data to give to our patients,
but still in a position
where it's really important that we talk about it.
- You may have two patients that come to your office.
One patient does not have to leave the home
and faces a lower risk of contracting COVID
because of their interactions.
They live in a single generational household.
Don't have to leave the house,
do not have to work, are financially stable.
They may face one decision and one recommendation
when it comes to getting the vaccine as a pregnant person
and the second patient who either needs to continue working,
lives in a multi-generation household,
has multiple people in their homes
who constantly leave and come back
and as a result faces higher risk,
they may make a different decision
and both could be the right decision for those patients.
- Absolutely.
And I think you've really hit on a perfect point there is,
whatever decision you make, if it is made with counseling
from your physician or your advance practice provider,
whoever's taking care of you and your baby,
it is the right decision.
And I'm here to provide all that information
to help you initiate that conversation and feel empowered
to ask those questions, but there's not a right
or wrong answer here.
This is very individual.
- This individual decision really breaks down to the fact
that initial research did not include pregnant patients,
our intuition and our logic and our experience
says likely you will be protected the same,
likely you will be safe,
but we cannot say that with the same certainty
we say that 95% protection.
When it comes to knowing the other side of that equation is,
we can tell you how dangerous COVID is.
We can tell you how dangerous it is
for you as a pregnant patient,
that it's more dangerous than the average person.
So, now you have to deal with this unknown
which we don't have the evidence for,
but you have some expert opinion
with the known of how serious COVID is
and you really have to weigh those two things.
My problem occurs with those
who have no logical, biological, plausible reasons
for saying it's dangerous, putting out information
as if it's fact or proven by some mechanism
and scaring the general public unnecessarily.
Have you seen examples of that?
- Something I saw that I really fought back against
and feel like we made some very good change in
was SMFM, which is the high-risk pregnancy society,
ACOG, which is pregnancy and gynecology.
All of these organizations came out
and said people who are pregnant deserve this choice.
You can't take away an adult person's autonomy
to choose the vaccination,
simply because we don't have fetal data.
This should be an autonomous decision.
And so, I really laid into that from the beginning
and most of those organizations
have been extremely supportive of that,
but what we saw was people going into
their place that's providing the vaccine,
their hospital, or health department, or whatever,
and being told, "You can't get the vaccine
because you're pregnant."
And this is essentially taking that autonomy away
from the pregnant person, despite the fact
that every major medical organization
in the United States, including ACIP and the CDC,
has said they deserve that choice,
especially in a high-risk situation where you're
at the bedside with people who have COVID.
So, that's a really important point as well.
- I think there are a couple
of instances that we should definitely talk
about to perhaps reassure the general public
of why it is what we're saying.
There have been several examples,
even a physician colleagues of you and I,
who have gotten the vaccine and are actively pregnant.
- Absolutely.
I have several pregnant obstetrician friends
who I have talked to about this.
I haven't found a single obstetrician who has been pregnant
and refuse the vaccine because we all feel
like the most likely scenario is
that it is safer to receive the vaccine
than to get COVID in pregnancy.
If I were pregnant, that's what I would choose 100%
after knowing all that I know.
We're really practicing what we preach in that area.
And I think that can make a huge difference
in public education.
- Yeah, leading by example as physicians has been huge
with this hashtag this is our shot movement
and I hope we continue to do that.
Have you seen in the research,
and this is something I came across,
that there were, in fact, some patients in the research
who did not know that they were pregnant
because pregnancy at times is unpredictable.
That became pregnant, got the vaccines, and still did fine.
- Yeah, so, we don't have a whole lot of information
on that subset of the people in the trials yet.
And so far there have been no reported bad outcomes related
to the vaccine and those people
who unintentionally got pregnant,
either between the doses or after one of the doses.
- Similar subject, you have a patient
who was recently pregnant and is now breastfeeding.
Are there any risks to getting the vaccine
and continue breastfeeding?
- You know, we're kind of end up in the same situation.
Although in this one, I would say I have even less concern
because there's really no way biologically
that an mRNA vaccine should be causing problems
through breast milk.
If anything, we would expect
that the maternal antibody transfer
through the breast milk would be beneficial
to the breastfeeding baby.
So, I think that this is the same situation.
Obviously we don't have direct data
and we're gathering that.
There are ongoing trials right now for this,
but we, I think, can pretty safely say
there's no biologic plausibility to any theory
that it would be dangerous to continue breastfeeding.
Again, this is based on past experience
and on just looking at data from other things.
So that could change.
We could find something different,
but I wouldn't hesitate to get the vaccination
while breastfeeding at this point.
