By Beth Kiernan, MPH, Interviewer & Teratogen Information Specialist, MotherToBaby

Kristin called MotherToBaby one afternoon saying, “I just took a home pregnancy test and it’s positive.” Kristin sounded beyond worried. “I’ve been taking a medication for ADHD since I was eight years old, and when I searched the internet it said it was harmful and that I should stop taking it before getting pregnant.” Kristin hadn’t planned on getting pregnant. Now, not only was she terrified she had hurt her unborn child, but she also found it impossible to think about stopping the medication for a very good reason: “I am a nurse in the Cardiac Intensive Care Unit at a hospital – staying focused is critical to the lives of my patients.”

Kristin isn’t alone in her concerns.
This is one of the most frequent topics asked about by people who contact MotherToBaby, which isn’t really surprising. About 1.4 million people in the U.S. have been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). Since nearly half of pregnancies in the U.S. are unplanned, her situation isn’t uncommon.

ADD and ADHD are chronic conditions often diagnosed in childhood. They cannot be cured, but can be treated with behavioral counseling/coaching, medication, or both. If you or someone you know are affected by ADD/ADHD, you know that there are some classic things that can be challenging, including difficulty staying organized at home and at school or work, problems with sleep, being distracted, acting without thinking things through, having trouble behaving appropriately, struggling to finish tasks, having a short temper, talking too much, feeling anxious or restless or bored, and sometimes addictive tendencies.

About 60%-80% of kids diagnosed with ADD/ADHD will need to take their medications into adulthood, since it often helps them in daily life. But what about when a woman with ADD/ADHD gets pregnant? This was Kristin’s concern, and Dr. Google (searching the internet for medication advice in pregnancy) isn’t the recommended solution! Thankfully for Kristin, this is our specialty here at MotherToBaby. We talk with women about all their medication choices and concerns, referring to key research to educate them. This gives them the information they need to discuss their medication choices with their healthcare providers.

Kristin was taking Ritalin.
Ritalin is a stimulant medication also called methylphenidate. Kristin’s concern reflects the fact that Ritalin is grouped with other stimulants like amphetamines and methamphetamine, so it can be hard to untangle the research when everything is lumped together in discussions of pregnancy. Obviously, drugs used in an addictive way like “meth” or “speed” aren’t advised in pregnancy because research has shown negative effects, like pregnancy complications and postnatal problems in behavior, emotions, memory, attention, and growth. However, taking a prescribed daily dose of methylphenidate or other ADD/ADHD medications during pregnancy hasn’t shown increased risks for having a baby with a birth defect. Nor have we seen an increased risk for pregnancy complications like preterm delivery or low birth weight. Plus, babies exposed to prescription levels of methylphenidate in utero that were studied up to a year of age have had normal development.

I told Kristin that, for people like her with ADD/ADHD, methylphenidate can really promote success at work, in school, and in getting along with other people. Going off this medication can create problems, so it’s good to know that the data we have on its effects in pregnancy is reassuring.

Other side effects of ADD/ADHD medications on a pregnancy.
I also shared with Kristin some pregnancy-specific information: sometimes people who take methylphenidate feel less hungry, and when combined with pregnancy this may lead to weight loss. Similarly, changes in the body while pregnant can mean that the prescribed daily dose level may need to be periodically changed during pregnancy to adequately treat ADD/ADHD. Lastly, stimulants can affect heart rate and blood pressure. I told Kristin that if she had any of these issues while pregnant, she should call her healthcare provider. And I added that if she still felt nervous about taking her medication, that perhaps her doctors could help her find other ways to manage her ADHD.

Still concerned, Kristin asked if her baby might be born addicted to Ritalin. I explained to her that sometimes babies exposed to stimulants right up until birth have shown symptoms of withdrawal after delivery. When babies have this condition, they may have trouble eating, may sleep too little or too much, may have very floppy or stiff muscles, or be jittery. These usually disappear within 1-2 weeks and there are no lasting effects. Babies who have more severe symptoms may have to stay in the hospital a little longer to be treated. However, we wouldn’t expect this level of withdrawal to occur with regular use of methylphenidate that is taken as prescribed by a doctor. In addition, it’s hard to predict if withdrawal symptoms will even happen. It’s seen more often when women take opioids and other medications for mental illness and epilepsy. With daily doses of methylphenidate, it’s possible that her baby could have mild symptoms or no symptoms, even if Kristin needed to take it until delivery.

What about breastfeeding?
Finally, Kristin said that, while she hadn’t planned to be pregnant, she was excited about it, and hoped to breastfeed too since she’d heard that was best for her baby. She asked if she could continue to take her Ritalin and nurse her baby. I told her that small amounts of methylphenidate have been found in studies on breastmilk, but that the levels are so low that it wouldn’t be expected to cause problems. Normal sleeping and feeding have been reported in the exposed infants. I suggested she also speak with her pediatrician about it once she found one in her insurance network.

