Immunizations in Pregnancy

Mar 9, 2021 | BFWHRI, Women's Health

Pregnancy is not only a time filled with wonder and joy, but also a time for women to optimize their health. It is important to focus on general healthy behaviors such as avoiding tobacco and excessive alcohol use, but during the flu season, generally fall and winter, it is also an excellent time to discuss immunizations in pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), immunizations are an essential part of prenatal care. Immunizations are known to reduce the risk and burden of infectious disease, not only to the mother, but also to the newborn child.

Juan A. Peña, MD MPH

Both ACOG, and the CDC’s Advisory Committee on Immunization Practices (ACIP) recommend immunization against seasonal influenza to any woman who is pregnant during the flu season. Because hormonal changes in pregnancy can make pregnant women more prone to infections, influenza can be especially risky during pregnancy. Influenza infection during pregnancy can be more severe, and increases the risk of preterm and cesarean delivery.

For example, during the 2009 H1N1 pandemic, pregnant women accounted for five percent of all deaths, but made up only one percent of all influenza infections. Moreover, influenza infection in the first trimester increases the risk of congenital anomalies. Immunization reduces the risk of influenza illness, hospitalizations, and also protects the infant for several months after birth.

Tetanus, diphtheria, and acellular pertussis (Tdap) is another vaccination recommended by both ACOG and the ACIP. Vaccinating the mother transfers antibodies to the fetus that protect it during the newborn period against the respiratory illness pertussis, also called whooping cough. This infection can be particularly severe for newborns, as they are vulnerable to this infection but are not vaccinated against whooping cough until two months of age.

In fact, most children who are hospitalized for pertussis are those that are less than two months old— vaccination can reduce this risk by almost 50 percent.  Tdap is therefore recommended with every pregnancy (even if you have had the vaccination previously) around 28 weeks. This ensures that antibodies to pertussis are transferred from the mother to her fetus with each pregnancy, protecting the newborn from serious pertussis in the first months of life.

You can find more information from the CDC on vaccine safety and on vaccines and pregnancy, and from the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine

Most immunizations are safe to administer during pregnancy. Immunizations are either derived from inactivated viruses, or from live, but weakened virus. Some examples of vaccines derived from inactivated viruses include influenza and Tdap. Immunizations made from a weakened (also called a live-attenuated virus) are contraindicated in pregnancy. Some examples of live-attenuated vaccines include the measles, mumps and rubella (MMR) and varicella vaccines; these should not be given during pregnancy. Some vaccinations, such as the pneumococcal, or hepatitis B vaccine, are recommended for certain pregnant women (i.e. women with diabetes mellitus). Most vaccines can be administered to post-partum and breastfeeding women.

The recent COVID-19 pandemic has highlighted the role that public health interventions, including immunizations, play in protecting the health of populations. Pregnant women should adhere to strategies recommended by the CDC that mitigate community spread of COVID-19 including hand washing, wearing masks, and social distancing. The U.S Food and Drug Administration has granted emergency use authorization to three COVID-19 vaccines and more will likely seek approval. Though pregnant women were excluded from the clinical trials of these vaccines, the CDC notes that limited data from animal studies have not demonstrated safety concerns.

According to ACOG and the Society for Maternal Fetal Medicine (SMFM), symptomatic pregnant women with COVID-19 are at increased risk of severe illness and death compared to non-pregnant peers. Therefore given these risks, both ACOG and SMFM stress that COVID-19 vaccines should not be withheld from pregnant women, and that pregnant individuals should be free to make their own informed decisions regarding COVID-19 vaccination after discussion with their provider. Information about COVID-19 is rapidly evolving, and women are encouraged to seek further information from the sources listed below as it comes out.

Being up to date with recommended immunizations is an excellent way of optimizing pregnancy care. Most immunizations are safe in pregnancy, and both the CDC and ACOG recommend vaccination with influenza and Tdap with each pregnancy.

