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Your Referral Improves Medication Safety Information in Pregnancy

By Patricia Markland Cole, MPH, MotherToBaby Massachusetts

**This information was current as of the time the blog was published. However, information is constantly changing. Please visit Zika Central for the latest information.**

When it comes to pregnancy, so much of the attention is focused on the woman: her nutrition, her health, her behavior and just about her whole world comes under scrutiny in order to promote a healthy pregnancy; but what about the man? His nutrition, health, and behavior hardly comes under that same intense scrutiny…until now. Enter Zika virus. A man who has traveled to a Zika-affected area and has a wife/girlfriend who is pregnant must play an active role in protecting his partner and baby from possible Zika infection. Even if his partner is not currently pregnant, a man must be aware of his role when it comes to preventing the spread of the Zika virus. Father’s Day starts well before you actually become one, men….here’s why:

This illness, which is spread by the bite of a mosquito, took the world by surprise last fall when an unusually high number of babies, particularly in Brazil, were born with small heads and brains, a birth defect called microcephaly. Zika is a mild illness and typical symptoms include fever, skin rashes, muscle and joint pain, headache and conjunctivitis or red eyes. These symptoms normally last for 2-7 days. Some adults do not even know that they are infected because they have no symptoms while others will recover with rest, fluids and taking over-the counter medications to control symptoms. While Zika is a mild illness for many adults, if a pregnant woman becomes infected she can pass the infection to her child and, as a result, increase the chance that her child may be born with microcephaly and other abnormalities. To complicate matters more, it became clear that Zika can be transmitted by a man to a woman through sex or intercourse. The virus can be spread before symptoms begin and after symptoms end. Also Zika virus can remain in the blood of an individual for a week (or sometimes longer), but in regards to men Zika can remain in semen even longer than in the blood. Since we still don’t know how long Zika can remain in the semen, a man has to be more proactive than reactive when it comes to protecting his partner and future baby.

And ladies, our men, especially fathers-to-be, are thinking about Zika and are making some life changing decisions to protect the welfare of their families. Take, for example, cyclist Tejay van Garderen (27 years old) who is considered a medal contender for this year’s summer Olympic Games in Rio de Janeiro, Brazil. He has decided to withdraw from consideration to be a part of the US Olympic team because his wife Jessica is pregnant and he doesn’t want to put her or the well-being of his unborn child at risk by possibly contracting Zika and passing the infection on to them. “I don’t want to take any chances. If anything were to happen, I couldn’t live with myself.” When you consider that Tejay will now have to wait 4 more years to fulfill his Olympic dreams and put all that training on hold for his wife and child, that is chivalry at its finest. (All I can hear is the song “When a Man Loves a Woman” playing in my mind right now!)

So what is a man to do?

If you have a pregnant partner and you have traveled or lived in a Zika-affected area:

The most conservative approach is to not have sex during the entire pregnancy. Although the thought of not having sex for several months might seem like the end of the world for some, the health and welfare of your child is well worth the sacrifice.

However, every couple has to do what will work for them, so if abstaining from sex is not possible then it is important to use a condom correctly and consistently while having sex for the entire time of intercourse. Condoms should be used regardless of whether you are having vaginal, anal or oral (mouth to penis) sex, even if you do not have symptoms. Remember: since Zika virus is found in semen, the idea is to make sure your partner has no contact with semen. Think, knight in shining latex armor, right? Yet another chance for chivalry, guys.

If your partner is not currently pregnant:

If you and your partner are planning or actively trying to get pregnant but you’ve recently traveled to or lived in a Zika-affected area, experts advise you to hold off on getting pregnant. The length of time you delay would depend on whether you’ve had symptoms of Zika infection: delay 6 months men, if you have had symptoms, or 8 weeks if your wife or girlfriend had symptoms.. Avoid sex or be sure to use condoms every time , as mentioned before, during this period. If neither one of you have experienced symptoms than it is advised that you wait 8 weeks before trying.

Even if you are not planning a pregnancy, it is advisable to wear condoms every time you have sex because (well, you know) accidents have been known to happen! And you can even go a step further by not having sex for 8 weeks after you return from a Zika-affected area, if you have had no symptoms or for 6 months if you do.