- When it comes to making a decision
of whether to get the vaccine when your breastfeeding,
we have to admit it is a harder decision
than if you're a person who's not pregnant,
who is not breastfeeding,
because there is a layer of unknown,
but it doesn't mean that it should 100% stray you away
from getting the vaccine.
Why? Because you have to still weigh that unknown
against the known of how dangerous COVID-19 is.
So, while there are unknowns,
there are also still very good reasons
as to why you should be getting the vaccine
and I think that's well heard in your recommendation
that you just said.
- And I wanna add one more thing.
It's something I hear often is people say,
"Well, we don't know the long-term effects of the vaccine."
And to that I would say,
"We don't know the long-term effects of COVID-19 either,
even in kids who get it,
who maybe don't have severe symptoms."
And if we look historically,
there are so many more viral illnesses
that can cause long-term problems
than any vaccination that we've seen
to cause a long-term problem.
- One of the major questions
that I see in the comment section
when I did my first vaccination video
and it continues to this day
is the conversation surrounding the vaccine
and infertility moving forward.
What are the claims that you have heard?
And do you have any idea how they started?
- This essentially came from a blog post
that was posted about quote, the head of Pfizer research,
or former head of Pfizer research,
has concerns about sterility from COVID-19 vaccination.
And if you really dive into where these concerns come from,
it's some scientists kind of thinking out loud
on a Reddit thread.
Now, importantly, we should consider this.
These are smart people.
We should look into it.
We should never just dismiss things like that.
But, the second half of that is once we look into it,
their claim is that this is a genetic sequence
in the spike protein, which is the part
of the COVID-19 or SARS-CoV-2 virus
that allows it to get into your respiratory system.
And they say, it's genetically similar
to the protein syncytin-1
This is the protein that helps your body create
a healthy placenta in the embryo.
And that happens at about eight or nine weeks.
So, we run into our first issue there
is that if this was gonna cross-react,
antibodies to syncytin-1 wouldn't even cause infertility,
they would cause miscarriage.
And that doesn't make sense
because you are pregnant for at least eight or nine weeks
before the placenta is actually working.
So, syncytin-1 in the placenta not working
will cause the pregnancy to fail, not to never exist.
And then the second half of that is the antibodies
when you get the vaccination are the same
as if you had COVID-19.
They're the same antibody against
the same genetic sequence in the spike protein.
So, we should be seeing then an increase
in early miscarriage in people who had COVID-19
if there was any plausibility to these claims.
And we haven't really seen that play out
in the literature yet.
Again, that could change.
I think it's highly unlikely that we would see that.
And then you also brought up earlier,
the point about some people got pregnant during the trials.
These were people who were told, "Be on contraception,
please don't get pregnant,
do everything you can to avoid pregnancy."
And we still had surprise pregnancies in the trials.
That would make very little sense
if this is truly causing infertility.
- All such great points arguing against it.
The weakness that we face here is our humility
and our dedication to honest reporting of facts, right?
Because if we wanted to, we could lean so heavily
on our expert opinion and just say this is nonsense,
just like how people who are,
I-know-all experts, or are very anti-vaccination.
They present their theories as if they're facts.
They are not.
Even when we discuss infertility now,
you rightfully say more research needs to be done.
This is what we think thus far.
We don't have perfect evidence for it yet.
That level of humility should inspire you
at home to understand that we're trying to give you the best
with what we have, as opposed to convince you
of some illogical explanation, which is happening.
Do not let the folks who are trying to misguide you,
who are trying to become popular,
who are trying to spread misinformation to thrive
because they're not following logic.
There's no humility in their arguments.
And I want you to pay attention to Dr. Jones' humility
because it's so important
for scientists to have good skepticism and humility.
And I think she expressed all of those
in answering your three most common questions
when it comes to pregnancy, breastfeeding,
and infertility with the COVID-19 vaccines.
Thank you so much for all of you who are watching.
Mama Doctor Jones, where can they follow you?
Where can they see more of your content?
- I am Mama Doctor Jones on every platform imaginable,
probably too many social platforms,
but you can find me in all those places.
- Last word.
I want you to leave the viewers with what you believe to be
the most important part of this conversation.
- I think the most important part
of this conversation is we are giving you information
to empower you, to have a discussion
with your healthcare provider.
Whatever questions you have,
this should be a jumping point
so that you have that information to talk with them about.
- We talked COVID vaccine.
Now, check out a day in the life of a doctor,
me, during COVID-19.
See what a true COVID-19 unit looks like.
Click here, check it out.
And as, always stay happy and healthy.
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