Ep 269: Vaccines & Pregnancy: Which ones, how they work, and why they’re important

Dr. Nicole (00:00): In this episode, you are going to learn all about vaccines in pregnancy.

(00:10): Welcome to the All about pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 269. Whether it is your first time listening or you have been here before, I'm so glad you are spending some time with me today.

(01:04): In today's episode, you are going to learn about vaccines and pregnancy. Vaccines are important in order to help prevent moms and babies from getting certain infections. Now, I originally did this episode in 2020, but since then two additional vaccines are now recommended during pregnancy, so you are getting that updated episode today. In this episode, you're going to learn how vaccines work. Vaccines are also called immunizations, and I will use that term interchangeably. Throughout the episode, you'll learn about the safety of vaccines, the big picture regarding vaccines in pregnancy, what those four recommended vaccines are, and why they're recommended, and the risk and side effects and things like that, and then the vaccines that are not safe during pregnancy. Now, before we get into the episode, let me do a listener shout out. This is from Helly Face Killer. All right now, and the title of the review says So incredibly helpful, and they left me this review in Apple podcast.

(02:08): It says, I just listened to the episode about cesarean birth. I have VA previa and I'll be having a c-section. I'm so grateful I found this podcast, which walked me through the entire procedure carefully with matter of fact language. I feel so much more prepared and no longer afraid. Thank you so much. Well, you are so welcome for that. I'm so glad you found that episode helpful. And another thing that will help you not feel afraid during birth is a birth plan. Do come check out my free lab birth plan class, make a birth plan the right way. It is going to help you make a birth plan that actually works to help you have the birth that you want. You can register for the free live class. The next one that's coming up, check it out@drnicolerankins.com slash birth plan. Okay, let's get into the episode about vaccines.

(02:56): So first of all, let me tell you about how vaccines work. So what vaccines do is that they introduce a weakened form of a virus or bacteria into your system. It's weakened, so it can't make you sick, but your body recognizes it as a virus or bacteria, and your body makes antibodies to it. So when your body actually gets exposed or when your body potentially gets exposed to the actual virus or bacteria, it is already prepared to aggressively fight that virus or bacteria because those antibodies were already made. So the virus or the bacteria doesn't have an opportunity to make you sick because those antibodies are already there and ready to go. There doesn't have to be that time for your body to make the antibodies. Okay? So if you get infected with the actual virus or bacteria, you don't get sick or you get less sick than if you didn't have the vaccine.

(04:06): Vaccines in general are very safe. By safe I mean the chances of having any problems or issues are low and the benefits greatly outweigh the risk. That does not mean that vaccines are risk-free adverse events do happen from vaccines, from things as simple as headache or fever to pain at the injection site. But there are rare serious events like seizures. However, the benefits in general far greatly outweigh the risk and the chances of having a serious complication from vaccines are quite rare. Vaccines in that regard are actually similar to childbirth and the fact that they are safe the vast majority of the time, just like childbirth is safe the vast majority of the time, but sometimes bad outcomes do occur. Some other things to be mindful of in terms of safety, we cannot give live vaccines in pregnancy, okay? We can only give what's called inactivated vaccines.

(05:07): So there's no evidence of harm to pregnant women or babies from inactivated vaccines. However, live vaccines meaning the bacteria, the bacteria or the viruses live, they may be harmful to a developing baby. So they are not giving during pregnancy, and I'm going to talk more about that in a minute. Also, in regard to safety, the overwhelming amount of evidence that's available does not support an association between vaccines and autism in children. Also, although there are some vaccines given to adults that contain thy Marisol, which is a mercury preservative that's used in vaccines, there's no evidence that Marisol containing vaccines cause any adverse effects in babies or in women who receive these vaccines during pregnancy. They don't need to be avoided during pregnancy. Now, if you have concerns about that, you can check with the FDA. They do contain a list of Marisol related vaccines, but there's no evidence that these mercury containing vaccines cause any adverse outcomes.

(06:16): Now, when we take a step back and look at the big pictures regarding vaccines in pregnancy, actually the vast majority of vaccines are not given during pregnancy. There are actually quite a few vaccines that are available in general, and most of them are not given during pregnancy. In fact, there are only four that are recommended during pregnancy, the flu vaccine TDAP vaccine. Now, the COVID vaccine and RSV vaccine are the two newest ones, and you're going to learn more about those in a minute. And there are also some vaccines that are specifically not recommended, but can be given in special circumstances during pregnancy. I'm not going to talk a lot about those because those are uncommon circumstances like meningitis, vaccine, yellow fever, rabies, things like that. And then there are some vaccines that cannot be given safely during pregnancy at all, and I'm going to touch upon those as well.