Juan A. Peña, MD, MPH, is a Maternal Fetal Medicine fellow at the Icahn School of Medicine at Mount Sinai and a member of the Blavatnik Family Women’s Health Research Institute. His research and background are in Obstetrics and Gynecology and Preventive Medicine.

Read more stories about the Blavatnik Family Women's Health Research Institute

Should You Get the COVID-19 Vaccine If You Are Pregnant?

Updated on Jun 30, 2022 | BFWHRI, COVID-19, Featured, OB/GYN, Vaccines, Women's Health

If you’re pregnant, you likely have a lot of questions about whether it’s safe for you and your baby to receive a vaccine against COVID-19. In this Q&A, Jill Berkin, MD, Assistant Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, draws on her vast experience as a high-risk obstetrician—as well as her own pregnancy—to offer her perspectives on side effects, vaccines and breastfeeding, and how to decide if vaccination feels right for you.

“Pregnant women should weigh their personal risks of coronavirus exposure against their tolerance of the unknown regarding vaccination,” says Dr. Berkin, who received two COVID-19 vaccine shots during her second trimester of pregnancy. “Right now our information is limited, but all the information we do have suggests that COVID-19 vaccines are safe in pregnancy.” She suggests those with specific questions about their own situation consult with their health care providers.

Why did you get the COVID-19 vaccine?

 As a high-risk obstetrician I saw firsthand how pregnant women were affected by COVID-19. I also thought about my day-to-day exposure to the coronavirus through my work. I was more concerned about the known risks of infection than the unknown risks of vaccination, so my decision was easy.

Jill Berkin, MD

In general, do you think other pregnant women should get the vaccine and why?

It’s really important for pregnant women to realize that we don’t have data saying the vaccine is unsafe during pregnancy. Even though our data are limited, all of it points to the fact that vaccination is safe, and we don’t see any side effects specifically impacting the pregnancy itself. We haven’t seen any harm among women who were pregnant after receiving the vaccine in clinical trials.

In addition, each individual pregnant woman has to evaluate her own potential risk for exposure just like I did for myself. As a health care worker my exposures were great, so they outweighed any fears of the unknown with the vaccine. And of course, people who are pregnant may want to consult their own physicians for advice as well.

What are the risks and complications of COVID-19 and pregnancy?

Most pregnant women infected with the coronavirus will have symptoms similar to those who are not pregnant. The vast majority of pregnant women affected are asymptomatic. A large portion of the population has symptoms similar to a cold or flu, including muscle aches and fever. Then there’s a small portion of the population that has more severe disease that might require hospitalization. The data we have now comparing pregnant individuals to non-pregnant individuals shows that symptomatic pregnant women do have a slightly higher risk of a hospital admission, ICU admission, and even mechanical ventilation, but there’s no increased risk of mortality.

Would you say then that pregnant women are at higher risk of developing severe COVID-19?

While it’s hard to fully analyze, the data suggests that pregnant women are at increased risk for developing severe complications of COVID-19. But we have to remind ourselves that in general, pregnant women who become ill are more likely to present to their physicians than women of the same age who are not pregnant, and that’s because you see a doctor more often when you’re expecting. Doctors will also be biased towards admitting women who are pregnant and keeping a closer eye on them because there are two patients at stake.

For those getting the COVID-19 vaccine, what are some side effects to be expected?

The most common side effect that people report is soreness in the arm, similar to a lot of other vaccines. Afterwards some patients might experience mild cold- or flu-like symptoms for about 24 hours. This seems to happen more frequently with the second dose, which is three or four weeks after the first dose. Pregnant women, along with the rest of the population, can take pain relievers such as Tylenol after their vaccine shots to help alleviate some of those symptoms.

Do you think there’s an optimal time for receiving the vaccine during pregnancy?

We don’t have any research to suggest that there is an unsafe time to vaccinate during pregnancy. However, pregnant women might consider not receiving the vaccine during the first trimester. This is only because in general we avoid medical interventions in the first trimester, which is the period of “organogenesis” when the baby’s organs are forming. We don’t have data suggesting there are any negative effects of the vaccine on organ systems. But because we are dealing with a lack of information regarding COVID-19 vaccines and pregnancy—and out of an abundance of caution—perhaps delaying vaccination until the second or third trimester, if possible, could be beneficial.