In the end, Kristin told me that she felt very relieved to get a full understanding of her situation, and to be able to more accurately understand the possible risks to her pregnancy versus the benefits for her of staying on her medication. Now she can “focus” on preparing for the next chapter in her life: impending motherhood!

Beth Kiernan, MPH, is a Teratogen Information Specialist with MotherToBaby Pregnancy Studies, a non-profit that conducts observational research about exposures in pregnancy and provides information to healthcare providers and the general public on medications and more during pregnancy and breastfeeding. She is based at the University of California, San Diego, and is a married mother of four children.

About MotherToBaby

MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures, like medications to treat ADD/ADHD, during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.

By Beth Conover, APRN, Beth Kiernan, MPH, and Al Romeo, RN, PhD – MotherToBaby Teratogen Information Specialists

From images of buildings destroyed by high wind to families stranded on roof tops by flooding (and the rising death toll), to say that hurricanes can be devastating would be an understatement. At MotherToBaby, we receive questions from moms and moms-to-be in storm-affected areas regarding the potential exposures they may be experiencing as powerful forces of nature wreak havoc on their homes and communities. We just wanted to let you know – MotherToBaby is here for you, your unborn child and your baby. We can answer your questions about the known facts surrounding these potential natural disaster-related exposures during your pregnancy or while breastfeeding. You can call us toll-free (866-626-6847), text us (855-999-3525), chat with us online or send us an email via MotherToBaby.org. Here are some common questions we’re getting and answers to help provide you with as much information as possible during this difficult time:

I’m pregnant and worried about possible things associated with a hurricane that might harm my baby.

Being pregnant can be a stressful time, without having the additional concerns of a natural disaster like a hurricane! However, remember that many pregnant women have been in similar situations and had normal pregnancy outcomes and healthy babies. There are some common sense things you can do to keep you and your baby safe:

• Continue to eat nutritious food…even if it is from a can.
• Drink safe fluids…bottled or boiled water, for example.
• Rest whenever you can and get the proper amount of sleep.
• Don’t overdo heavy lifting.

MotherToBaby has a fact sheet on pregnancy during natural disasters: https://mothertobaby.org/fact-sheets/natural-disasters/

I am worried that there might be industrial chemicals released into the air and water after a hurricane. Will this present a risk to my pregnancy?

Local industry may be affected by heavy rain, wind, tornadoes, and flooding from a hurricane. Various chemicals (carbon monoxide, ammonia, chlorine, hydrochloric acid, sulfuric acid) can be released into the air or flood waters from damage to those industrial sites. Local authorities will often notify the public about any chemical spills and explain what the public should do to avoid or reduce exposures (staying indoors, for example). If you think the smell is natural gas, go to a safe area away from the smell and call 911 or the local gas company.

You may want to start taking notes on paper or making some mental notes in case you have questions about how those chemicals might affect your pregnancy or your breastfed baby. Contact your health provider or MotherToBaby and be prepared to answer these questions:

• The names of the chemicals
• New or increased symptoms (vomiting, headache, dizziness, etc.)
• How you came into contact with the chemicals (breathing, touching, in your mouth or eyes, etc.)
• How long you were in contact with the chemicals

Fortunately, exposures like these are often small enough that they don’t present a risk to the pregnancy. For example, just smelling something may not result in a significant amount being passed to the baby. However, each chemical is different, so be sure to ask about any of your concerns.

I’m worried about whether my drinking water is safe…can I get an infection from it that could harm my pregnancy?

Infections are common after a natural disaster. These can include bacterial infections and parasites from dirty water. Many of these infections are important to treat, and you should contact your obstetrical health provider (Midwife or OB) if you think you have an infection. MotherToBaby has fact sheets on common infections and many medications used to treat them: https://mothertobaby.org/fact-sheets-parent/

All this water is resulting in a lot of mosquitoes! Not only are they unpleasant but can’t they spread infections that may harm my pregnancy? Is insect repellent safe to use in pregnancy?

You are correct that mosquitos can sometimes carry serious infections such as Zika and West Nile disease. MotherToBaby has fact sheets on these diseases and many others: https://mothertobaby.org/fact-sheets/zika-virus-pregnancy/ and https://mothertobaby.org/fact-sheets/west-nile-virus-infection-pregnancy/.

