Host (Simon Floss): Hello, welcome, and thanks for listening to the special podcast from the experts at Sanford Health. I’m your host Simon Floss with Sanford Health News. We’re continuing our discussions on the COVID-19 pandemic and the COVID-19 vaccines.
Today, we’re specifically talking COVID and pregnancy. The expert to help answer our questions is Dr. Jessica Sedevie, a physician and obstetrician gynecologist at Sanford Health in Bismarck, North Dakota. Dr. Sedevie, thanks for taking the time and chatting with me today.
Jessica Sedevie, MD: Thanks for having me.
Host: Let’s first discuss the vaccine as it pertains to pregnant women. Recently, health leaders have recommended the vaccine for women who are pregnant, breastfeeding, or looking to become pregnant. Why is this?
Jessica Sedevie, MD: So, initially when the vaccine came out ACOG (American College of Obstetricians and Gynecologists) was very proactive and ACOG is our professional organization. They were proactive about saying that pregnant women should be able to receive the vaccine if they wanted to. And so, since the vaccine was available, we’ve been collecting data on pregnant women and the effects of COVID on pregnancies, as well as the safety and efficacy of the vaccine in the specific population of pregnant women and in lactating women.
At this point we have data to suggest, first, that COVID is dangerous for pregnant women. And so if a pregnant woman gets COVID, she is more likely to need to be hospitalized, on oxygen, intubated, admitted to the intensive care unit, on ECMO, or at risk of death compared to her same self, not pregnant. Pregnant women are also at increased risk for preterm delivery, stillbirth, and pre-eclampsia. Concurrently, while we were realizing how dangerous COVID is for pregnancy, we were getting safety and efficacy data about the vaccine. And so, we have seen that we are, you know, we’re not seeing any increased risk of miscarriage, stillbirth, small for gestational age, (or) birth defects. And so we have something that is safe and effective that we can use to prevent these bad outcomes for women. And so that, that’s why it’s being recommended.
Host: I’ve personally spoken to other providers at Sanford Health who have basically echoed your sentiment saying that pregnant women who become infected with COVID-19 are at a greater risk of miscarriage and birth defects. What have you personally been seeing?
Jessica Sedevie, MD: You know I think that in general we’re seeing what feels like more of just bad outcomes in general. What I, what we tend to notice you know, if you were to ask me what’s, what is the biggest impact that I have seen COVID play on pregnancy? It’s, you know, these patients who come in and are late second trimester, early third trimester who ended up getting admitted with COVID and ended up needing delivery.
You know, I would say three times in the past couple of weeks, I’ve had patients who have delivered preterm, infected with COVID, and then their infants have to go up to the NICU. And so then those moms aren’t able to go and see their baby for that period of time either. And so you know, these are babies that are being born either preterm or sick.
Jessica Sedevie, MD: And so, if we have a normal term delivery, certainly we’re trying to keep moms and babies together so that they don’t have to go through one more thing because we, you know, we want to keep them together. But at this point we’re seeing a lot more separation, or moms who’ve had multiple vaginal deliveries whose babies are in distress and end up needing C-sections. And so I think it really is impacting patients, pregnancies, their delivery, timing, their delivery, route, their birth experience. And I’ve had many of them say afterwards that they wish that they had received the vaccine.
Host: A common misconception or concern that we’ve heard about the vaccine since it was rolled out nearly a year ago, was that it can impact fertility. Can the vaccine have a negative impact or effect on fertility?
Jessica Sedevie, MD: We have not seen decreased fertility related to the COVID vaccine. The initial theory behind that was something that has since been explained by experts as being something that isn’t actually seen in women. Maybe the theory was okay, but we’re not actually seeing that come to effect. The interesting thing too, I think is that this theory was projected, you know, about the same time that the vaccine came out and you need about a year of somebody trying before you say that they have infertility. That’s the definition, right? It’s a year of trying to conceive without conception. So that wasn’t even something that we could say then. Now, the vaccine has been under the EUA since when I got my vaccine and December and some of the trials started before that.
Jessica Sedevie, MD: So, we’re closer, but we’re not seeing rates of infertility that have increased related to the vaccine. When you look at our professional organizations, so the American society for reproductive medicine, American college of obstetrics and gynecology, society for maternal fetal medicine, all are committed to healthcare for women and all recommend that women who are trying to get pregnant, who are pregnant, who are lactating, that they receive the vaccine.
I received the vaccine when I was 34 weeks pregnant the first week it was available because I had been working in the hospital through the pandemic, through my pregnancy. I signed up for every study. I could find because those of us who are providing health care, who are part of these groups, we want to make sure that we’re getting the best information possible for women so that, you know, if there was a safety concern, if it was going to cause infertility or birth defects or pregnancy effects, that we can figure that out and tell patients. It’s the people in these cohorts that we’ve been studying or are people like me who just want to provide good information to women. And at this point we’re not seeing those fertility concerns.
Host: What about future pregnancy? Is there any correlation there?
Jessica Sedevie, MD: As far as if you’re trying to get pregnant and concerns for if you get pregnant afterwards?
Host: Yeah, correct.
