Back when the Zika epidemic was sweeping the western hemisphere, answering these travel-related questions was fairly straightforward. It was easier to know where there was a risk for Zika infection as governments and public health organizations around the world collaborated to identify and report cases. Since then, the number of reported Zika cases has fallen dramatically, but sporadic, low-level transmission continues to happen in some areas. Systems for detecting and reporting cases vary widely from country to country now, making it difficult to know the exact level of risk in any given area.

So, what’s a traveler to do?

First and foremost, all travelers should avoid mosquito bites to help prevent not only Zika, but also other diseases spread by mosquitoes. Preventing bites is important for everyone, especially those who are pregnant or planning a pregnancy and their partners. The best way to prevent mosquito bites while traveling is to use an Environmental Protection Agency (EPA)-registered insect repellent with one of the following active ingredients:

• DEET
• Picaridin (also known as KBR 3023 and icaridin)
• IR3535
• Oil of lemon eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone

Other ways to help prevent bites during travel include wearing loose-fitting, long-sleeved shirts and pants, and sleeping in areas free of mosquitoes (such as accommodations with window and door screens or air conditioning, or sleeping under a mosquito net).  

Second, consider your destination.

Check for active Zika Travel Health Notices from the Centers for Disease Control and Prevention (CDC). Travel Health Notices indicate areas with known current transmission of Zika.

After checking for Zika Travel Health Notices, visit the CDC interactive Zika map. The map uses different shades of blue to broadly classify Zika risk in countries and territories around the world:

• Dark blue areas have reported Zika transmission in the past and there could be current sporadic or low-level transmission in some areas. As in any area, there could be delays in detecting and reporting any new outbreaks.
• Medium blue areas have the kind of mosquitoes that most commonly spread Zika, but they have not reported Zika cases in the past.
• Light blue areas are not known to have the kind of mosquitoes that most commonly spread Zika, and they have not reported Zika cases in the past.

Third, learn the recommendations.

Learn the recommendations related to pregnancy based on your destination (summarized below). Depending on where you’re thinking of going, CDC might advise that you avoid travel, take steps to prevent passing the virus to a partner through sex (sexual transmission), and/or delay pregnancy if you or your partner are planning to become pregnant. Preventing sexual transmission of Zika means using condoms or dental dams, not sharing sex toys, or not having sex for 2 months after travel (for biological females) or 3 months after travel (for biological males). If delaying pregnancy after travel, follow these same timeframes (2 months after travel for biological females and 3 months after travel for biological male partners).

Recommendations for areas with a Zika Travel Health Notice:

• If you are pregnant, avoid travel to these areas.
• If your partner is pregnant and you must travel to these areas, prevent mosquito bites and sexual transmission during and after travel according to the guidelines and timeframes above.
• If you or your partner are planning a pregnancy and you choose to travel to these areas, prevent mosquito bites, prevent sexual transmission, and delay pregnancy after travel according to the guidelines and timeframes above.

Recommendations for areas with current or past transmission (dark blue on the map):

• If you or your partner are pregnant and you choose to travel to these areas, be sure to prevent mosquito bites. If you are concerned about Zika, prevent sexual transmission during and after travel according to the guidelines and timeframes above.
• If you or your partner are planning a pregnancy, be sure to prevent mosquito bites. If you are concerned about Zika, prevent sexual transmission during and after travel and consider delaying pregnancy according to the guidelines and timeframes above.

For travel to all other areas with mosquitoes, take steps to prevent bites.

Lastly, talk to your healthcare provider.

Talk to your healthcare provider about any questions or concerns. They can help you consider the nature of your travel, your ability to prevent mosquito bites and sexual transmission, the risks associated with a potential Zika infection, your pregnancy plans, and any other factors specific to you, your partner, and your circumstances. 

MotherToBaby specialists are also available to talk with you about Zika or other travel-related exposures before or during pregnancy. Safe and happy travels!

The post Zika, Pregnancy, and Travel in a Post-Epidemic World appeared first on MotherToBaby.

When I logged into our live chat service at www.mothertobaby.org on Tuesday morning, a chat from Alyssa popped up right away. “I’m currently 18 weeks pregnant and there was a measles case reported at my son’s preschool. Do I need to be worried?”

It’s understandable that Alyssa would be concerned. Measles (also known as rubeola) is a highly contagious respiratory disease caused by a virus. According to the Centers for Disease Control and Prevention (CDC) the measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If people breathe the contaminated air or touch the infected surface, then touch their eyes, nose, or mouth, they can become infected. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.

Symptoms of measles generally appear about 7-14 days after a person is infected, and can include high fever, dry cough, runny nose, red watery eyes, and a rash all over the body. To date, studies have not identified an increased risk for birth defects when pregnant people get infected with measles during pregnancy. However, research suggests that a measles infection can be associated with an increased risk for miscarriage, premature delivery (having the baby before 37 weeks), and stillbirth.

The first question I asked Alyssa on chat was if she had ever received the Measles, Mumps, and Rubella (MMR) vaccine. Just one dose is about 93% effective at preventing measles, while two doses is close to 97% effective, so it’s the best way to prevent this disease. These vaccines are routinely given in childhood, so Alyssa couldn’t remember if she had received both, but after texting her mom she was able to confirm that she was fully vaccinated. Whew, that was good news. Next we discussed the date of exposure. I asked Alyssa when the positive case was reported at daycare, to which she answered that it was about two weeks ago. More good news. Since neither Alyssa nor her son had experienced any symptoms yet, infection was unlikely.

Since measles doesn’t seem to be going away anytime soon, knowing how to best protect yourself against the illness at all reproductive life stages is important.