(07:13): Now actually, the first step in relation to vaccines and pregnancy is to be up to date on your vaccines before you get pregnant, and those are two vaccines in particular that you want to be up to date on before you get pregnant. That is MMR, which is measles, mumps, and rubella, and then varicella, which is the chickenpox vaccine. And that is because these vaccines specifically cannot be given during pregnancy because they're live virus vaccines and measles and rubella and particular as well as varicella can have really, really devastating effects in pregnancy. Measles during pregnancy is associated with the increased risk for both serious maternal and fetal complications. It can cause diarrhea, pneumonia, encephalitis, and that is in the mom and rare instances, it can all, and I should say not even rare. In one study, about 12% of pregnant women died who caught measles during pregnancy.

(08:17): So that can be very significant. And then for babies, there's a risk of low birth weight, miscarriage, still birth, and so all of those things are potential issues related to measles. We don't see this very often because measles, mumps and rubella is a childhood vaccine. So it's not very common that people aren't vaccinated against those. And as an aside, in general, we don't necessarily understand the importance of vaccines or under appreciate the importance of vaccines because we don't see the diseases that they cause anymore because so many people are vaccinated and because so many people are vaccinated, even if there are a few pockets of people who are not vaccinated, they are protected because the people around them are vaccinated. So vaccinations really are an important public health strategy to help keep all of us safe. I'll give you an example, like the polio vaccine.

(09:09): We all get the polio vaccine. Most people have never heard of polio or seen polio. I have because my mother had polio when she's a child, when she was a child. She's 85 now and she had it as a very young child. As a result, she walked with a limp. It caused some long-term issues for her health wise. So when we don't see those things, we don't necessarily understand the importance of vaccines and how they play such a big role in reducing us seeing bad outcomes from diseases. Okay, getting back to the impact of certain things on pregnancy, rubella infection can also have really catastrophic effects on a developing baby. It can result in miscarriage, stillbirth, the growth restriction. It can also cause congenital defects in the baby, particularly if mom gets infected within the first 16 weeks of pregnancy. It can lead to deafness, cataracts, heart disease.

(10:07): It can actually even potentially affect every single organ. So you really want to be vaccinated against rubella before pregnancy and then chickenpox during pregnancy can be associated with some severe maternal complications and can also cause congenital varicella syndrome and what's called neonatal varicella zoster infection. Congenital varicella syndrome is where baby can have scars and a specific pattern on the body. There can be a small head, something called microcephaly. There can also be the opposite, which is hydrocephalus or fluid on the brain, which usually leads to a bigger head. There can be seizures, there can be issues with cataracts, issues with the eyes where the optic nerve is affected. There can be issues with the limbs. There can be issues with the intestinal system, with the bowel. There can be reflux, there can be low birth weight. Congenital varicella syndrome actually has a really high mortality rate of 30% within the first few months of life and a 15% risk of developing herpes zosters in the first four years of life.

(11:18): And the neonatal vari varicella infection can happen if the virus is transmitted from mom to baby just prior to delivery, their risk of having more severe infection at birth. As you might understand, if mom is sick, then there's a higher chance of baby having issues from varicella as well. Now again, most of us are going to have these vaccines prior to pregnancy. MMR is a childhood vaccine. Varicella has been given as a vaccine since the late nineties, or you may be exposed to it naturally with varicella and chicken pox. When I was young back in the day, we didn't have a varicella vaccine, but you got exposed to it when your friends got it and things like that as a child because it's a highly communicable, particularly childhood disease. However, we do check for immunity to these two things in your prenatal labs and most likely you're going to be immune to them.