There are also some things you can do to lower your chances of being bitten by a mosquito:

• Stay indoors with proper screens during peak times of mosquito activity (usually overnight from dusk through dawn)
• Wear long sleeved shirts and pants when outdoors
• Consider using insect repellent containing an effective ingredient such as DEET or picaridin. Apply the repellent sparingly to exposed skin and outer clothing, and wash it off when you are back inside and no longer need it. MotherToBaby has a fact sheet on insect repellents at https://mothertobaby.org/fact-sheets/insect-repellents/

I’m just so stressed out by the whole situation! Our home is destroyed and we are staying in a shelter. I’ve heard from my grandmother than stress can harm the baby. Is this true?

Pregnant women often worry that stress can affect the pregnancy and cause miscarriage, premature delivery or low birth weight. Fortunately, most experts agree that moderate levels of stress are unlikely to harm the pregnancy. It’s still best to keep as calm as possible, and try to quit worrying about worrying! It’s normal to feel irritable and out of control, and to be tearful and worried. Stress can make existing medical conditions worse, so it’s important that you take care of yourself even as you are taking care of family members:

• Pay attention to your blood sugar levels and blood pressure.
• Do things to relax. Get some exercise, even if it’s just a short walk.
• Take deep breaths and think positive thoughts about your baby.

If you feel depressed, talk to someone such as your partner, a relative or friend, or a health care provider. If you have been taking medicine for mental health issues, keep taking it unless your doctor tells you to stop. It’s OK to ask for help. Treating depression and anxiety helps your baby. Check out this fact sheet for more information: https://mothertobaby.org/fact-sheets/stress-pregnancy/

The good news is that my home is still standing. The bad news is that the hurricane has caused a real mess in my home! What types of cleaning agents are safe to use while I am pregnant?

First of all, remember that you don’t need to take on everything…you are pregnant after all! Let others do the heavy lifting or handle possibly toxic cleaning chemicals. However, most household cleaning agents are pretty low risk. To help protect yourself and your baby, wear gloves when using cleaning agents and try to keep fresh air moving through your work area (consider a fan and open the windows).

What about mold? Hurricanes involve rain and can cause flooding…and all this water in my house has caused mold in my walls. Will this hurt me or my pregnancy?

After the rain has stopped and flood waters go down, mold may start to grow in damaged homes, cars and businesses. Whether you are young or older, pregnant or not pregnant, mold exposure can make you sick. However, there is no proof that exposure to mold increases risks for birth defects or pregnancy complications. Companies can help with the cleanup, but you can do some on your own if you take the right precautions. MotherToBaby has a fact sheet on mold: https://mothertobaby.org/fact-sheets/mold-pregnancy/

Here’s how to learn about cleaning mold in your home: https://www.epa.gov/mold/mold-cleanup-your-home

If you must live or work in a place where mold is being removed, try to open windows so that your exposure is less to airborne mold spores. If you can sleep somewhere else at night and just return to clean up for a short period each day, that may be best for you.

What if I am breastfeeding my baby? Do I need to worry about exposures or should I use formula?

Breastfeeding is good for you and your baby! It is even more important when there are concerns that the water used to make formula may be contaminated. Be sure to keep yourself well hydrated, and use common sense about your exposures. MotherToBaby has a fact sheet on breastfeeding in a natural disaster: https://mothertobaby.org/fact-sheets/breastfeeding-natural-disaster/

Here is another website to check out:

Centers for Disease Control and Prevention:

https://www.cdc.gov/reproductivehealth/emergency/safety-messages.htm

More about MotherToBaby

MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures resulting from a natural disaster during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding. MotherToBaby has been able to embark on new outreach efforts to reach underserved populations and launch new communication technologies through a cooperative agreement with the U.S. Health Resources and Services Administration, as well as through the generous donations made by the public.

By Lori Wolfe, Certified Genetic Counselor and Teratogen Information Specialist,
MotherToBaby North Texas

Have you ever had a pregnant friend tell you, “it is OK to have just one glass of wine now and then, that’s what my doctor said,” or “my mother drank beer when she was pregnant with me, and I turned out fine.” As a Teratogen Counselor (a birth defects expert), I hear these statements more than you would imagine. You may think it is common knowledge that there is no safe level of alcohol use during pregnancy, and that any use of alcohol while pregnant has the potential to harm the baby. Yet that message is not getting out there to everyone. Studies have long shown that heavy use of alcohol during pregnancy can cause Fetal Alcohol Syndrome, while more recent studies suggest that moderate use (and possibly even light use) can cause long term developmental problems in an exposed child. In fact, Fetal Alcohol Spectrum Disorder is thought to be the leading cause of developmental delays in children. Despite this, studies also show that 1 in 10 to 1 in 13 women continue light drinking of alcohol, even after they know they are pregnant. So I started thinking… Why do some woman continue to drink alcohol during pregnancy?

