While the coronavirus pandemic spread across the world, Ob/Gyns, like many other healthcare professionals, had to quickly educate themselves on the evolving information and data being disseminated. They also had to retrain and shift their practices to best keep themselves and their patients and families safe. Concerned patients looked to them for advice and guidance. And now, with the development of a COVID-19 vaccine, there are many new questions and considerations for Ob/Gyns to address as they continue to counsel their patients.
Jeannie Kelly, MD, MS, Washington University maternal-fetal medicine specialist at the Women & Infants Center, a partnership among Barnes-Jewish Hospital, St. Louis Children’s Hospital and Washington University Physicians talks about COVID-19, how it has impacted obstetrical care, how it affects the health of women during pregnancy and during breastfeeding, and the recommendations for this population as they become eligible to receive the COVID-19 vaccine.
For a maternal-fetal medicine consult or patient referral at the Women & Infants Center, call 1-855-747-5300.
Welcome to a woman and Infant center podcast brought to you by the Washington University Department of O B G Y n at Barnes Jewish Hospital. I'm Melanie Cole, and I invite you to join us as we discuss navigating covid 19 the vaccine in pregnant and breastfeeding women. Joining me is Dr Genie Kelly. She's an assistant professor of O B G Y n in the division of maternal fetal medicine at Washington University School of Medicine. Doctor Kelly, thank you so much for joining us today. So what do we know as of now about how covid 19 affects pregnancy? The mom and the fetus Thank you so much for having me today. So our data is still limited since we only have kind of 10 months to a year of data. But what we are seeing pretty clearly coming through is that when a woman is pregnant and she gets covid 19, she's at higher risk of having more severe disease. So a pregnant woman is going to have higher risk of being hospitalist, needing a ventilator or going to the ICU and even death if she gets covid 19 compared to someone who is not pregnant Doctor. How is prenatal and postpartum care changed due to this pandemic? What have you learned? What challenges have you overcome? Have you been able to use telemedicine for certain appointments or not? In this case, tell us what's changed and how your practice has evolved? Absolutely. I think challenges is the right word to describe it all in the beginning of the pandemic. Back in the spring, we didn't know a whole lot about how this was going to affect pregnancy. We weren't 100% clear about how this disease was spread. You know, I think all of us were still wiping down all of our groceries and, you know, washing our fruits and vegetables with soap and water. We have learned a lot in the last 10 months since pandemic life sort of took over us here in Missouri. And so we have shifted a lot of our outpatient visits to telemedicine, and we have provided our patients with a lot of tools such as, you know, blood pressure cuffs, that they can take their own blood pressure at home, do their own weights. And, you know, I still have a pretty good visit from a telemedicine point of view. But sometimes in pregnancy, some of those assessments of the baby's health has to be done in person. So, for example, doing an ultrasound to make sure that the baby is growing well, or doing the ultrasound to make sure that the baby doesn't have any birth defects. These are not things that we can do via telemedicine. And so obstetrics, unlike many other specialties, still necessitates our patients coming into the hospital and doing these assessments and exams on the in patient side again. We've learned a lot since the beginning of this pandemic. We were really scared in the beginning and similar to kind of other labor and delivery units across the country. There are some pretty draconian and drastic measures being taken. For example, if a mom is positive for Covid, 19, she was separated from her baby. We quickly realized that these practices did not make a whole lot of sense, and what I mean by that is a mom was diagnosed with Covid, 19, and everyone's scared that she's going to pass Covid, 19 to the baby, so we separate them in the hospital. But then, two days later, when Mom is going home. You give them this newborn that they haven't even touched in the two days that they've been home. And they're expected to care for this newborn and also do it while taking all of the precautions it just logistically, logically. And also just from a humane point of view, what just felt awful. And so we quickly reverse these policies from the beginning. And, you know, as of right now, if my mom is positive for Covid 19, when she comes in for delivery, we you know, our take a couple of extra precautions in terms of our protective equipment that we wear. We wear special gowns, gloves, special masks. But part of our policy now is that babies still remain with Mom. Our moms are still going to have their visitor because we think it's important for a support person for for a mom to be there. And we teach our moms how to keep their babies and their support person safe during kind of that newborn neonatal period, because we think that's really important that moms know how to do it and feel confident and know and knowing how to take care of their babies. Another thing that we've changed is that we've realized quite a significant number of our months. Actually, more than any other surgical or procedural site in the hospital, have covid 19 and don't have any symptoms. So our asymptomatic covid rates upon labor and delivery is somewhere from 4 to 8%. And so for our own protection and to prevent us from, you know, taking the infection from one patient into other rooms. We've actually started universally testing everybody who comes in for delivery for covid 19, and so that helps us remain safe from the staff and provider point and also to prevent us from spreading it around. But it also helps us teach your mom's. Hey, you know you have covid 19 whether you have symptoms or not, and these are important precautions we need you to take with your baby, but also with grandma's and grandpas and friends and relatives potentially visiting you. So tell us what extra precautions you're suggesting you're pregnant. Individuals and their families take during the pandemic. As you've said, some of them have to come in for certain appointments, that's for sure. But what about regular life grocery shopping, other siblings, kids that