Pre-Conception: People who are planning a pregnancy in the future should make sure they are up to date with their MMR vaccines BEFORE they get pregnant. If you can’t find your vaccine record, call your healthcare provider who may know. If they don’t have a record, a blood test (titer) can be done to determine if you have immunity to measles. If it turns out you are not immune, you’ll want to get two doses of MMR vaccine for optimal protection. Just make sure you wait at least one month after getting the last shot before attempting to get pregnant.

Pregnancy: Since pregnant people shouldn’t receive live vaccines (like MMR), the best thing you can focus on during pregnancy is prevention. Good hand washing is always a good idea. If there is a confirmed measles outbreak near you, consider avoiding crowded public places and steer clear of any locations that have been identified as a known risk.

Breastfeeding: Once you are no longer pregnant, the MMR vaccine can be administered. The CDC considers the MMR vaccine compatible with breastfeeding and side effects for the breastfed baby are not expected.

If you have any questions about measles infection or the MMR vaccine while planning a pregnancy, during pregnancy or while breastfeeding, MotherToBaby is here to help. Give us a call at 866-626-6847, text, or chat with one of our information specialists today.

The post The Return of Measles appeared first on MotherToBaby.

Years later, as a teratogen information specialist for MotherToBaby, I realized some of the best gifts for a healthy pregnancy didn’t come with ribbons and bows, but from awareness and education! For example, did you know the holiday buffet table could include foods that could potentially cause harm to a developing baby? Or, if not careful, decorating could put a pregnant person in a dangerous situation? Today I encourage pregnant people to master must-know safety tips long before putting together must-have gift lists this season. Here are a few of my tips:

Tip 1. Importance of Getting Vaccinated

It is recommended that pregnant people have a flu vaccine in every pregnancy and be current on Tdap vaccine and Covid 19 vaccines.  People who are 32-36 weeks pregnant are currently eligible for the RSV vaccine https://mothertobaby.org/fact-sheets/rsv-vaccine/. This vaccine can pass protection to the developing baby, helping lower the chance of severe RSV infection once the baby is born.  

Not only should a pregnant person be up-to-date on vaccines, but  anyone older than 6 months of age who will be around a newborn should be vaccinated.

Tip 2. Choose Wisely at the Buffet Table

Drinks like eggnog and spiced cider may contain alcohol https://mothertobaby.org/fact-sheets/alcohol-pregnancy. If you’re not sure what’s s in a beverage, ask the host. Also, avoid soft cheeses made from unpasteurized milk, as they may contain bacteria that can cause a serious illness for a developing baby called Listeria https://mothertobaby.org/fact-sheets/listeriosis-pregnancy, as well as increased risk of miscarriage, uterine infection, or premature labor. Meats like cocktail franks and pâté can also contain bacteria. Meats need to be thoroughly cooked so that bacteria are killed.

Tip 3. CMV (cytomegalovirus) May Be Lurking

CMV is a common virus that often has no symptoms. If a pregnant person gets CMV https://mothertobaby.org/fact-sheets/cytomegalovirus-cmv-pregnancy, the baby could be at increased risk for hearing loss, developmental delays, or birth defects. To prevent infection, pregnant people should wash hands after changing diapers, feeding children, wiping children’s noses, or handling children’s toys. Also, avoid sharing food, eating utensils, toothbrushes, and pacifiers with children.

Tip 4. Holiday Decoration Safety

Some artificial trees, strings of lights, and ornaments may contain lead. Use gloves or wash hands after handling decorations to reduce exposure. Because of changes in their center of gravity, pregnant people should stay off ladders and let others decorate the hard-to-reach places.

Tip 5. Manage Anxiety and Depression

Having a ‘happy holiday’ can mean lots of stress, especially when pregnant.  Anxiety https://mothertobaby.org/fact-sheets/anxiety-fact to have that perfect holiday is real. Depression https://mothertobaby.org/fact-sheets/depression-pregnancy can be triggered this time of year as well.  Don’t hesitate to ask for help if you are feeling overwhelmed with all the gift giving and holiday activities.  Stay in-touch with your healthcare providers because…. help is available!

I hope these tips are helpful. While my son did end up turning out to be just fine, I think I would have caused myself less stress and worry had I known these tips during my pregnancy. If you have questions, don’t hesitate to reach out to MotherToBaby by phone, text, chat or email.

On behalf of all of us at MotherToBaby, here’s to wishing you a happy and healthy holiday!

The post Top Tips For A Holly Jolly Pregnancy This Season appeared first on MotherToBaby.

Ava, 24 weeks along with her first pregnancy, contacted the MotherToBaby live chat service early one morning with some questions about the new RSV vaccine. First, she wanted to understand how vaccinating a pregnant person could provide protection for a baby. As a Teratogen Information Specialist, I was happy to answer this question for Ava. I started by explaining that when a person gets vaccinated, their body makes antibodies. These antibodies protect the body against the actual infection if a person is exposed to the virus or bacteria later in life. During pregnancy, the antibodies that a pregnant person makes after being vaccinated can cross the placenta and pass to the developing baby, providing the newborn with some protection against the infection during the first few months of life.

I went on to explain that although the RSV vaccine is new, the idea of getting a vaccine during pregnancy to protect the baby (called “passive immunity”) has been around for some time. The Tdap vaccine, which protects against tetanus, diphtheria, and pertussis (whooping cough), has been recommended for use in pregnancy since 2011. Whooping cough is another infection that can be very serious for newborns, so having protection from birth as a result of maternal vaccination is ideal. The flu shot and COVID-19 vaccine can also pass antibodies to the developing baby during pregnancy. This is great news since newborns can’t get their own flu or COVID-19 shots until 6 months of age and need to rely on passive immunity in the meantime.