1. You Didn’t Know You Were Pregnant
Most women find out they’re pregnant when they are 4-6 weeks along – and many may not recognize the signs of pregnancy for quite a few months. So unless you are planning your pregnancy (50% of all pregnancies today are unplanned!), you may indulge in alcoholic beverages before you even know you are pregnant. Thankfully, the majority of women will stop using alcohol once they find out they are pregnant. But unfortunately, the damage could already be done. Harmful exposures (like alcohol) during those first critical weeks of pregnancy have the greatest risk of causing major birth defects. This is why experts at the Centers for Disease Control and Prevention (CDC) recommend that women avoid alcohol not only if they are pregnant or trying to become pregnant, but also if they are sexually active and not using an effective method of birth control.

2. Mixed Messages
It’s not uncommon for pregnant women to receive mixed messages from people they trust about how safe alcohol may be in pregnancy. Even her own doctor may tell her that an occasional glass of alcohol won’t harm her baby. There’s a lot of misinformation out there, even among healthcare providers! It’s important for you and your healthcare provider to keep in mind that the experts at the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics (among many others) advise that women avoid alcohol entirely while pregnant, because no amount of alcohol – even light-to-moderate amounts – can be considered safe for a developing baby.

3. It’s A Social Thing
Social pressure from family or friends can be strong. If a woman is used to going out on weekends with her friends and everyone has a glass of wine, she may feel that she needs to drink too, just to fit in. Plus many women feel that the risk of having just a little alcohol during pregnancy is low. These same woman may be doing everything else that they can to remove all other risks to their pregnancy, but they still continue to use alcohol. At MotherToBaby, we understand that the use of alcohol during pregnancy may have perceived benefits to a woman. But we also know that alcohol provides ZERO benefit for a developing baby, and, in fact, can only harm the baby. And because the exact amount of alcohol that could harm a baby is unknown at this point (and does vary woman-to-woman and even pregnancy-to-pregnancy), our philosophy is: WHY TAKE THE RISK?

4. It Helps Me Relax, De-Stress, and Just Deal with Everyday Life
Recently a 35 year old caller told me that she continued to enjoy a half glass of wine every weekend as a treat to herself. “Susan” (not her real name) knew that she was not supposed to drink alcohol, and she even said she got a lot of negative feedback from family and friends, yet she continued to drink throughout her pregnancy. Without realizing it, Susan and other women may be using alcohol to help deal with other unrecognized issues in their lives, such as depression and anxiety, high levels of stress, or little outside support for the pregnancy. At MotherToBaby, it is our job to help women understand how fragile and vulnerable a pregnancy can be to certain exposures; alcohol is one of the dangerous ones. While it may seem a hardship to give up alcohol entirely while pregnant, think about it this way: Pregnancy is only 9 months long (less if you base it on when a woman learns she is pregnant). If a woman is strong enough to survive childbirth, courageous enough to take on the toughest job on earth (parenthood), and resilient enough to survive that job, then abstaining from alcohol for the duration of a pregnancy is nothing. And if it means giving your baby a chance at the best possible start in life, then not drinking alcohol while pregnant is everything.

What Do We Know? There is not a known safe level of alcohol use during pregnancy.
We have known about Fetal Alcohol Syndrome for over 40 years now. Dr. Kenneth Jones, the doctor who first named Fetal Alcohol Syndrome in 1973 states: “When talking about the prenatal effects of alcohol, we usually think exclusively about the dose, the strength, and the timing of alcohol exposure. However, perhaps even more important are factors involving the mother – her genetic background and nutritional status to name just two. Without knowing those genetic and nutritional factors that are critically involved with the way a woman metabolizes alcohol, it is not possible to make any generalizations about a “safe” amount of alcohol during pregnancy.” Studies have shown moderate use, and possibly even light use, of alcohol during pregnancy can cause long term developmental problems in the exposed children. In fact, Fetal Alcohol Spectrum Disorder is thought to be the leading cause of developmental delays in children. Scientists are continuing to study how and why alcohol affects the developing baby, and in future years we will know more about this. But for now we do know there are always risks with drinking alcohol during pregnancy.

Lori Wolfe is a board certified Genetic Counselor and the Director of MotherToBaby’s North Texas affiliate. MotherToBaby aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free number and by email, Wolfe also teaches at the University of North Texas, provides educational talks regarding pregnancy health in community clinics and high schools, and counsels adoptive parents.

MotherToBaby is a service of OTIS, a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about viruses, alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets, email an expert or chat live.