(12:14): If not, then we're going to recommend that you get these vaccines after birth, before you leave the hospital. Okay? So that's the first step for protection, get vaccinated against MMR and varicella before pregnancy. Now during pregnancy, there are four vaccines that are recommended, only four flu, Tdap, covid, and RSV. And the reason that we recommend certain vaccines, I'll explain each one and why it's recommended, but in general, when you are pregnant, your immune system is not as quick to respond to illnesses as when you're not pregnant. Your body knows that pregnancy is okay. We don't know exactly how a body perceives that pregnancy is okay and that this foreign thing is okay to be in the body. We think it's related to the hormones and the placenta, but it knows that it shouldn't attack the baby. It shouldn't reject the baby. But in order to do that, your body naturally lowers your immune system's ability to protect you and respond to illnesses so that it can create a welcoming environment for your growing baby.

(13:25): However, that lowered immune system means that you are more likely to catch viruses and they are more likely to have an impact, a negative impact specifically on your body and your health than if you were not pregnant. It doesn't mean that it's always going to be bad, it just means that the chances are higher of having complications than if you were not pregnant. So let's first talk about the flu vaccine. And the flu or influenza is a virus. It can actually cause pretty serious illness. It's more than just a runny nose and sore throat. The flu can make you quite sick and it can be especially harmful if you get it during or right after pregnancy, and it spreads really easily from person to person. When someone has the flu and they cough, they sneeze, even they talk, the virus can spread through the air and you can get infected with the flu virus if you breathe it in or if you touch something like a door handle or a phone or a counter that has the flu virus on it and then you touch your nose, you touch your eyes or you touch your mouth.

(14:33): The flu virus can actually survive on hard surfaces for 24 hours. Now as terms of complications from the flu, pneumonia, which is a potentially serious and even deadly complication from the flu can happen and it can be worse. If you are pregnant, you're more likely when pregnant than other adults to have those serious complications. It's more likely to affect your immune system. It's more likely to affect your heart, more likely to affect your lungs. Another reason the flu can be harmful during pregnancy is that your lungs need more oxygen, especially in the second and third trimesters. But your growing belly is in a way putting pressure on your lungs. They have to work harder in a smaller space because your baby is taking up more space in your belly and in your chest. You even may feel shortness of breath normally during the end of pregnancy just because there's not as much space and your lungs have to work harder.

(15:30): Your heart is also working harder, pumping extra blood. That's a bit of a stress on your body during pregnancy. And then if you get the flu on top of that, it can increase the chances of those serious complications occurring. And then pregnant women who get the flu are more likely than pregnant women who don't get the flu. If you're pregnant and you get the flu, you're more likely to have preterm labor. You're more likely to have preterm birth that's labor or birth before 37 weeks. And then that really high fever that can happen from the flu can be linked to birth defects like neural tube defects. Those are defects of the brain and spinal cord and potentially other problems for your baby. So let's talk about the flu shot or the flu vaccine. The flu shot contains a vaccine that helps prevent you from getting the flu.

(16:25): The flu shot does not cause the flu and it's safe to get at any time during pregnancy. Ideally, it's best to get it before flu season, which is October through May. But even though you're more likely to get flu during flu season, you can actually get flu anytime of year. There are lots of different flu viruses and the flu virus is always changing. Every year a new flu vaccine is made, and it's the best guess of the most popular or the most, what's the word? Prevalent strains of the flu that are suspected to be present for the year coming up. So that protection from a flu shot only lasts about a year. Every year the flu vaccine is updated, so it is important to get that flu shot every year. You can get it from your OBGYN's office. You can often get it from many pharmacies.

(17:22): Most pharmacies offer vaccines these days, whether it's CVS or Walgreens or whatever it is. And even some workplaces will do flu vaccines in the fall. Again, it is considered very safe. It's been given to millions of pregnant women over many years with an excellent safety record. Now, you may ask about the nasal spray. There is a nasal spray flu vaccine, but that cannot be given during pregnancy because it contains the live vaccine, okay? It contains a live virus vaccine, and we don't give pregnant women live vaccines. Now, in addition to the benefits of helping you not get the flu vaccine also has positive benefits for your baby as well. When you get vaccinated while you are pregnant, those antibodies that you develop are transmitted across the placenta to your unborn baby. So you getting the flu vaccine can protect your baby for up to six months after birth from those antibodies that you make that are passed through the placenta.