Next, Ava had a question about when she should get the RSV vaccine. She had plans to get her flu shot and Tdap vaccine at her next prenatal visit at 28 weeks. She wanted to know if she could get the RSV vaccine at the same time. Although these three vaccines (along with the updated COVID-19 vaccine) can all be given on the same day, the RSV vaccine should be given during a specific timeframe in order to pass as many antibodies as possible to the baby. Experts recommend that the RSV shot be given between 32 and 36 weeks of pregnancy. This allows enough time for RSV antibodies to pass to the baby before delivery.

With this recommendation in mind, Ava decided that her prenatal appointment at 32 weeks would be the perfect time to get the RSV vaccine. She had seen firsthand just how serious RSV can be when her 1-month-old niece was hospitalized with RSV last winter, so she didn’t want to take any chances with forgetting to get the RSV vaccine during her pregnancy.

Before we ended the chat, I mentioned to Ava that there is also a shot called nirsevimab (Beyfortus^TM) that can be given directly to babies under 8 months of age. Also known as a monoclonal antibody, this shot is another way to protect infants against severe RSV disease. Most babies do not need nirsevimab if their mom received the RSV vaccine during pregnancy. I suggested Ava talk with her healthcare provider about the pros and cons of both options.

Although having to remember to get another vaccine in pregnancy can feel like just one more thing a pregnant person needs to add to their never-ending to do list, the decision to vaccinate can prevent serious complications from RSV, and possibly even save the baby’s life. Here at MotherToBaby we are happy to go over the current recommendations for vaccines in pregnancy and answer any questions that you may have. Don’t hesitate to call, chat, text, or email with any questions about the RSV vaccine or other exposures during pregnancy. You can also check out our newest fact sheet about this vaccine here https://mothertobaby.org/fact-sheets/respiratory-syncytial-virus-rsv-vaccine-abrysvo/.  

References:

Centers for Disease Control and Prevention. 2023. RSV Vaccination for Pregnant People. Available at: https://www.cdc.gov/vaccines/vpd/rsv/public/pregnancy.html

Centers for Disease Control and Prevention. 2023. RSV Surveillance & Research. Available at: https://www.cdc.gov/rsv/research/index.html

The post Another Vaccine In Pregnancy? Yes, and Here’s Why That’s Good News! appeared first on MotherToBaby.

Melissa is not alone. Many people contact MotherToBaby to find the most up-to-date information about vaccines during pregnancy. Protecting yourself from circulating viruses can also help protect your developing baby. Infections such as influenza, pertussis, rubella, chicken pox, and COVID-19 can cause serious problems in both a pregnant person and their developing baby.  In light of August being National Immunization Awareness Month (NAIM), let’s navigate through the current recommendations.

Plan to Receive Some Vaccines Prior to Pregnancy

You may have heard there are some vaccines you should not receive during pregnancy. These “live” vaccines are avoided as they are made from viruses or bacteria that have been weakened, but not killed. Due to the small chance that a live vaccine might cause the disease itself, live vaccines are not routinely given to pregnant people.

So how can you protect yourself and your developing baby from viruses like measles, mumps, rubella and chicken pox (varicella) if it is not recommended (also known as contraindicated) to receive the vaccine during pregnancy? Your healthcare provider can take your titers (lab test that measures the antibody levels in the blood) before pregnancy to make sure you have enough antibodies to help protect yourself from these infections during pregnancy. Low titer levels? You can safely receive the necessary live vaccines needed before that positive pregnancy test! Out of an abundance of caution (small possibility of that infection) it is advised to wait at least one month before becoming pregnant after these vaccines. This is just one reason why it is beneficial to have a pre-pregnancy health checkup and to discuss any future conception plans with your provider!

Keep Up with Recommended Vaccines During Pregnancy and Encourage Others to Do So, Too

So, which vaccines should you receive during pregnancy?

The Centers for Disease Control and Prevention (CDC) recommend all people who are pregnant receive the influenza vaccine each year and a Tdap (tetanus diphtheria pertussis) vaccine for each pregnancy, and the most up-to-date COVID vaccine when you are due. These vaccines are not live vaccines and have not been associated with an increased chance for birth defects or pregnancy complications. An exception would be the live attenuated Influenza vaccine which is intranasal (given through the nose).

The flu vaccine usually becomes available in September and is offered throughout flu season. CDC recommends getting a flu vaccine by the end of October despite flu seasons varying in their timing from season to season. This timing helps protect a pregnant woman before flu activity begins to increase. Protection begins about two weeks after you get the flu shot and lasts at least six to eight months. It is necessary to receive the seasonal flu shot each year to be protected in the current flu season. Getting vaccinated during your pregnancy may also help protect your baby from getting sick during the first 6 months of life! This is especially important because infants less than 6 months of age cannot receive the flu vaccine.

“I just had a Tdap vaccine a couple years ago – so I don’t need another one, right?” Melissa asked a very common question we receive regarding the Tdap vaccine during pregnancy. Although this vaccine is recommended for adults every 10 years, for people who are pregnant, receiving the shot in the 3^rd trimester (specifically 27-36 weeks gestation) can help the baby get as many of the mother’s antibodies as possible. After delivery, these antibodies provide some protection against pertussis (a very contagious respiratory infection) until the baby can receive his/her own dTAP vaccine (at 2 months of age). Additionally, if everyone who lives with you and any caregivers get the vaccine, it can lower the chance for the baby to get pertussis.