By Angela Messer, MS, Teratogen Information Specialist, MotherToBaby California

“I love the way my eyebrows look!” Emily just found out she was 6 weeks pregnant, and had started the process of microblading (a cosmetic tattooing technique, in which a tool made of small needles is used to add semi-permanent pigment to the skin; resembling the hair on the brow) before she knew she was pregnant. Logging into the MotherToBaby chat for some guidance, after online searching resulted in mixed answers, she wanted to know if it was still ok to continue microblading during her pregnancy.

Emily’s question is a common one we receive here at MotherToBaby. With new and upcoming products in the beauty industry, many women want to know if it is ok to start or continue treatments like microblading when they become pregnant. Procedures like these often require more than one visit, broken up between weeks or even months. For pregnant women, the “nine month stretch” raises questions about their use in pregnancy.

The difficulty in answering a question like Emily’s comes down to the lack of information about these types of procedures in pregnancy and also while breastfeeding. Without the research available, we simply do not know about how they may, or may not, affect your pregnancy or your breastfed infant.

Ink

The pigments used in microblading are made up of different types of chemical compounds, like oxides, which can be pre-mixed and purchased by the cosmetic tattoo artist. They may also be mixed by the professionals themselves. A few unknowns are how much pigment, if any, is going into the skin, is entering the mom’s blood, crossing the placenta, and reaching the baby – which also means we do not know if the ingredients in the pigment could pose any risk. The same goes for breastfeeding moms – without good data, we do not know how much pigment, if any, is getting into the milk reaching the breastfed baby.

Possibility of infection

Another thing to consider about microblading in pregnancy and breastfeeding is the risk for infection. As previously mentioned, during the microblading process, a cosmetic tattoo artist deposits pigment into the outer layer of the skin by penetrating the skin with tiny needles. There is a possibility that the needles used may not be completely sterilized, which can lead to a higher risk of health issues such as staph infection, abscess, skin inflammation, or other infections like Hepatitis B and HIV. Medications like antibiotics may be needed to treat these conditions, sometimes requiring weeks or months of treatment. If left untreated, they can lead to health issues for mom and baby. Visiting a reputable business with good hygiene practices in place is a good idea should you choose to have microblading done during pregnancy or while breastfeeding.

Pain

Some women report that the microblading treatment can be painful. If that’s the case, the cosmetic tattoo artist may recommend the use of additional medications to control the pain (e.g. a topical lidocaine cream, or Tylenol). During pregnancy and breastfeeding, Tylenol (acetaminophen) is considered by most healthcare professionals to be the preferred pain reliever: https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/. With topical exposures, like lidocaine cream, a significant amount is generally not expected to enter the mom’s blood and result in an exposure to the pregnancy. Consider these additional exposures during pregnancy or while breastfeeding when deciding whether or not to book an appointment.

With all these unknowns in mind, it can be difficult to evaluate what possible risks a developing baby or breastfed infant might face. Ultimately it comes down to weighing the risks vs. the benefits, and this is exactly what I discussed with Emily on our chat. Having gone to a licensed cosmetic tattoo artist, Emily was reassured that her microblading procedure early in pregnancy was unlikely to be a concern. Moving forward, she decided that given the lack of research, she would prefer to wait until she was no longer pregnant or breastfeeding to resume further treatment. “My eyebrows might not look as great for the next year, but I won’t have to constantly worry about the ink reaching the baby or the possibility of infection from having this done!” she shared as we wrapped up the chat.

If you have questions about microblading while pregnant or breastfeeding, don’t hesitate to contact a MotherToBaby specialist via phone, text, chat, or email.

Angela Messer, MS, is a Teratogen Information Specialist with MotherToBaby California. She earned her undergraduate degree in psychology from Chapman University and her Master’s degree from Kansas State University in academic advising/counseling.  Angela has been with MotherToBaby since 2009 and holds a special interest in maternal medical conditions in pregnancy. In her free time, she enjoys spending time in her hometown of San Diego, CA with her husband and 9 month old daughter.

About MotherToBaby 

MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets. Also, make sure to subscribe to The MotherToBaby Podcast available on iTunes, Google Play Music, Spotify and podcatchers everywhere.

Michelle Fiscus, MD, FAAP from the Association of Immunization Managers (AIM) joins host Chris Stallman, CGC to discuss respiratory virus season and what pregnant people can do to help protect their babies against RSV, COVID-19, Seasonal Influenza (flu) and whooping cough (pertussis).

Resources mentioned in this episode:

Association of Immunization Managers:

Immunizationmanagers.org

BOOSTRIX Tdap Vaccine – MotherToBaby Pregnancy Study

Ep. 78 Transcript

  You’re listening to the Mother 2 Baby podcast, medications and more during pregnancy and breastfeeding. Ask the experts with your host, genetic counselor and mama for Chris Stallman.