What do you recommend about vaccination during breastfeeding?              

The vaccine certainly has no risks, and only potential benefits. We know that one of the most wonderful things about breastfeeding is that women pass antibodies through their breast milk to their babies. We don’t have much information specifically about antibodies created from COVID-19 vaccination being passed through breast milk. But we do have encouraging data about women who were infected with coronavirus itself forming antibodies and passing those antibodies along through the placenta and through breast milk. So the benefit of being able to protect children against coronavirus when a vaccine is not currently available to children is a remarkable thing and a unique advantage of being a lactating mom.

Luciana Vieira, MD, who conducted the Q&A, is an assistant Clinical Prof of OB/Gyn and Reproductive Science at ISMMS and the Blavatnik Family Women’s Health Research Institute Scholar for 2020-2021. Dr. Vieira has been integral in creating a perinatal database to collect/analyze data on maternal + neonatal outcomes within Mount Sinai Health to improve care.

 

 

 

 

 

 

Read more about what Mount Sinai experts say about vaccines

No Quality Without Equity: The 2021 Maternal and Child Health Equity Virtual Summit Proceedings

Updated on Jun 30, 2022 | BFWHRI, Diversity and Inclusion, Women's Health

Elizabeth Howell, MD, MPP

“Systemic racism has taken an extraordinary toll on the health and wellness of Black women and babies. We are here today to develop actionable items to improve maternal and infant health equity.”

This powerful sentiment is how Elizabeth Howell, MD, MPP, Chair of the Department of Obstetrics and Gynecology at the Perelman School of Medicine and the University of Pennsylvania Health System, opened the Maternal and Child Health Equity Virtual Summit on January 12.

The five-hour summit was held on the New York Academy of Medicine Zoom platform and included featured presentations and panels of diverse members including leaders in medicine, nursing, community-based-organizations, and perinatal and maternal health research.

Dr. Howell, the previous Director of Mount Sinai’s Blavatnik Family Women’s Health Research Institute, partnered with the New York Academy of Medicine, the Institute, and the University of Pennsylvania to establish this important educational summit as the final phase of her NIH-funded research investigating the contribution of hospital quality to racial and ethnic disparities in maternal and infant health. Dr. Howell co-chaired the summit with Danielle Laraque-Arena, MD, a senior scholar-in-residence at the New York Academy of Medicine.

Dr. Howell presented the findings of her research to the more than 450 attendees of the virtual summit, outlining the interactions between structural racism, system factors, clinician factors, patient factors, and community or neighborhood to influence racial and ethnic disparities in maternal and infant morbidity and mortality.

According to their findings, there were clear themes between hospitals that outlined high and low performance of maternal health outcomes. High performing hospitals had a stronger focus on standards and standardized care, stronger nurse-physician communication, and a higher awareness that disparities and racism may be present in hospital settings and could lead to differential treatments.

Dr. Howell’s group went further to analyze within-hospital disparities. After calculating similar risks of severe maternal morbidity for patients within the same hospital insured by Medicaid or commercial insurance, they found that Black women as compared with White women had higher maternal morbidity rates (after adjusting for insurance, obesity, etc.). Dr. Howell and her research clearly demonstrate the health care crisis for moms of color, and the rest of the day’s programming helped bring diverse voices to the conversation and plan action steps to reduce these disparities.

The summit was divided into three parts: Maternal Health, Infant Health, and the Mom-Baby Dyad, each with one featured speaker and a panel of diverse experts. The featured speaker for Maternal Health was  Karen A. Scott, MD, a leading OB/Gyn from UCSF School of Medicine, who outlined the “sacred birth” movement.

“Sacred birth is a radical attitude towards human births, specifically Blackness, Black bodies, and Black births. The movement advocates for safer, respectful more dignified and higher quality participatory birth care,” she said.