It is well known that pregnant people are more likely to get very sick from COVID-19 compared to those who are not pregnant. This is why is so important to receive your COVID-19 vaccinations when you are due, anytime during pregnancy, for the best protection against severe illness. CDC recommends one updated (no longer called “booster”) Pfizer-BioNTech or Moderna COVID-19 vaccine to be up-to-date:  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html.

Pregnant people who receive vaccines can also share their experiences with maternal health researchers, like MotherToBaby. Our studies are published in medical journals and product labels, and can help others like you when navigating vaccine decisions in pregnancy.

There are no Vaccines to Prevent Some Infections

Many people are packing their bags for a getaway during these summer months. If you are considering an upcoming vacation or babymoon, it’s important to protect yourself from viruses and infections with the appropriate vaccines for that area. Where are you headed? Check with your healthcare provider regarding any specific travel vaccines you might need. CDC recommends discussing any travel plans with your provider 4-6 weeks before your trip. Contact MotherToBaby to check the information on any vaccines your healthcare provider recommends.

Zika is a virus that is usually spread by mosquitos. Being infected with the Zika virus during pregnancy is known to increase the risk for serious and lifelong problems for the baby. While there are no current outbreaks of the Zika virus, it can still be circulating in some levels in many countries and there is no vaccine or treatment currently for Zika! The safest approach during pregnancy would be to not travel to areas with any possible level of risk; should you choose to travel, it’s important to protect yourself using the recommended insect repellents among other ways to help reduce risk.

Although masks are no longer required in most public areas, this is still a great way to reduce the risk for infections and illness while around others! Good hand washing, good ventilation, air conditioning, staying outdoors as much as possible, etc. can also be considered.

After chatting with Melissa, she decided to make her appointment for her COVID-19 and Tdap vaccines (you can get them at the same time!) and will go in ASAP when the flu vaccine for this season is available. She felt reassured knowing she had decided to give herself and her developing baby the best protection from these illnesses as possible.  “Thank you for all this info! I just want to make the best choice for me and my baby – I feel so much better.”

Do you have questions about vaccines during pregnancy? Call, chat, text, or email MotherToBaby!

References:

https://mothertobaby.org/fact-sheets/vaccines-pregnancy/

https://mothertobaby.org/pregnancy-studies/

https://www.cdc.gov/vaccines/parents/by-age/pregnancy.html

https://www.cdc.gov/vaccinesafety/concerns/vaccines-during-pregnancy.html

The post Immunization Education: Everything You Need to Know About Vaccines Before and During Pregnancy appeared first on MotherToBaby.

But what about now? The number of reported Zika cases has fallen dramatically in recent years. However, the accuracy of reporting can vary widely from country to country, so the once-clear world map of Zika risk now appears much less well-defined.

One of the most common Zika-related questions we still get at MotherToBaby is, “How likely is it that I’ll get Zika if I travel to Country X?” (Or a variation of the same: “We went to Country X. Do we really need to wait 3 months before we try to get pregnant?”) One resource to help answer that question is the interactive world map maintained by the Centers for Disease Control and Prevention (CDC) to illustrate areas with Zika risk. Visit the map now and you’ll find four colors, each indicating a different level of Zika risk and the corresponding recommendations for pregnant people, their partners, and those who are planning pregnancy.  Let’s take a look at what each color means :

• Red areas have active Zika transmission. Travelers to red areas are at risk of Zika infection.
  • Pregnant people and their partners should avoid all unnecessary travel to red areas.
  • Couples and individuals who travel to red areas should wait at least 2 months (women) or 3 months (men) before trying to get pregnant, and have only protected sex during that wait time.
• Purple areas have had active Zika transmission sometime in the past, and there could still be sporadic cases. Travelers to purple areas might be at risk of Zika infection.

Pregnant people, their partners, and those who are planning pregnancy are encouraged to talk with their healthcare providers to make decisions about travel to purple areas. Careful consideration should be given to the risks and consequences of Zika infection in pregnancy, the nature of their travel, how much potential risk they are willing to accept, how soon they want to get pregnant (if they are not already), and any other factors specific to that individual or couple at that time.

• If pregnant people or their partners decide to travel to purple areas, they should take steps to minimize risk, including using insect repellent and considering the use of condoms for the rest of the pregnancy.
• People planning pregnancy who travel to purple areas should also take steps to minimize risk, including using insect repellent and considering following recommended wait times before trying to get pregnant (2 months for women, 3 months for men).

There is a sub-category of light purple, which shows higher elevations above 6,500 feet where mosquitoes that can transmit Zika don’t usually live. The chance of getting Zika in light purple areas is very low. However, be sure to consider if your travel plans would take you through dark purple areas on the way to these lighter purple zones.

• Yellow areas have mosquitoes that can transmit Zika, but have not had reported cases of Zika transmission. Travelers to yellow areas are at low risk of Zika infection.
  • All travelers to yellow areas should take precautions to prevent mosquito bites.
• Green areas do not have mosquitoes that can transmit Zika and have not had any reported cases of Zika transmission. Travelers to green areas are not at risk of Zika infection.
  • There are no Zika-related travel recommendations for green areas.

Given that many countries are included in the purple category, how does this map help you know what your risk really is if you travel to a purple area? The answer is that it doesn’t. Purple only tells you there is some level of risk. Here’s why purple—and we at MotherToBaby—can’t be more specific:

• Reliable data for every country around the world simply does not exist.Since Zika virus is no longer considered a public health emergency, many resources that once helped support global data collection have moved on to other, more pressing issues.
• The level of risk within a purple country could change without us knowing right away.The ability of any country to quickly identify and report cases depends on resources, logistics and other factors. This means there could be delays in detecting and announcing any new outbreaks.