(18:32): Flu shot can also be given if you are breastfeeding and it is safe for mother who are breastfeeding in those antibodies will pass through breast milk as well. Okay, really the only side effects from the flu vaccine or the biggest ones are soreness, tenderness, redness, where the shot was giving. All of those side effects are fairly common, but limited in how long they last. Okay? Next recommended vaccine is tdap. TDAP stands for tetanus, diptheria and a cellular pertussis. That vaccine, they're all given together in one vaccine and it is to provide primarily protection against pertussis, which is whooping cough. The prevalence of pertussis or whipping cough in the United States has been increasing, and that's because immunity wanes over time after the vaccination is given, immunity doesn't last forever. So adults who develop pertussis can transmit the disease to susceptible babies in the household. And it's a concern because infants or babies who are under three months of age are at the highest risk of having problems from pertussis, and the pertussis vaccine is not recommended until age two months.

(19:57): So you have that period of time where babies are really susceptible potentially to have complications from it, not that they're going to have complications, but there is a higher risk. Now, in terms of the effects of whooping cough, it can be that distinct cough, and you can Google the sound of whooping cough. It's very like startling. It can last for two to eight weeks. It's a really violent cough. It can cause gagging. The baby can turn blue struggle to breathe. It can be accompanied with vomiting. Recovery can take some time. It has been called the cough of a hundred days, and there can be more serious complications that can develop, including poor weight gain, pneumonia, seizures, and in rare cases, even death. Over 50% of infants who get pertussis get it from a family member most often from their mothers. So that's why vaccination of mom, you as the pregnant person is really important, but other household contacts should be vaccinated as well.

(21:03): It's going to significantly decrease the risk of your baby being exposed. And placental transfer of those maternal antibodies is highly effective in protecting your baby against pertussis in those first few months of life. Remember, the baby can't get that immunization until two months. So that antibody transfer is really critical in helping protect them against pertussis. So you should get the vaccine ideally between 27 and 36 weeks of pregnancy. That is going to maximize the amount of time that your body can develop the antibodies and then transfer the antibodies across the placenta to your baby. The TA vaccine also does offer some protection against tetanus. That is not as much of an issue in the United States, which is a more highly resourced country. But in more developing countries where children don't routinely get tetanus vaccine, then it is more of an issue, but it does offer some protection against tetanus as well.

(22:11): Now, if Tdap is not given during pregnancy, then we recommend giving it immediately postpartum if you have not previously received tdap, and that can provide some protection for the baby through breastfeeding, the antibodies will transfer in breast milk, but the immune response is not as strong as during pregnancy, and it may not be as rapid or fast enough in order to provide protection until a couple weeks. So there's going to be a couple week period if you get it after pregnancy where your body is building up the immunity. So there's a gap or a delay in the sense of there's a period of time where your baby isn't protected if you don't get TDAP until after pregnancy. And as I mentioned, TDAP is recommended for family members, childcare providers who are expected to have close contact with a newborn who is younger than 12 months of age, and they have not received the TDAP vaccine previously.

(23:13): So definitely grandparents, anybody who's going to be around the baby a lot should also get the TDAP vaccine until your baby can get their own pertussis vaccine. And pregnant women are the only population where we do recommend repeating it every pregnancy. It's recommended to be repeated every pregnancy in order to build up those antibodies again to transfer to the baby. Now, household contacts don't have to get it every time you get pregnant because we believe their immunity enough, but it has to build up a high level of antibodies in order to transfer it to the baby to provide protection each pregnancy. Okay, let's talk about the two new vaccines in pregnancy in the last few years. And those are Covid and RSV. So first of Covid, we know from lots of evidence that covid during pregnancy can have significant effects on both you as the person who's pregnant and your baby.

(24:17): Some of the potential effects are that pregnant folks are at a higher risk of developing severe covid compared to non-pregnant folks of the same age. Again, this is because of that immune system effect that I talked about earlier. This is going to increase the likelihood of requiring hospitalization, intensive care, or even needing to be intubated or having mechanical ventilation. Pregnant women with covid also have a higher risk of death compared to non-pregnant women with covid who are the same age. Now, I want to be clear that the absolute risk of dying from C or getting severe disease from Covid is still low, but it is significantly elevated in pregnancy compared to the general population. And if you have a preexisting condition like high blood pressure diabetes, or you carry extra weight or considered obese, then you are at an even higher risk of severe complications from contracting covid during pregnancy.