Dr. Scott powerfully stated at the summit, “We need to shift power to generate and disseminate knowledge of the QI space that has been usually excluded to hospital administrators and executives over to Black mothers, birthing people, community members and scholars.”

The Maternal Health panel, moderated by Wendy Wilcox, MD, (NYC Health+Hospitals) included Sascha James-Conterelli, DNP, (Lecturer in Nursing, Yale School of Medicine), Chanel Porchia-Albert (Founder, Ancient Song Doula Services), Natalie D. Hernandez, PhD, (Assistant Professor, Morehouse School of Medicine) and Dr. Allison Bryant, MD, (Massachusetts General Hospital). The panel discussed diversification of the labor and delivery workforce, anti-racist medical models, and quality improvement. Dr. Bryant stated one of the most salient quotes of the day: “No quality without equity.”

The second part of the summit, Infant Health, began with Dr. Howell conveying her research findings on infant morbidity and mortality. Dr. Howell led the next section of the summit: Infant Health Inequities.

“Very preterm births account for only 2 percent of all births but 53 percent of all infant deaths, and Black infants are three times more likely than white infants to be born very preterm,” she said. Based on Dr. Howell’s findings, up to 40 percent of the Black-White disparity in very preterm birth morbidity and mortality was due to the difference in which hospital the child was born in.

Jeffrey Horbar, President of Vermont Oxford Network, was the featured speaker and built upon Dr. Howell’s research, noting that white infants are overrepresented at high-quality hospitals in New York City and black infants are underrepresented at those same hospitals. Dr. Horbar’s theme throughout his presentation was clear: the importance of following through for patients.

“Our responsibility to NICU infants and their families extends beyond hospital walls, following through to address their social determinants of health, which will ultimately determine the health and well-being of infants and their families,” he said.

Dr. Horbar also outlined his organization’s new innovation grants to promote health equity, “Take Action to Follow Through,” which can jump start equity and quality improvement programs in NICUs around the country.

The Infant Health panel, moderated by Deborah Campbell, MD, (Albert Einstein College of Medicine) included Dr. Horbar, Teresa Janevic, PhD, MPH, Assistant Professor of  Obstetrics, Gynecology and Reproductive Science, and Population Health Science and Policy at Icahn Mount Sinai, and a member of the Blavatnik Family Women’s Health Institute, and Adrienne Mercer, EdD, (Northern Manhattan Perinatal Partnership). Panelists discussed paid-parent advisor positions to work with physicians, structural racism, and the significance of doulas in supporting birthing people. Dr. Mercer shared the sentiments of one of the women that her organization worked with. In describing her doula, the woman said, “Having a woman I can talk to made me feel supported and that I matter.”

The final part of the summit called “Mom-Baby Dyad” began with Jennifer Zeitlin, MA, DSc, an epidemiologist who has been a co-investigator in much of Dr. Howell’s research. She discussed how Black and Latina mom-baby dyads face a double threat, a domain in health care that needs actionable change.

Her research specifically showed that severe maternal morbidity is an independent risk factor for very preterm mortality. She stated that efforts to integrate and strengthen quality improvement in both obstetric and neonatal care at hospitals where Black and Latina women deliver may be a critical step to reduce the co-occurrence of disparities for maternal and child health outcomes.

The final panel of the day, moderated by Lynn Roberts, PhD, (CUNY), included Mary D’Alton, MD, (Columbia), Colette Sturgis (Urban Health Plan), and Jochen Profit, MD, (Stanford) who discussed their own institutions’ efforts to reducing maternal and child morbidity and mortality. Dr. D’Alton discussed the specific significance of maternal mental health as absolutely integral to the overall health of the mother, and Colette Sturgis, the Program Director at Urban Health Plan, discussed how their Maternal and Infant Community Health Center has adapted through the pandemic to support mothers.

Dr. Laraque-Arena of NYAM began the closing remarks of this important event, stating “We have a lot of work to do in deconstructing the entities that have supported inequities in maternal and infant health.”