The bottom line is that our post-Zika-epidemic world requires that we take the health of current and future pregnancies into consideration when planning travel. Ask ourselves how much potential risk we are willing to accept when we book our vacations and business trips. Does that mean that couples and individuals who want to have children should never go to areas that ever had Zika? Not at all! But if they are currently pregnant, or are not willing or able to effectively prevent pregnancy for at least 3 months after traveling, they might prefer to visit one of the many areas where there is no known risk of Zika. (Think yellow! Think green!)

MotherToBaby is here to answer your questions about Zika or other exposures before or during pregnancy. Happy travels!

The post Special Edition Baby Blog: What Do All the Colors Mean? Zika, Pregnancy & Travel in a Post-Epidemic World appeared first on MotherToBaby.

With schools back in full swing, fall activities underway, and children gathered once again in classrooms and other indoor settings, parents—including those who are pregnant—have renewed questions about COVID-19 and COVID-19 vaccines. MotherToBaby is seeing an increase in questions from pregnant people who want to protect themselves and their families as much as possible. Although more and more people are confident about getting vaccinated against COVID-19 in pregnancy, we continue to get questions about vaccine safety, as well as inquiries about eligibility for the updated boosters. MotherToBaby has teamed up with the Centers for Disease Control and Prevention (CDC) to give you the latest about vaccination for those who are pregnant and for children.

What is the current impact of COVID-19 and pregnancy? 

At this point in the pandemic, we know the importance of taking steps to help prevent a COVID-19 infection in pregnancy. Research has shown that people who are pregnant have a higher chance of becoming very sick, being admitted to intensive care, and needing to be put on a ventilator if they get COVID-19. Some studies have reported a slightly higher chance of death. Researchers have also found increased chances of adverse effects on the pregnancy itself, including preterm delivery, stillbirth, and complications such as preeclampsia.

The good news is, a recent study found that pregnant people who received two doses of an mRNA COVID-19 vaccine had lower rates of stillbirth than those who were unvaccinated. Furthermore, those who also received a booster had lower rates of infection, hospitalization, and pregnancy complications related to COVID-19 than those who received only the two primary doses. This finding is reassuring that staying up to date on the vaccines provides good protection in pregnancy in case of a breakthrough infection.

Why should people who are pregnant and those trying to expand their families consider getting vaccinated against COVID-19?

Vaccination is the best way to protect yourself against getting seriously ill, being hospitalized, and dying from COVID-19. This is true for everyone, but especially for those who are pregnant and others who are at higher risk of complications from COVID-19. Getting vaccinated during pregnancy has the added benefit of passing antibodies to the developing baby, which has been shown to lower the baby’s chances of infection or hospitalization with COVID-19 during the first few months of life.

For those planning a pregnancy, the preconception period is a great time to become up to date on recommended immunizations, including COVID-19 vaccines. This helps ensure that future pregnancies will start out as protected as possible from COVID-19 and other vaccine-preventable illnesses. CDC has helpful information here about vaccines before pregnancy: https://www.cdc.gov/vaccines/pregnancy/vacc-before.html.

What are the long-term effects on the baby when a person gets a COVID-19 vaccine during pregnancy?

It will take time to follow the children of people who were vaccinated in pregnancy to be able to answer this question with data. However, based on what is known about how these and other vaccines work, getting a COVID-19 vaccine during pregnancy is not expected to cause long-term problems for the child. In fact, a pregnancy that stays up to date on the vaccines is more protected and less likely to have complications from COVID-19 that could affect a child’s future growth and development, such as preterm delivery. In addition, studies have demonstrated antibody protection for the infant following vaccination during pregnancy. And, of course, vaccination during pregnancy will continue to protect the parent after delivery while they are caring for their newborn.

Should people who are pregnant get an updated booster?

It is common for vaccines to be updated over time to give better protection against new variants spreading in the community, just as the flu shot is updated every year to provide the best protection against current strains of influenza. The updated COVID-19 booster, which gives added protection against the Omicron variant, is also referred to as bivalent. People who are pregnant should receive this latest booster for the most up-to-date protection against COVID-19. CDC and the American College of Obstetricians and Gynecologists strongly recommend that pregnant people stay up to date with COVID-19 vaccines, including booster doses.

Like most other people, those who are pregnant are eligible for the updated booster if they have completed a primary COVID-19 vaccine series and it has been at least two months since their last dose (primary or booster). The updated booster can be given in any trimester of pregnancy. Anyone who has had a recent COVID-19 infection can consider delaying the booster by up to 3 months from the time their symptoms started or they tested positive.

Are COVID-19 vaccinations recommended for breastfeeding?

Studies have found that the components of mRNA COVID-19 vaccines are unlikely to enter the breast milk, and no serious side effects have been reported for the breastfed baby. In rare cases, there may be a temporary reduction in milk supply when a person gets an mRNA COVID-19 vaccine, but reassuringly, supply is expected to return to normal within a day or two. In more good news, antibodies against the virus that causes COVID-19 have been found in the breast milk of people who have been vaccinated with mRNA COVID-19 vaccines while breastfeeding. This is a promising finding, although more research is needed to know how much and for how long these antibodies might protect a breastfeeding child against the virus.

CDC, the Academy of Breastfeeding Medicine, and the American Academy of Pediatrics recommend that people who are breastfeeding stay up to date with COVID-19 vaccines, including booster doses.

What resources help pregnant people make informed decisions about protecting themselves and their families against COVID-19?

For questions about COVID-19 vaccines and other exposures during pregnancy and breastfeeding, talk with your healthcare provider or contact a MotherToBaby specialist. You can find MotherToBaby resources on COVID-19 and COVID-19 vaccines at https://mothertobaby.org/pregnancy-breastfeeding-exposures/covid-19/.