Jessica Sedevie, MD: So, I have encouraged many of my patients who are trying to conceive to get the COVID vaccine, because I think if you’re hesitant, when you’re making this decision for one person then you’re even more hesitant when you are pregnant and making the decision for two. I’ve had several patients who have expressed that they wish they would have just gotten it before they were pregnant, because now it feels like it’s so much more weighted. And so if I know somebody is trying to get pregnant, then I encourage them just to get it because really my only concern about getting the vaccine during pregnancy is if a patient runs a really high fever over 102. Usually this is something that we can manage. But if you get your vaccine and have that protection before the pregnancy, then you have completely eliminated that concern altogether.
Host: Does the vaccine impact breastfeeding in any way?
Jessica Sedevie, MD: So, we are recommending the lactating women received the vaccine. Patients who are lactating will give their baby IGA through their breast milk. And so I, it impacts in the way that you are passing along some of that immunity to your breastfeeding infant. I have really nothing to indicate that supply or breastfeeding successes in any way impacted. It certainly is something that’s considered to be safe that m-RNA never makes it through the breast milk. Just those really amazing antibodies.
Host: So, getting the vaccine is an individual’s choice. And as you just said, a few moments ago for pregnant women, it’s a choice for two people. What have you said to pregnant women or those who are trying to get pregnant when they ask about the COVID 19 vaccine?
Jessica Sedevie, MD: I have been very open in most cases in sharing with my patients about my decisions regarding the vaccine and that I received it when I was 34 weeks pregnant. Literally the first week that it was available. I encourage them to ask specific questions if they have any hesitancies so that we can get them information that is unbiased and science driven and try to help them make that individual decision with respect for their autonomy. But for my part, I would really love if all of my pregnant patients were immunized.
Host: Let’s talk about now, those who don’t choose to get the vaccine. What serious illnesses are pregnant women putting themselves at risk of by not getting the COVID-19 vaccine?
Jessica Sedevie, MD: The biggest thing that I’ve been seeing is just COVID pneumonia, shortness of breath, persistent cough and need for oxygen. I would say almost every day we have at least one person who is admitted needing oxygen in pregnancy. Pregnant patients, or patients in general, but pregnant patients even more are at increased risk for blood clots.
So, you’re already at increased risk when you’re pregnant. And then, adding COVID on top of that. Also with more advanced or severe disease, with respiratory failure needing to be intubated potentially flipped over, so prone, on ECMO, in the ICU, those sort of situations. Also death, and then specific to the baby, increased risk of early delivery and then pregnancy related pre-eclampsia. Also, what I’ve been seeing with fetal heart rate tracings lately, you can definitely see (where) if these women didn’t come in and seek care, I can think of three situations very recently, where patients could have lost their babies and delivered by emergency C-section.
Jessica Sedevie, MD: The really hard thing is then you have moms who are recovering from surgery, who now their babies are up in the NICU, and we have to keep them separated. And that’s just really hard too. I think the other thing is that we have such great data for the vaccine that when moms get COVID, even if they’re not initially severely ill, that can happen after several days. And so we’ve been recommending monoclonal antibody therapy to try to reduce their illness. We’ve used monoclonals for a really long time in pregnancy for other indications with good outcomes. But, it’s a relatively new therapy as far as COVID. And so, trying to help navigate that decision-making is really a challenge. And so it was something else that moms are having to face. And I probably stopped clinic a couple of times a day in order to address those concerns for moms too, since it’s a time sensitive issue.
Host: Sure. Would you recommend universal masking around pregnant women regardless of vaccination status?
Jessica Sedevie, MD: I do encourage my pregnant patients to mask. Obviously, the masking seems to work better if it’s the infectious person who’s masking. And so I think the more that we can, I, you know, I think it’s a whole it’s the whole picture. So social distancing, masking, and immunization in order to get us to the other side of this pandemic or endemic, whatever we’re calling it these days. But, I would recommend that the safest thing for pregnant women is for others to mask around them
Host: Before we wrap up here. Is there anything else that you’d like to say or anything important that you think people should know about?
Jessica Sedevie, MD: I would encourage patients to discuss their specific concerns regarding the vaccine with their healthcare provider. You know, I think more than ever, it’s important to have somebody that you’re in a partnership with who you trust to give you good information, and we want to, we want to be able to do that for you. So if patients have specific concerns or questions while trying to decide about getting the vaccine, then I would encourage them to ask and really look into studies or information. I hand the ACOG practice bulletin out to all of my patients so that they can have all of this access to all the same information that I’m looking at. But really getting reliable evidence-based sources to try to make those decisions.
Host: Well, Dr. Sedevie, thank you again so much for chatting with me today.
Jessica Sedevie, MD: Thank you so much for having me. I appreciate it.
Host: Before we say, see you later, a couple of housekeeping items. If you like what you heard here today, give us a follow and a thumbs up. Sanford Health podcasts are available on your favorite podcast apps like apple and Spotify. You can also find these podcasts and all of your medical news on Sanford Health News’ website, news.sanford health.org.
A reminder, if you have any questions or concerns about the COVID-19 vaccine, get your information from trusted sources like your primary care provider, the CDC website, or trusted publications like Sanford Health News.
Thanks again for listening. I’m Simon Floss with Sanford Health News.
Posted In Bismarck, COVID-19, Expert Q&A, Gynecology, Immunizations, Pregnancy, Women's