Other Means of Prevention

Here in the United States, we do not yet have local cases of Zika – meaning that all reported cases in the US to date are from individuals who lived in or traveled to Zika-affected areas and have traveled back to the United States. While this is reassuring, we cannot be completely at ease and need to take the proper steps to prevent infection – especially since there is no vaccine or medicine to treat Zika. The use of insect repellents is an important tool in the prevention of Zika for everyone and especially those who are traveling back to the United States from Zika infected areas. The Centers for Disease Control and Prevention has some great info about Zika prevention: http://www.cdc.gov/zika/prevention/ 

If you are uncertain about your risk of infection, you should talk to your doctor sooner than later so that they can make a proper assessment of your level of risk. Zika testing is available for people who believe they have been exposed through sex and have symptoms; however, keep in mind that testing blood, semen or urine will not tell you the level of risk for passing the infection to someone during sex. In addition, because Zika can remain longer in semen than in blood, a man could get a negative blood or urine test but still have the Zika virus in their semen.

So men, prepare for your most chivalrous self. We need you in the fight against Zika! Your partner and future child will appreciate all you do to protect them.

Patricia Cole, MPH, is the Program Coordinator for MotherToBaby Massachusetts. She obtained her Bachelor’s degree in Biology from Simmons College in Boston and her MPH in Maternal and Child Health from Boston University School of Public Health. She has been the serving the families of New England as a teratogen counselor since 2001 and provides oversight for the day-to-day functions and outreach of the program. She has also provides education to graduate students and other professionals.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (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 counseling 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. MotherToBaby recently released an evidence-based Zika virus fact sheet for concerned pregnant and breastfeeding women. It can be found here: https://mothertobaby.org/fact-sheets/zika-virus-pregnancy/

References:

Macur, Juliet. (2016, June 3) Fearing Zika, a Top American Will Skip the Olympics. He May Not be the Last. The New York Times (Sports of The Times). Retrieved from: http://www.nytimes.com/2016/06/04/sports/olympics/zika-cycling-tejay-van-garderen.html?_r=0

Sara contacted us on the MotherToBaby live chat service after being referred by her OB/GYN who had told her that the Paxil (drug name paroxetine) she was taking could cause a heart defect. She was 14 weeks along and wanted to learn more, but was confused because all her genetic testing results had come back normal. She asked: “How could my baby have a heart defect if my non-invasive prenatal testing (NIPT) was negative?”

During pregnancy, there are many tests done to check on the health and development of your baby. It can be difficult to keep track of what they are all looking for and why they are important. To understand these tests, it can be helpful to know the differences between a birth defect and a chromosomal abnormality and what they each mean for the health of your baby.

All pregnancies have a background risk for birth defects of 3-5%, but certain exposures can increase the risk of birth defects above this background estimate. Most birth defects occur during the first trimester while the baby is growing and developing. A certain body part – such as the heart, brain, or limbs – might not develop correctly, and the baby’s body may look or function differently than it should. You may have heard of a baby being born with a hole in the heart, or with something called a cleft lip. These are two examples of birth defects that can occur during pregnancy. Birth defects can range from mild to severe, and the health of the baby will be dependent on where the birth defect occurs and how severe the problem is.

Certain tests done during pregnancy can look at your baby to see if there are birth defects. For example, most pregnant individuals will go in for an anatomy scan between 18 and 22 weeks where the healthcare provider will look at the baby using an ultrasound. Most people know this as the time when they can learn the gender of the baby, but the ultrasound will also take a detailed look at the baby’s organs and body parts, including the heart, brain, face, and stomach, to check for birth defects. While this is an important screening test, it is not perfect, and more minor defects may go unnoticed until birth.

Chromosomal abnormalities are changes in the baby’s DNA that happen at the time of conception. The best way to understand DNA is to think of it like a recipe book that holds all the recipes for the growth and development of different body parts. If a certain recipe calls for one stick of butter, but the printed book accidentally says two sticks of butter, the recipe will turn out different. In the same way, sometimes people have extra or missing amounts of DNA that can cause changes in development. For example, people who have a chromosomal abnormality known as Down syndrome have three copies of their 21st chromosome rather than only two. This extra amount of DNA is what causes the developmental differences in individuals with Down syndrome.

During your pregnancy, your healthcare provider may suggest that you meet with a genetic counselor to have non-invasive prenatal testing, or NIPT, performed. This test can be done as early as 10 weeks. During pregnancy, some of the baby’s DNA enters the pregnant woman’s bloodstream. By taking a small blood sample from mom, a lab can take a look at the baby’s DNA and tell if they have certain chromosomal abnormalities, such as Down syndrome. When you meet with a genetic counselor, they will go over all of the pros and cons of this test as well as your family history, and will meet with you again to review the results.