For guidance surrounding kids, we’ll turn to Leandris C. Liburd, PhD, MPH, the Associate Director for Minority Health and Health Equity for the Centers for Disease Control and Prevention (CDC).

The post Kids, Pregnancy, and the Latest on COVID-19 Vaccines appeared first on MotherToBaby.

What is a vaginal yeast infection?

Vaginal yeast infections are caused by an overgrowth of a fungus called Candida.  All people have a balanced mix of fungus (yeast) and bacteria that naturally grow in or around the vagina.  If this natural balance is disrupted, yeast can “overgrow” and cause a yeast infection.  Other names for yeast infection are “vaginal candidiasis,” “vulvovaginal candidiasis,” or “candidal vaginitis.”

Most of the time yeast infections are random, but there are some things that can disrupt this balance and increase the chance for a vaginal yeast infection.  Yeast loves to grow in humid and wet conditions, so simple things like not changing out of a wet bathing suit or sweaty yoga pants for a long time can increase chance for a yeast infection.  Changes in hormones can also increase the chance for a yeast infection.  The change in hormones is the reason why yeast infections also happen more commonly in pregnancy. 

How do I know if I have a yeast infection?

Signs of a yeast infection may include itching, burning and redness around the opening of the vagina, pain or discomfort during urination or sexual intercourse, and white or yellow “cottage cheese like” vaginal discharge.

It is important to know, however, that signs of a yeast infection can be very similar to other vaginal infections or sexually transmitted diseases.  Because of this, if you have the above symptoms during pregnancy do not assume that it is caused by a yeast infection (even if you have had yeast infections before).  Please call and visit your OB or midwife to confirm that it is yeast and not another infection, like bacterial vaginosis or a sexually transmitted disease.  

To confirm that it is a yeast infection your healthcare provider may do a pelvic exam and take a small sample of the vaginal discharge to examine in the office or send to a laboratory before recommending treatments. 

Are yeast infections harmful?

Other than being uncomfortable and sometimes painful, yeast infections do not usually cause complications in pregnancy or for the baby during pregnancy over the background risk.  We know that every pregnancy starts out with a 3-5% chance of having a birth defect and 10-15% chance for miscarriage. This is called the background risk. 

If left untreated, however, a yeast infection could pass to your baby’s mouth during labor and delivery and may cause the baby to have a condition called “thrush”.  Baby may then return the yeast infection back to you if the baby breastfeeds (causing yeast infection on the nipples).  Very rarely a yeast infection in babies can become serious because their immune systems are not yet well-developed.

Yeast infections can also cause body-wide infections and serious complications in pregnant people, especially those who have a weakened immune system because of other health problems. 

How do I treat a yeast infection?

Good news is that yeast infections are usually easy to treat and there are treatments that can be used in pregnancy!  Yeast infections are treated either topically (by placing an antifungal medication into the vagina) or orally (by taking a pill).  

• Oral Medications:  The most common oral antifungal used to treat yeast infections is called fluconazole (Diflucan®) and is typically given once in a single 150mg dose.  It is unlikely that the use of a single low dose of oral fluconazole during pregnancy would greatly increase the chance of birth defects or complications. However, the use of high dose fluconazole for many weeks in the first trimester of pregnancy might be associated with an increase in the chance of birth defects and miscarriage.  Because of this, the Centers for Disease Control and Prevention (CDC) have posted guidelines for treating vaginal yeast infections in pregnancy and these guidelines recommend topical therapies rather than oral medication.  For more details, visit our  Fluconazole (Diflucan®) Fact Sheet.

• Topical Medications: Most common topical therapies include antifungals called azoles and are usually used over a 7-day period.  There are many types of azole medications, but the most common ones used are clotrimazole or miconazole (common trade names include Monistat®, Micatin® and Mitrazole®).  For more details, visit our  Miconazole | Clotrimazole  Fact Sheet.

Some of these topical medications are also available over-the-counter (without a prescription).  You should not use an over-the-counter yeast infection medicine without first talking to your doctor.  Like we talked about before, there are other infections that may mimic a yeast infection and you do not want to be treating the wrong infection!  If you have used an over-the-counter medication and your symptoms do not go away, see your OB or midwife.

Rarely, some individuals may have more complicated yeast infections that last for a long time or come back more than four times a year.  These may have to be treated differently.

Is there anything I can do to prevent a yeast infection?

There are some things that can be done to help lower the chance of an infection developing.  Make sure to talk to your OB or midwife about other ways to lower the chance for yeast infections.

Some of these include:

1. Change out of wet clothes (such as a swimsuit or sweaty leggings) as soon as you can.
2. Use plain warm water to clean the outside of the vaginal area. Avoid using scented tampons and menstrual pads. Avoid hygiene sprays and douching.   
3. Sleep without underwear or in loose fitting pajamas.

Unfortunately, you cannot control the pregnancy hormones, so it is not possible to completely prevent yeast infections!  But the sooner you get it treated, the sooner you can go back to enjoying the regular miseries of being pregnant during the summer!

For more information please see:

Vaginitis | ACOG

Vaginal Candidiasis | Fungal Diseases | CDC

The post When Yeast Overgrows: What You Should Know About Vaginal Yeast Infections During Pregnancy  appeared first on MotherToBaby.

The United States has the highest maternal mortality rate out of all industrialized countries and Black pregnant individuals are three times more likely to die during or after childbirth compared to white pregnant people. As a matter of fact, from the time I received my graduate degree over 40 years ago until now, the maternal mortality rate has not changed for Black people and they still trail behind white people in the majority of health outcomes.  As a public health official, it was not surprising to learn that Black people have been disproportionately affected by the COVID-19 pandemic compared to white people.  Therefore, we need to consider the impact this could have for pregnant Black individuals who are already behind in the majority of health outcomes.

