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The COVID-19 vaccine and pregnancy; Nothing yet to suggest pregnancy issues

DEAR DR. ROACH: What are your thoughts on the COVID-19 vaccine during pregnancy? I have read that it is safe. Could you explain how? I have a minimal understanding of the mRNA vaccine, and no understanding on how the vaccine could affect pregnancy. — H.B.

ANSWER: Pregnant women do not seem to be more likely to get COVID-19, but they are more likely to have complications from it. Preterm birth rates and the need for Caesarian section both are increased in a pregnancy that is affected by COVID-19, when compared with women who do not get infected. Fortunately, over 90% of infected pregnant women will recover from COVID-19 before delivery. Still, pregnant women are more likely to require intensive care and mechanical ventilation, so protection should be top of mind.

Since the vaccine is brand-new, there are not robust safety data on the use of the vaccine in pregnancy (pregnant women have been excluded from the vaccine trials); however, expert opinion is generally on the side of recommending the vaccine. The mRNA vaccines made by Moderna and Pfizer do not contain any live virus. An mRNA vaccine works by “telling” the muscle cells in the arm the vaccine is injected into to make a viral protein, called the spike protein. “mRNA” is for “messenger RNA”: It’s how DNA encodes instructions for making proteins. The mRNA last for only a short time in the body and cannot become part of a person’s cells because mRNA is destroyed by the body’s own mechanisms shortly after the cells have made the spike protein. The body learns to recognize the spike protein as a foreign invader, with the protein the body acting as a primer to the immune system. Long after the spike proteins made post-vaccination by the muscle cells are destroyed, the B cells and T cells remember how to mount a fast and effective response to destroy any virus before it can cause illness, should the person become exposed to the virus. Neither the mRNA nor the spike protein poses a danger to the developing fetus.

Because the vaccine is effective, and because the risks for pregnant women are greater than those of nonpregnant women, the vaccine is probably more important to give to pregnant women. Even though long-term safety data in pregnancy do not yet exist, the threat from COVID-19 in the population now is so great that, in my opinion, the benefits dramatically outweigh the risks. Every pregnant woman should get thorough counseling and an explanation of the risks and benefits before making her decision for herself and her baby.

The same arguments and conclusions apply for women who are breastfeeding.

DEAR DR. ROACH: My doctor started me on Flomax for prostate symptoms, but I developed retrograde ejaculation. It really bothers me. What should I do next? — V.M.

ANSWER: Retrograde ejaculation refers to semen traveling backward into the bladder during sexual activity. It is sometimes called a dry orgasm. It is a known complication of alpha blockers, such as tamsulosin (Flomax). It is a cause of infertility, which may or may not be a concern for you.

Although medications can be used to treat retrograde ejaculation, I suspect your doctor will stop the tamsulosin and try a different class of medication for your prostate symptoms, such as finasteride. These take much longer to work than tamsulosin. Alternatively, a urologist can provide other options for prostate treatment, such as surgery, and newer procedures, such as laser, freezing, urethral lift and water vapor treatments.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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