This episode contains evidence-based information that’s current as of the day recorded and may change as more data becomes available. To get the very latest information about this topic or other topics in pregnancy and breastfeeding, Please contact a mother to baby specialist at 866 626 6847, by text at 855 999 3525, or through our website at mothertobaby.org.

Welcome to another episode of the MotherToBaby podcast. My name is Chris Stallman, and I’m a genetic counselor, a mom of four, and a teratogen information specialist. So what that means is that I talk to people, so patients, family members, healthcare providers, and the general public about exposures that can happen before pregnancy, during pregnancy, while breastfeeding, or in cases of adoption.

And an exposure can be anything. So it could be a chemical at your job. It could be a medication that you take, or it could be a vaccine. Our guest today is here to talk with us about respiratory virus season and vaccines. Dr. Michelle Fiscus is a board-certified pediatrician and chief medical officer at the Association of Immunization Managers, or AIM, which helps to support the CDC funded immunization programs across the country.

Dr. Fiscus, welcome to the show. Great to be here. Thanks, Chris. So can you tell us a little bit about the AIM organization? Sure, we are a small but mighty 501c3 nonprofit that works nationally, as you said, to support the CDC funded immunization program. So every state in the United States has an immunization program, usually housed at their state department of health.

And then there are some cities, some major cities like Washington, D. C. or New York City or Philadelphia, Philadelphia. That have their own immunization programs within their states. And then we also support the immunization programs in the U. S. territories and freely associated states like Guam and Micronesia and the U.

S. Virgin Islands and Puerto Rico. And so we help. Those program managers, um, make their jobs a little easier. They have a lot that they have to do to make sure that vaccines are available in their jurisdictions to make sure that, um, every person that’s, that’s there has the ability to get vaccinated and to make sure that the information that they’re getting about vaccines is correct.

Very, very critical. I feel like it had always been, but I think in the last few years, especially we we’ve learned collectively, you know how important that correct and timely information is so. Speaking of that, what are respiratory viruses and when is respiratory virus season? Respiratory viruses are, are those, um, illnesses that circulate in fall.

Um, sometimes they’re common colds, which can be caused by thousands of different kinds of viruses. But the ones that we really think about with respiratory season are seasonal influenza or the flu, um, something called respiratory syncytial virus, which may be a little less. We call that RSV because respiratory syncytial virus is really kind of hard to say.

And then, um, we also see, um, COVID 19, of course, SARS CoV 2, which is the virus that causes COVID 19, which really hasn’t settled into a season yet, but Because of the number of hospitalizations and sick people that we get from COVID 19, when you layer that on top of the fall flu cases and the fall RSV cases, it really starts to strain the U.

S. health system. Um, and so we’re going to lump COVID 19 into this too for the purpose of this discussion. Okay. Why is vaccination important? Well, vaccination is really our best, uh, defense against any of these viruses. Viruses are super smart. They’re really good at mixing up their, their genetics and finding ways to get around.

Um, defenses that we have to fight them off and some of those viruses, like for instance, influenza or SARS CoV 2 that causes COVID, they change constantly from season to season and sometimes even within seasons. And so our bodies may have experienced those viruses before and they created this great immune protection against those viruses.

But then that virus goes out and puts on like a big nose and glasses and a mustache and it comes back and it looks completely different from the virus that your body saw the last time. And so these are vaccines that we really have to get over and over again. We’re talking about influenza or COVID 19 because those viruses keep trying to outsmart the defenses that we have in place to keep us from getting super sick.

So when you’re pregnant, You, um, you’re a little bit, what we call immunosuppressed. You’re, you’re, it’s a little easier for you to get sick. You’re a little run down. Sometimes you’re a little anemic because of pregnancy. And it’s easier for those viruses to get in and cause problems that make pregnant people super sick.

And sometimes put them at, at much higher risk of being hospitalized or even dying from infections that maybe wouldn’t be as serious had they not been pregnant. Okay. Absolutely. And what about risks to the newborn for things like RSV or whooping cough and pertussis? Well, those little babies come out pretty defenseless, too.

They get some antibodies from their mom from either transfer across the placenta. So if you get vaccinated with, say, a vaccine that protects against pertussis or whooping cough while you’re pregnant, then that antibody can pass to your baby. Because when the baby comes out, they’re not old enough. get vaccinated.

So we really rely on those antibodies that mom can give to protect and we all want to protect our babies the best possible way. So, um, so being vaccinated while you’re pregnant, breastfeeding, these are all things that help protect the baby and help develop their immune system so that they can fight off a virus if they come into contact with it.

The other thing that we can do is, Make sure that if we’re vaccinated, we’re not bringing those viruses and those bacterial illnesses like pertussis into our house where then we’re face to face with our babies and putting them at higher risk of getting them super sick. Those little babies, um, have to work really hard if they get a respiratory virus.