This issue is made worse by the state of vaccine hesitancy that exists across the nation, especially among the Black community. Therefore, the issue of being Black and pregnant poses its own set of challenges.  The question remains, is there a role that MotherToBaby can play in addressing vaccine hesitancy?

The State of COVID-19 in the Black and Pregnant Population

COVID-19 has proven to be a formidable opponent. As of January 30, 2022, there have been more than 372 million cases worldwide and over 5.6 million deaths. The United States has the highest death toll of over 906,000 compared to other nations.  Data shows that people of color are disproportionately affected by COVID-19 compared to white individuals. Black people are 10% more likely to get coronavirus compared to white people, three times more likely to be hospitalized and twice as likely to die from the disease.

While people of color are disproportionately affected by COVID-19, data has emerged about the effects to pregnant individuals.  COVID-19 infection has not been associated with an increased chance of birth defects or miscarriage. In addition, while pregnant individuals are not more vulnerable to infection than the general public; they tend to suffer more severe symptoms of the disease than non-pregnant individuals if they get infected.  The pregnant population was twice as likely to be admitted to the ICU or require life support and 70% more likely to die than individuals who were not pregnant.  In addition to the risks of severe illness and death for pregnant people, there is an increased risk of pregnancy complications and poor pregnancy outcomes, particularly an increased chance of preterm birth (birth before 37 weeks of pregnancy) and admission of the newborn to the neonatal intensive care unit (NICU), according to the Centers for Disease Control and Prevention (CDC). Data indicates that approximately 97% of pregnant people hospitalized (either for illness or for labor and delivery) with confirmed COVID-19 infection were unvaccinated.

The Complexities of the COVID-19 Vaccination among the Black Community

The state of the pandemic continues to fluctuate because the virus keeps changing. Currently we have different variants circulating around in the United States that are more contagious and are causing infection rates to rise. Vaccine hesitancy has proven to be another obstacle in the fight to combat the COVID-19 pandemic.

Despite the number of deaths and risks of COVID-19, only 40% of pregnant individuals are vaccinated, according to the CDC. Among people of color, the lowest vaccination rates are among Black pregnant people (38%% among Hispanics and only 26% among African Americans).This is particularly concerning for pregnant Black people since COVID-19 impacts communities of color disproportionately and the risk of infection increases the chance of preterm birth that was already 50% higher in the black community compared to the white population even before the pandemic began.

What are the Reasons Behind COVID-19 Vaccine Hesitancy?

Racism and its subsequent effects on social and economic factors have resulted in the virus disproportionally affecting Black people and maternal mortality rates.  The historical treatment of the Black community in this country has promoted a level of distrust in the government and medical profession that have been noted in many studies. When asked, Black people mention the history of racism in medical research (Tuskegee experiment) and care as the key reasons for not being vaccinated. Black people also express that they feel dismissed or ignored by medical professionals; that they do not have a voice and are not heard.  There has also been the issue of availability due to supply, location and transportation that has been an obstacle for Black and underserved communities to get vaccinated.

In one study among pregnant individuals, additional reasons for not getting vaccinated included the speed in which the vaccine was produced, the safety of the vaccine for themselves and their pregnancies and its effectiveness. This study reflected the same trend that the lowest vaccination rates were among Black individuals compared to white people and other people of color.

Future Steps to Reduce Vaccine Hesitancy

Among pregnant individuals that were vaccinated, they mentioned their healthcare provider, primarily their OBGYN, as being a trusted resource.  Some studies stress the need for having more people of color in medicine to promote a level of trust in all fields of medicine. While Black people make up 13% of the US population, they only make up 4% of US doctors and less than 7% of medical students.²

MotherToBaby can continue to be the resource that providers can trust to give them the information they need to advise their patients. We can continue to use social media and other outlets to provide evidence-based information on the safety of the COVID-19 vaccine.  The advantage of MotherToBaby is that it is an independent non-profit organization with a mission to provide evidence-based information to serve all. Since MotherToBaby is a free service there are no restrictions in access for anyone.  We can expand our partnerships and collaborations with community-based organizations that serve people of color including churches, mosques, barber shops, hair salons, schools and other groups and businesses that play a role in promoting health education and combatting COVID-19 vaccine misinformation. We need to make sure that our materials speak to the communities that we are trying to reach by being culturally and ethnically appropriate.

Our own Dr. Richard Miller led us in a discussion during our monthly seminar about how we, as MothertoBaby, can help with vaccine hesitancy. Many good points were made including the following: “Be a good listener, and meet people where they are. People want to be heard and once we understand where they are, we can provide them the information they need.  Not all will be receptive but we can help as many as we can.”

Dr. Martin Luther King Jr, said it best, “Education must enable one to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction.”   Our goal at MotherToBaby is to do exactly that for all. We would not lie to you-Let’s all be well.

Get the facts by visiting our online Resource Hub on common exposures during pregnancy including COVID-19 and the COVID-19 vaccines. If you have a question that is not addressed, our confidential experts are available at no-cost (and health insurance is never asked about or required). Contact an expert for personalized COVID-19 information today!

    References

• Battarbee AN, et al.  2022.  Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August-December 2020. Am J Perinatol. 2 Jan;39(1):75-83. 2021 Oct 1.

• Cato TL. 2021. Addressing Justified Vaccine Hesitancy in the Black Community. J Racial Ethn Health Disparities. Mar 30 : 1–4.