might be in the house. What are you recommending that patients do? And how can other providers counsel their patients on these safety things? Since this is such a different situation, Absolutely. So we are recommending that, uh, pregnant patients, especially because they are at higher risk for that severe disease take all of those precautions. So those precautions include, you know, masking any time that you're in public hand washing and hand hygiene and, you know, making sure that you're socially distanced. So that might mean, you know, don't go to these parties, don't go to these get togethers. And really be careful of who you're leading into the house. This is really not the time to be hosting uh, large baby showers in person. This is not really the time to be attending other birthday parties or those sorts of things because of the risk not only to the mom but also to the fetus. And, of course, the Covid 19 vaccine is a topic that frequently comes up with our patients and potentially, is a method to prevent infection as well. So now let's talk about covid 19, the vaccine. What are you recommending? As far as the vaccine for your pregnant women, your postpartum women, the baby Tell us about how this vaccine is changing your practice and what you're recommending as far as that goes, great question and a really hot topic at the moment. So as we all know, pregnant patients were not allowed to be a part of the fighter or the Madonna trials. And this is pretty routine of vaccine trials and trials for medications in general. There's a sense of we really need to protect pregnant women when they're designing these trials, so they exclude them from the inclusion. But the problem is on the flip side. Suddenly, when your results come out, you don't have any data, uh, in pregnancy. And so it's a frustrating place for us on the obstetrician side, but also certainly many of our patients who are pregnant. So in terms of how the vaccine works, there's this M RNA that encodes part of the protein that's on the outside of that coronavirus, and your body makes that protein so your body learns to recognize that outer shell of the coronavirus and learns to attack it and form antibodies to it without you needing to become sick with Corona virus. The way that that works, we don't think that really should increase any risk during the pregnancy or to your baby. We, unfortunately just don't have the data to say that, you know for sure, because pregnant women were not included but understanding the mechanism of how this vaccine works. This should be low risk in pregnancy. Vaccines in general are considered safe in pregnancy except for some live vaccines that are not given. And this is not a live vaccine. And so, generally speaking, we believe that this vaccine should be safe in pregnancy. The flip side is that we know Covid 19 is dangerous in pregnancy and can make moms and their babies incredibly sick. And so it becomes this shared decision that we make with our patients. You know what is going on in that patient's life? Do they live in a situation where they're exposed because there are health care worker or they live with someone who is a health care worker or an essential worker that, you know, they have to be exposed and going into work all the time? Are they living in a community where the rates of Covid 19 are pretty high for us here in ST Louis, in Missouri, that answer is yes. We have widespread community rates right now. Do they potentially have another health condition that makes them even higher at risk for getting really sick, such as diabetes or high blood pressure, or a BMI over 30? And and, you know, is the anxiety and the worry of getting covid 19 scarier and worse for them than the unknowns of the vaccine, which are should be relatively low, I would say, generally speaking, with our patients who are pregnant, most of them have come to a conclusion that they should seriously consider or go out and get the vaccine, because the risks of getting covid are significantly higher for the vast majority of our patients right now, compared to the theoretical, unknown risk of the vaccine itself, which again should be low. We know from animal data from Pfizer and Moderna that in rats this was not associated with any big problems in pregnant rats or their offspring. And we also know from a handful of patients who got pregnant in the Madonna and Pfizer trials, you know, even though they weren't supposed to still people get pregnant that they have not had any issues with their pregnancies. Generally speaking, most health care workers who are pregnant have gone ahead and gotten the vaccine because they know we see what Covid does to patients in the hospital all the time. And that risk is much too high for the vast majority of health care workers who are pregnant. So much information, Doctor, you're speaking to other obstetricians, gynecologists and primary care providers. What would you like them to know about the questions you're getting the most. What's your patients are most concerned about and how they can work with their patients in answering all these questions we've discussed here today? It's a really great question. I think the most important thing for all of us to remember is that all of our expert committees so that's the American College of Obstetricians and Gynecologists. That's the society for maternal fetal medicine. That's the CDC and also the w h o. All of them say the same saying, which is that pregnant women should be offered the vaccine. There really should be no one out there saying you're pregnant. There is no reason that you should get the vaccine. That's actually not what the recommendation is, and I encourage our providers to open this conversation up with their patients. And if the conversation is getting to a point where you know you need more help or advice, we are always willing to come talk to any any patient about a consult regarding the quota vaccine and help them make a choice. The other part is that whatever choice our patients make, we should all support them, whether that's to get the vaccine or to wait for more information before they get it while they're pregnant. We should all be supportive of that choice. Thank you, Dr Kelly. So much for joining us. What great information to refer your patient to a Washington University O B G Y n or maternal fetal medicine specialist. Please call the doctors access line at 1 800 to 5 to 36 to 7. Or you can visit Barnes, jewish dot org slash women and infants for more information. Thanks so much for listening. I'm Melanie Coal