They’ve got little tiny lungs and not a lot of capacity. And so if we start to stress them, Um, then they have a really hard time eating. They have a hard time sleeping. They have a hard time growing. They might be super fussy. And sometimes we have to put them in the hospital just because they get dehydrated and need some oxygen to try to help, um, manage them until their bodies can fight off whatever illness we’re dealing with.

So the vaccine certainly, as you said, can protect babies. family members, but also the person who is pregnant or newly delivered or breastfeeding as well. Because as you say, you know, we are absolutely worried about those around us, but we also need that person who was pregnant or who is breastfeeding. We need them to be healthy too, not only for their own well being, but for, you know, taking care of themselves and the people around them.

That’s exactly right. And you know, when you get vaccinated, when you’re pregnant, you kind of get to double dip a little bit because that vaccine. against flu or, or COVID is helping you not get seriously ill from flu and COVID. But then you’re also giving those antibodies to your baby. So if they come into contact with it when they’re really young and before they can get vaccinated, then that’s also helping to protect them.

Remember, babies can’t be vaccinated against COVID until they’re six months old. So they have a really long window of exposure. exposure, where if we can get mom to give them some antibodies, they can really help protect them. And they also can’t get vaccinated against influenza until they’re six months old.

And then it has to be in the season when we’re actually vaccinated against influenza. So some babies might be closer to a year. Before they get their first flu vaccine and um, and you know, having moms help give them a good healthy start with that protection is really important in those early days. I didn’t even think of that, but I’m so glad that you mentioned it.

So my last two were both born in January. Um, and obviously we had to wait six months for these vaccinations and it, it did, you know, we’ve just waited until the next cold and flu season, you know, it was a bit more than six months for us and honestly, I never would have put that together. So I think that’s a great reminder that sure, six months is, is where it can start.

if you’re in that particular season for flu. I know you had mentioned that COVID doesn’t really have a season, but for flu, you know, there are some, some clear guidelines and they’re not available everywhere throughout the entire year. Right. And the same goes for RSV. We, we only, um, vaccinate pregnant people right now when it’s RSV season, when we’re, when we’re looking at having a baby during RSV season, which generally runs October to March or so, November to March.

Um, So, you know, if you’re pregnant and it’s April, you may not be able to get an RSV vaccine right now, and your baby may be born without the ability to protect them. So we do have kind of a safety net or a second chance with RSV, something called nircivumab, which needs an acronym. But yeah. But that is a, what’s called a passive antibody that we can give newborns that come into their first RSV season.

It’s not really a vaccine. The vaccine teaches your body how to make antibodies. This is actually giving the baby antibodies. Our to what the mom would give if the mom had been vaccinated, and we can give that one shot to a newborn baby who was born during our RSD season to help protect them. So if the mom didn’t have an opportunity to protect their baby because of these vaccines, the timing of their pregnancy in the RSD season, there is an opportunity to protect the baby directly when the baby’s born.

What vaccines are recommended during pregnancy that can protect against respiratory viruses? And is there a specific time in pregnancy where people should get them? Great question. So, for your time. Every person needs to get a flu vaccine and that can happen at any point in a pregnancy. So, um, if, you know, if you’re getting into October and you’re pregnant, that is a perfect time to get vaccinated against influenza.

You can even get vaccinated a little earlier in the season if you’re due to deliver your baby in like September or October. You might even be able to get vaccinated against influenza as early as August in some cases. So, if you If you’re pregnant right now, you should go get a flu vaccine. Um, I’m a pediatrician.

We like to say flu before boo. So we want to get everybody vaccinated against influenza before Halloween. Yeah, that’s awesome. That’s the ideal time. But if you miss that, you can get vaccinated against influenza anytime during the season. But, but really the idea is you want to get that vaccine in before we really start seeing the virus.

Thankfully right now in the U. S. influenza is still pretty quiet. CDC does a lot of careful watching to see what’s happening with these viruses and we’re not really seeing much in the way of flu. So you’ve got some time, but really ideally before the end of October. you want to try to get a flu vaccine.

You should also get what’s called a Tdap vaccine, which is not against a virus but protects your baby against whooping cough or pertussis. That’s a bacterial infection that babies can get when they’re very young. They themselves can’t start getting vaccinated against it until they’re two months old and even then that’s just the first of a series of shots.

So they have a period of time in their early months. where they’re vulnerable to whooping cough, and that’s a bacterial infection that can be fatal in newborn babies. And so, giving mom the Tdap vaccine helps to give those antibodies to the baby before they’re able to get vaccinated themselves, and helps to protect them.