• Gillispie-Bell V. 2021. The Contrast of Color: Why the Black Community Continues to Suffer Health Disparities. Obstet Gynecol.  Feb 1; 137(2):220-224

• Holness NA. et al.  2020. Pregnancy and Postpartum Challenges During COVID-19 for African-African Women. J Natl Black Nurses Assoc.  Dec;31(2):15-24.

• Njoku A, Joseph M, Felix R. 2021. Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination.  Int J Environ Res Public Health. Sep 20;18 (18):9904

• ina-Odunsi AJ. 2021.  Commentary:COVID-19 vaccines inequity and hesitancy among African Americans. Clin Epidemiol Glob Health. Oct-Dec;12:100876.

• Priya Kr. 2021.  CNN ’ Visualizing the stark maternal health inequities in the United States’ CNN.

• Centers for Disease Control and Prevention. 2021. Emergency Preparedness and Response. COVID-19 Vaccination for Pregnant People to Prevent Serious Illness, Deaths, and Adverse Pregnancy Outcomes from COVID-19. Retrieved from https://emergency.cdc.gov/han/2021/han00453.asp

The post Would I Lie to You? The Issue of COVID-19 Vaccine Hesitancy among the Black Community during Pregnancy appeared first on MotherToBaby.

COVID-19:

Try as we might, we can’t escape it or wish it away. We are, in fact, still in the middle of a pandemic, with new variants appearing and cases still rising and falling unpredictably in most places. Traveling on public transportation (such as airplanes, ships, trains, subways, taxis, and ride shares) can make getting and spreading COVID-19 more likely. So can being in crowded indoor spaces, especially if not everyone in those spaces is fully vaccinated against COVID-19 and/or wearing a mask. Having COVID-19 in pregnancy can increase pregnancy risks such as stillbirth and preterm delivery. So, how can you eliminate or reduce your chance of exposure to the virus?

• Avoid public transportation. If you must travel, using your own vehicle with members of your own household is the safest bet. Using drive-thrus or packing your own food to stop and eat along the way is safer than eating in crowded restaurants full of other holiday travelers.
• If you must travel on a plane or use other public transportation, wear a well-fitting mask the whole time (this is required), stay at least 6 feet away from other travelers when possible, and wash your hands/use an alcohol-based hand sanitizer frequently. Most importantly, make sure you’re fully vaccinated before you travel, including getting a booster dose when you’re eligible.
• Did I mention making sure you’re FULLY VACCINATED before travel? It’s the single best way to reduce the chance of getting very sick if you’re exposed to the virus that causes COVID-19. Pregnancy and being very sick don’t go well together, so this one is really, really important, whether you’re traveling or not. MotherToBaby has helpful resources on the COVID-19 vaccines and booster shot, and you can contact us to talk through any questions or concerns you may have about getting the vaccine.
• Even if you’re fully vaccinated, you might still consider wearing a mask indoors during holiday gatherings (and elsewhere), especially if you’re getting together with people from different households coming from different places. If everyone else at the gathering also wears a mask indoors, even better.  
• Find more tips and information about safer holiday celebrations and travel in the time of COVID at this link: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/celebrations.html.

Influenza (the Flu):

Flu season carries its own risks for people who are pregnant. Like COVID-19, having the flu during pregnancy increases the chance of being very sick compared to people who aren’t pregnant. Many of the same precautions that apply to COVID-19 apply to the flu as well:

• Get the flu shot. Like the COVID-19 vaccine, the flu shot can be given at any time during pregnancy, and can even be given at the same time as a COVID vaccine or booster. The sooner you’re vaccinated, the sooner you and your pregnancy will have good protection against becoming very sick from the flu. And (bonus!) getting vaccinated in pregnancy may pass some protective antibodies to your developing baby.
• Avoiding public transportation and crowded indoor spaces will also reduce your chance of exposure to the flu virus. Washing your hands frequently/using an alcohol-based hand sanitizer is also an excellent flu prevention technique.

Zika:

Yes, Zika is still around. There are no known “outbreaks” of Zika anywhere in the world at this time, but there is ongoing, low-level, sporadic transmission in some places. Having Zika during pregnancy increases the chance of serious and lifelong effects for a developing baby. There is no vaccine against the Zika virus.

• The safest course in pregnancy (or if you’re trying to conceive) is to avoid travel to places with a chance of exposure. Unfortunately, it’s virtually impossible now to know the exact risk of being exposed to Zika in any given country, but if you must travel, you can use the CDC’s Zika map to help you plan.
• If you travel,use insect repellent and take other precautions to help avoid mosquito bites, such as wearing long sleeves and pants. If your partner travels with you, take steps to avoid sexual transmission of Zika. If you’re planning a pregnancy, follow the recommended wait times (2 months for women, 3 months for men) before trying to conceive.

Other infections:

If you’re considering international travel, there may be other infections to consider, such as malaria and foodborne illnesses. You might also need other vaccines, so be sure to review the current vaccine recommendations for your destination. Some vaccines can be given during pregnancy, but it’s a good idea to check with your healthcare provider or contact MotherToBaby to discuss the risks and benefits of specific vaccines as you’re deciding about travel. 

Medical concerns:

Other travel considerations include the increased chance of blood clots during travel if you’re pregnant, and where you will receive medical care in case of unexpected preterm labor or another medical emergency. Before any travel, be sure to talk with your healthcare provider about any additional considerations that are specific to you and your pregnancy.

Given all these considerations, if you’re pregnant you might decide this year is a good one to enjoy low-key holidays at home and save the travel for another time. However you decide to spend the season, we hope it’s safe, healthy, and happy!

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