(25:23): Now, when we look at potential effects on the growing baby covid during pregnancy does increase the risk of preterm birth. It does potentially increase the risk. There are some studies that suggest that covid can increase the risk of growth restriction where the baby doesn't grow as well. There's also evidence to suggest that covid may slightly increase the risk of stillbirth. That risk is higher in cases of severe covid, particularly when there are complications like pneumonia. Vertical transmission, meaning passing the virus from mom to baby is quite rare, but it is possible. There are a handful of newborns who have tested positive for covid shortly after birth and when their mother had it, the long-term effects of that are still being steady. And speaking of long-term effects in general, the long-term effects of covid on children who are born to mothers who had covid during pregnancy. We just do not know that yet. There hasn't been enough time to understand what those potential long-term effects are. There are ongoing studies that are tracking developmental milestones, immune responses, and overall health of babies where moms had covid during pregnancy. So we'll have more information. It's just going to take time.

(26:50): So given the increased risk for both moms and babies of covid during pregnancy, it's strongly recommended that pregnant folks take preventative measures including getting the covid vaccine to reduce the likelihood of severe illness and protect their babies as well. There has been extensive research and large numbers of folks looking at the safety of covid vaccines in pregnancy and multiple studies have shown that covid vaccines, including the mRNA vaccines like the Pfizer vaccine, the Moderna vaccine, they are safe for pregnant women and the CDC, the World Health Organization and acog, they all recommend Covid vaccination for pregnant folks. Again, it helps protect both the mother and baby from severe illness complications and preterm birth related to covid. Pregnant women who get the vaccine develop a strong immune response similar to that of non-pregnant individuals. And those antibodies that are generated by getting the vaccine can also pass through the placenta to the baby, potentially providing some protection for the baby.

(28:04): The vaccine is recommended at any stage of pregnancy, including the first trimester. It is also safe to get if you are planning pregnancy, the side effects of the vaccine are similar to those in the general population, and that would be soreness in the injection site fatigue, sometimes a mild fever. There has been no evidence of increased risk of miscarriage, stillbirth, or other adverse pregnancy outcomes related to getting the covid vaccine. Covid vaccine is also considered safe for breastfeeding and the antibodies that are generated and passed through breast milk may provide some additional protection for your baby. Now of course, I will acknowledge, just like we dunno, the long-term effects of C on moms. Actually, we don't know the long-term effects of covid on anybody quite yet, but we don't know the long-term effects of mom getting covid during pregnancy and if that can affect the baby.

(29:03): We dunno the long-term effects of getting the covid vaccine during pregnancy. And if there are any long-term issues for mom or babies from getting the covid vaccine during pregnancy, we don't suspect that there are any, and we don't suspect from other vaccines that there will be any long-term issues. But again, we don't know. So there are ongoing surveillance programs in order to continue to monitor the safety of covid vaccines during pregnancy. The CDC maintains a registry that's called vse COVID-19 Pregnancy Registry to track outcomes in vaccinated pregnant folks. And then the last vaccine that is now recommended during pregnancy is RSV that stands for Respiratory sensorial virus. And the RSV vaccine is recommended during pregnancy primarily to protect your baby from severe RSV infection. And that's because RSV can cause quite serious respiratory illnesses in infants, including bronchiolitis, which is inflammation of the bronchials in the lungs and the pneumonia, which is the actual actual lung tissue.

(30:17): And that can be life-threatening newborns, especially those who are younger than six months are at a higher risk because their immune systems are not fully developed. What happens is when a pregnant woman, just like other vaccines, when you're pregnant and you receive the RSV vaccine, you produce antibodies against the virus. These antibodies are transferred to the baby through the placenta, provide the newborn with what's called passive immunity during the first few months of life when they are most vulnerable to severe RSV infection. And studies have shown that when you as a pregnant person get vaccinated against RSV, it significantly reduces the risk of RSV related hospitalizations in infants similar to tdap, the vaccine is typically recommended towards the later stages of pregnancy between 32 36 weeks to maximize the amount of antibodies that are passed to the baby before birth. Now, be mindful that the vaccine given during pregnancy is called a brisbo. There's another vaccine that's not given during pregnancy, and it's actually not a vaccine. It works differently. It's called a monoclonal antibodies. So it's actually the antibodies themselves. Whereas a BRISBO is a vaccine that's designed to elicit an immune response, and it's designed specifically to be given to pregnant women in order to protect their baby from severe RSV by providing them with the immune response through the transfer of maternal antibodies. Okay?