From whooping cough, which is really, really important. And then, um, the RSV vaccine, if you’re pregnant, coming into RSV season. So, um, beginning now, September, October, until, um, January or so of this year. It was between 32 and 36 weeks gestation is when you should get your RSV vaccine against respiratory syncytial virus.

Again, that is mainly to protect the baby, although moms can get serious RSV illness as well. But really what we’re trying to do is protect that baby who was born during RSV season. So if you’re between 32 and 36 weeks of your pregnancy, that’s the window where we want to get you vaccinated against RSV to help the baby.

And then COVID vaccines can happen at any time. And so just recently in August, we had new updated COVID 19 vaccines approved. And if you are pregnant, you Or even if you’re not pregnant, if you have not had that new updated 24 25 COVID 19 vaccine, you really need to go get that. You can get it at any time during your pregnancy to help protect you from serious COVID disease, but also help to pass some of those antibodies to, to your baby, who again can’t get vaccinated until they’re six months old.

Um, a lot of people think, you know, well, I’ve had COVID, so I don’t need to worry about getting COVID vaccine. And the way I like to think about this is, you know, if you’ve got a kid and, um, let’s say they’re five years old and you go into the closet and get out last year’s winter coat and put it on your now six year old, it’s going to be way too small for them in most cases.

And that coat might give them a little bit of protection against the cold in the winter, but if it gets really bad, it is not going to be enough. And that’s kind of how I think about COVID vaccines. Last year’s COVID vaccine, yeah, might cover you a little bit, but the new viral variants that keep evolving and changing and putting on new disguises are looking a lot more like a blue flannel coat than last year’s pink puffy coat, and your immune system might not know what to look for.

So you really need to go get that updated vaccine, so if you have not had a COVID vaccine since September, you’re behind, and you really need to go get that updated one, especially if you’re pregnant. And are there other vaccines that might be recommended for some people during pregnancy? I’m going to give the very, um, scientific response of independent.

If, if you are someone who might be at high risk for something like Hepatitis B, um, it might be recommended that you get a Hepatitis B vaccine, again, to protect yourself and also to protect your baby from Hepatitis B. Hepatitis B is one of those viruses that down the road can cause cancer. Um, liver cancer is what we see with hepatitis B.

So that’s one that we really want to prevent in everyone. Um, so you could get a recommendation for that if you’ve not had those vaccines. Hepatitis A is another one. If you’re someone who maybe has liver disease or is at high risk of having trouble from a hepatitis infection, it might be recommended that you get a hepatitis A vaccine.

And if you’re planning on traveling internationally while you’re pregnant, there may be certain travel vaccines that are recommended. So make sure you check with your doctor to make sure that if there are any travel vaccines that might be recommended that you’re getting those too far in advance of you going on those international trips.

So as you said, you know, it’s going to depend and I’m going to add a very mother to baby answer to that, which is. Also, something you’ve already mentioned, talk with your health care provider and they can let you know what vaccines are recommended for you. Absolutely. The best place to get information. Dr.

Fiscus, thank you so much for being on the show today. But before you go, what is the final thought you would like to leave the audience with? The one. The best thing that you can do this respiratory season to help protect you and your baby the best is to receive vaccines against RSV, COVID 19, and influenza, and also the Tdap vaccine to prevent whooping cough in your baby.

We all as moms want to do the absolute best thing we can do to protect our babies and these are the absolute best things that you can do to make sure that your baby gets off to a healthy start and to protect you for the rest of your pregnancy to make sure that you don’t suffer any serious consequences from any of these diseases that we can so easily prevent with a vaccine.

So true. Thank you again. Um, and in our show notes, we’ll put some information about the mother to baby vaccination fact sheets that we have. And of course, some information about AIM. Perfect. So you can find out more about AIM at immunizationmanagers. org. We do have a lot of resources there that might be helpful, but also look at places like March of Dimes, the Centers for Disease Control and Prevention, and healthychildren.

org, which is the American Academy of Pediatrics. parent facing website. All of those are great resources for factual information about the immunizations that you and your baby need. Excellent. Thank you so much. Thanks for having me. Oh, you said the magic words. That means we would like to have you back for a future show.

Absolutely. Anytime. That would be wonderful. Thank you. And that’s going to do it for this episode of the Mother2Baby podcast. On the next episode, we’re going to be joined by a special guest from our partners at an organization called Vaccinate Your Family. She is currently pregnant and we’ll talk about some of the myths she’s been hearing among her circle of friends surrounding vaccination during pregnancy.

Don’t miss this myth busting episode up next. Be sure to hit that subscribe button. Subscribe button so that way you never miss a new episode and you can go back and listen or re listen to some of those older episodes as well. You can find us on iTunes, Spotify, Audible, or however you like to listen to podcasts.

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