Back on the live chat service, Sara asked: “So because my NIPT results were normal, the baby is unlikely to have a chromosomal abnormality. However, a birth defect still could have happened in the first trimester, and I need to wait until my anatomy scan to get those results, is that right?” That’s exactly right, I replied. I then went on to explain that although Paxil (paroxetine) has been shown to increase the risk for heart defects in some studies, other studies do not suggest a risk, so the overall chance of the baby being affected is low.

As we ended our chat, Sara shared that she was feeling much more knowledgeable about the difference between a birth defect and a chromosomal abnormality. She was able to breathe a sigh of relief that her NIPT results came back normal, indicating a low risk for conditions like Down syndrome. She also felt much more confident heading to her anatomy scan in a few weeks knowing that this test, while not perfect, would be the best way to identify birth defects before her baby is born.

If you have any questions about birth defects or exposures during pregnancy, speak with a MotherToBaby specialist via phone, text, live chat, or email. For any questions regarding genetic testing in pregnancy, or to find a genetic counselor in your area, visit the Find a Genetic Counselor page on the National Society of Genetic Counselors website: https://findageneticcounselor.nsgc.org/

Morgan called late Friday afternoon with a question about COVID-19 booster shots. She shared that she was 37 weeks along and had received both shots of the Pfizer COVID-19 vaccine back in February, at the very beginning of her pregnancy. Morgan wanted to do what was best to protect her baby, and asked if she qualified for the booster shot that was now available.

As a Teratogen Information Specialist at MotherToBaby California, COVID-19 vaccine questions are my number one inquiry right now. With the guidance continuing to evolve as the pandemic rages on, it can be hard for pregnant women to keep up! Luckily, that’s what we are here to help with. I shared with Morgan that although the vaccines are still working well to prevent severe illness, hospitalization, and death, overall effectiveness has been shown to decrease over time (called waning immunity). Because of this decreased protection, the Centers for Disease Control and Prevention (CDC) have recommended booster shots for some people over the age of 18, including:

• Certain groups – including those who are pregnant or recently pregnant – who got both doses of an mRNA vaccine (Pfizer or Moderna) at least 6 months ago, and
• Everyone who got the Johnson & Johnson vaccine at least 2 months ago.  

So, what does this mean for my pregnant caller Morgan? Women who are pregnant and recently pregnant (up to 42 days after delivery) may be more likely to get severely ill from COVID-19. We know that there are higher risks of ICU admission, need for a ventilator, and death when a woman gets COVID-19 while pregnant, so protection of this group through vaccination is extremely important. I shared with Morgan that since it has been more than 6 months since she received her first two doses of the Pfizer vaccine, and since she is currently pregnant, she may choose to get a booster shot. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) have both recommended the booster at any time in pregnancy once you’re eligible for it.

Morgan and I went on to review the latest pregnancy data on the COVID-19 vaccines, which now includes thousands of women who have received mRNA vaccines (Pfizer or Moderna). Reassuringly, the available data does not suggest a risk for pregnancy complications (including miscarriage, preterm birth, stillbirth, effects on the baby’s growth, or infant death). Although COVID-19 booster shots have not been specifically studied in pregnancy, the Pfizer and J&J boosters are the same dose and contain the same ingredients as the initial doses, and the Moderna booster contains just half of the original dose. Most experts agree that the components of the COVID vaccines only stay in our bodies for a short time, and are not expected to cross the placenta to reach the baby.

Morgan was happy to hear that she qualified for the booster shot. Her three-year-old was in preschool, and although he wore his mask every day, she was still worried about him bringing home COVID and infecting her. She also visited her grandparents often, and wanted to keep them safe. For her, the benefits of protecting herself and her unborn baby definitely outweighed any potential risks.

Before we disconnected, Morgan asked about her sister-in-law who received the Moderna vaccine three months ago and was now pregnant. “Would she be able to get a booster?” Looking at the latest CDC guidelines, I informed Morgan that her sister-in-law would need to wait until 6 months after her second dose of Moderna before she became eligible for the booster. However, I also reminded her that her sister-in-law still has good protection against becoming very sick or hospitalized from COVID-19 from her initial vaccination. Like everyone who is pregnant, she should continue to take other precautions, such as wearing a mask and avoiding crowded indoor gatherings.

If you are unsure whether or not you qualify for a booster or you have other vaccine-related questions, please reach out to a MotherToBaby Specialist. And for anyone who has not yet received their initial COVID-19 vaccine, please know that it is strongly recommended before or during pregnancy by many organizations focused on maternal and child health, including the CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. If you would like to go over the latest pregnancy information for the COVID-19 vaccines, COVID-19 boosters, or any other exposures, please give us a call.