And Dr. Howell concluded by summarizing action steps for the future, including improving workforce diversity, integrating Black and Brown women’s lived experience into health care, supporting doulas through Medicaid coverage, and engaging community members in quality committees and improvement. Dr. Howell encouraged leaders in executive and administrative positions to be proactive and vocal about these significant issues.

“It takes bold leadership to take a strong stance and say: we have to do better,” she said.

The New York Academy of Medicine has more information on the Maternal and Child Health Equity Virtual Summit, including PDFs of speaker’s presentations and a recording of the entire event.

Mahima Krishnamoorthi, BA, is the Clinical Research Coordinator at Blavatnik Family Women’s Health Research Institute, where she develops and fosters her passion for women’s health and reproductive justice.

 

 

Read more stories about the Blavatnik Family Women's Health Research Institute

Marking Cervical Health Awareness Month

Updated on Jun 30, 2022 | BFWHRI, Women's Health

January is Cervical Health Awareness Month, and in celebration we are resharing an interview with Whitney Lieb, MD, MPH, in which she answers some frequently asked questions on cervical health.  

During the video Dr. Lieb provides useful gynecological information including what is the cervix, what is human papillomavirus (HPV) infection, and what are recommended screening guidelines for cervical cancer. The information provided is based upon The American College of Obstetricians Gynecologists Frequently Asked Questions.  

Although the number of cases and deaths from cervical cancer has decreased significantly over the past 40 years, it is still the fourth most frequent cancer in women around the world and significant racial health disparities persist.  Black, Latina, American Indian, and Alaskan Native women continue to be disproportionately affected by cervical cancer compared to white women. The mortality rate from cervical cancer in Black women is twice that in white women.

Dr. Lieb highlights that education, regular screening, the HPV vaccination, and follow-up after an abnormal Pap results are ways to help reduce these disparities.

Whitney Lieb, MD, MPH, is the Women’s Health Scholar with The Blavatnik Family Women’s Health Research Institute. She is also an Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai. Her interests include cervical cancer screening and prevention, maternal mortality, and reproductive health in the United States and globally.

Amy Balbierz, MPH, is a program manager in the Department of Population Health Science and Policy and for The Blavatnik Family Women’s Health Research Institute. She has worked alongside Elizabeth Howell, MD, MPP, founding Director of The Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai, on her NIH and RWJF funded research for the last 10 years.

 

Read more stories about the Blavatnik Family Women's Health Research Institute

Siobhan Dolan, MD, MPH, Joins the Blavatnik Family Women’s Health Research Institute

Oct 29, 2020 | BFWHRI

Siobhan Dolan, MD, MPH

Siobhan Dolan, MD, MPH, has joined the Blavatnik Family Women’s Health Research Institute and the Mount Sinai Health System as System Vice Chair for Research in the Department of Obstetrics, Gynecology and Reproductive Science.

In her role as Director of the Division of Genetics and Genomics, Dr. Dolan will be responsible for leading strategic patient care and research initiatives and fostering a collaborative relationship with Mount Sinai’s Department of Genetics and Genomics and the Institute for Genomic Health. As System Vice Chair for Research, she will lead obstetrics and gynecology research, overseeing the strategic development and administration of the Department’s basic, clinical and translational research programs. She joins Mount Sinai from Albert Einstein College of Medicine and Montefiore Medical Center and will continue to bring her enthusiasm for women’s health and medical genetics to the greater New York area.

Her background as an obstetrician who continued to develop her academic prowess and career with both a genetics and public health focus uniquely solidifies her foresight and expertise in a field that has been expanding for years.

She earned her BA from Brown University and her MD from Harvard Medical School. She did her OBGYN residency at New York Hospital-Cornell Medical Center and Yale New Haven Hospital, followed by a fellowship in Clinical Genetics at Albert Einstein College of Medicine/Montefiore Medical. She earned her Masters of Public Health from Columbia University, and is currently a candidate for an Executive MBA in Healthcare Leadership at Cornell SC Johnson Graduate School of Management and Weill Cornell Medicine.