(31:59): A brisbo is a single dose, again, given towards the end of pregnancy that timing is chosen to maximize the transfer of antibodies from mother to baby. Large studies have shown that it is quite effective in reducing the incidence of severe RSV related infections and hospitalizations during the first six months of life. So that doesn't mean that your baby may not get RSV at all, but it's not going to be as severe. Again, extensively studied in pregnant women and been found to be safe for both mothers and babies. Common side effects are similar to other vaccines like mild pain at the injection site fatigue and headaches. I will also acknowledge that this is a newer vaccine, so we don't have long-term follow-up studies yet. There are long-term follow-up studies ongoing to monitor the health outcomes of both mothers and babies after vaccination. But I will acknowledge that we do not yet have that long-term data.

(33:04): The data we do have is reassuring, but that long-term data doesn't exist yet. There hasn't been enough time. And if you want to know some other preventative measures, just really just to prevent these diseases in general, simple hygiene is going to be so, so important in helping your baby stay healthy. So whether that's RSV, whether that's pertussis, whether that's flu, any of those things, make sure everyone who touches your baby washes their hands, okay? You got to have the hand sanitizer around. So frequent hand washing, obviously avoid close contact with sick individuals, disinfect surfaces that are frequently touched. This is going to be particularly important within those first few weeks of life. As the baby gets older, definitely past six months, yes, the risk of things is there, but it's going to start to decrease. This is really important within those first few weeks while their immune system is developing some other strategies that you need to do or just limit the baby's exposures to large groups of people you want to limit if you can, a huge daycare kind of thing, or crowded public places within those first few weeks of life.

(34:18): Obviously, keep your baby away from people who have any cold like symptoms. These are just common sense measures that can help. Breastfeeding is a big thing that can help. It'll provide babies with antibodies, with immune boosting factors that can help protect babies against infections, including RSV, maybe even including pertussis. All of those things. Breastfeeding is important. So it's not enough by itself to prevent a baby from getting sick, but it certainly helps. And then one final thing is you can use the humidifier to maintain optimal humidity levels in your home that can help keep your baby's airways moist, and that may reduce the risk of respiratory infections. Okay, so the last thing I'm going to do is quickly touch upon vaccines that are not safe at all during pregnancy. One is HPV. If you happen to get the HPV vaccine while pregnant, there are no known harms, but it has not been studied in pregnancy.

(35:18): It's never been studied in pregnancy. It's not a live vaccine. So we don't anticipate those issues. But again, just because it hasn't been studied, we don't know. So if you happen to get it, there are no known harms. You just finish it after you deliver. And if you started the series before you get pregnant, you just finish it after birth. You do not want to get the varicella vaccine during pregnancy because it is a live virus vaccine, and the live virus vaccine increases the risk of potentially infecting the baby. So you don't want to do varicella. You also don't want to do MMR because that is also a live virus vaccine. There have not been reported cases of issues in newborns of mothers who received live vaccines during pregnancy, not significant cases, but there have been what's called subclinical infections where infections have been documented, just a low level of infection.

(36:17): So we just avoid live vaccines during pregnancy at all because we don't want to take that risk. So just to recap, vaccines work by giving you an inactive form of a virus or bacteria. Your body forms antibodies to it, and then if your body is exposed to the actual bacteria, your immune system is ready to go with the antibodies. So you either don't get sick or you get less sick than if you hadn't got the vaccines. Vaccines are safe during pregnancy. The four vaccines that are recommended, that is flu, Tdap, COVID, and RSV, all of those vaccines are considered safe during pregnancy, and vaccines in general are safe. All of those things can cause issues in pregnancy, potentially severe issues, even if they are rare, and that's why they are recommended in pregnancy. Now, before pregnancy, you want to get that MMR and varicella vaccine to prevent measles, rubella, and varicella in particular.

(37:24): All of those can actually have quite devastating effects during pregnancy. You cannot get those live virus vaccines during pregnancy because they are not safe during pregnancy. Okay, so there you have it. Share this podcast with a friend. Also subscribe to the podcast wherever you're listening to me right now, and leave me and review an Apple podcast. I'd love to hear what you think about the show. You can also send me any questions you have, any thoughts, any comments on Instagram? I'm on Instagram @DrNicoleRankins. My dms are open. That's it for this episode to come on back next week. And remember that you deserve a beautiful pregnancy and birth.