In addition to her academic achievements, Dr. Dolan involves herself in the community with organizations such as the March of Dimes, Centers for Disease Control and Prevention, and the World Health Organization. She is currently a Medical Advisor at March of Dimes Birth Defects Foundation. She also has active leadership roles with the American College of Obstetricians and Gynecologists, New York City Department of Health and Mental Hygiene, Preterm Birth International Collaboration, and several ethics boards and study sections.

The intersection of women’s health, genetics, and public health allow Dr. Dolan to participate in extensive research on topics including the prevention of birth defects and the reduction of infant mortality and preterm birth. She has received numerous grants from the NIH as well as from other national organizations. She also has authored a nationally recognized pregnancy guide called Healthy Mom, Healthy Baby that has been a popular source of reference for prospective and new parents. She has also mentored many students and junior faculty and has been recognized for her professionalism and work-family balance.

The Institute looks forward to Dr. Dolan’s insights and contributions and for her to be a guiding and collaborative partner as the Institute continues to lead in the progress toward health equity.

Heather Reis, MBA, uses her experience, education, and personal interests to foster her career as an administrative women’s health professional. As a project manager in the OB/GYN department and member of The Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai, she continues to develop her passion for women’s health current topics and innovation.

Read more from The Blavatnik Family Women's Health Research Institute

Tracy Layne, PhD, MPH, Receives the Schneider-Lesser Foundation Fellowship for Junior Faculty

Updated on Jun 30, 2022 | BFWHRI, School

Tracy Layne, PhD, MPH

The Blavatnik Family Women’s Health Research Institute (BFWHRI) congratulates Tracy Layne, PhD, MPH, who was recently awarded the Schneider-Lesser Foundation Fellowship for Junior Faculty. The fellowship is intended to advance the chances of long-term success for promising junior faculty in the Investigator or Clinician-Educator Tracks at the Icahn School of Medicine at Mount Sinai.

Dr. Layne is an Assistant Professor in the Departments of Population Health Science and Policy and Obstetrics, Gynecology and Reproductive Science as well as a faculty member of the Blavatnik Family of Women’s Health Research Institute.

Since joining the BFWHRI in December 2018, Dr. Layne has had the opportunity to join multiple projects, including a study examining whether there are treatment differences among Black and White women with advanced endometrial cancer. A cancer epidemiologist with a background and interest in the multifactorial and often interrelated drivers of racial and ethnic cancer disparities across the cancer continuum, Dr. Layne focuses on the etiology of disparities in endometrial and ovarian cancer risk and mortality. Her research centers on endometrial cancer and is aimed at understanding the elevated risk of aggressive disease among Black women and the contributors that make it the largest Black-White disparity in gynecologic mortality. A critical component of her work is collaborating with faculty across multiple disciplines and institutions on a range of clinical, epidemiological, and socioeconomic issues relevant to narrowing gaps in women’s health disparities research.

In 2020, five fellowships of $20,000 each were awarded to recipients that have demonstrated high impact research accomplishments and have strong potential for an independent scientific career. Dr. Layne will use her support from the Schneider-Lesser Foundation Fellowship for Junior Faculty to develop preliminary data that examines the relationship between vitamin D metabolism and endometrial cancer disparities between Black and White women.

“Black women are virtually missing from the preclinical and observational research examining the relationship between vitamin D activity and endometrial cancer,” says Dr. Layne. “This despite preclinical research suggesting that vitamin D metabolism is altered in endometrial cancer tissue and may be associated with aggressive disease.  It is also notable given that Black women have well-established higher rates of both aggressive endometrial cancer and chronically lower circulating vitamin D concentrations compared to their White counterparts. With these factors in mind, this project will use next-generation sequencing to evaluate whether patterns of vitamin D activity, as measured by gene expression and genomic interaction, differs in bio-banked tissue from non-Hispanic Black and non-Hispanic White women with endometrial cancer.”

We look forward to highlighting Dr. Layne’s research findings from this prestigious award in the coming months. Congratulations and well done, Dr. Layne!

Read more from The Blavatnik Family Women's Health Research Institute

Pin It on Pinterest