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Behind the Science: Pregnancy and Multiple Sclerosis – What’s The Link?

Interviewees: Pia Campagna, Postdoctoral Fellow, Monash University, Melbourne, Australia Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: December 15th, 2023

When there are clear sex differences in disease prevalence, researchers must question the underlying factors. Women with Multiple Sclerosis (MS) outnumber men 4 to 1. What is being done to understand this statistic? How can we look into female-specific factors to disentangle these questions?

For this month’s Behind the Science, we interviewed Pia Campagna who provided some insight into these questions.

Can you tell us about your research?

Our lab studies Multiple Sclerosis (MS) and other neuro-immunological conditions. Much of my work focuses on incorporating women’s health into MS research by looking at pregnancy and menopause. MS affects 2 million people globally, roughly 75% of which are women. Previous work from our group has shown the clinical effect of pregnancy, where a pregnancy before disease onset delays the onset of MS symptoms by 3.4 years. After onset, the effect of pregnancy is more controversial, but work from our group has shown a protective effect of pregnancy on long-term disability accumulation.In my postdoc, I’m seeking to understand the biological mechanisms underpinning these clinical effects via a national multi-site prospective study.

Why did you want to get involved in women’s health?

I started research in MS due to the demographic of those affected – women. Because of this, it’s an interesting population to study in light of all of the female-specific experiences that interact with this disease. For example, it’s a disease that’s primarily diagnosed in a woman’s reproductive years (20-40 years old) so there are interactions with pregnancy, and due to the chronic nature, women are living with MS during perimenopause and menopause too.

I started my Ph.D., focused on genomics, prognostic modelling and machine learning in MS. It just so happened that other people in our group were doing this fascinating work on pregnancy. I had the opportunity to delve into the epigenetic impacts of pregnancy in women with MS, which sparked my interest in women’s health route MS. I did love the bioinformatic aspects of my Ph.D. work and hope to incorporate that down the line when we have the data available.

Is there anything interesting that you’ve learned from your research findings?

When we compared the whole blood DNA methylation profiles of women with MS who had not given birth, we identified differences in methylation patterns at genes enriched in neurogenesis and axon guidance pathways. After noticing these signals, we hypothesized that the hormonal changes from pregnancy created long-term effects that drive changes to the clinical course of MS. Now, we are collecting blood from women with and without MS before, during and after pregnancy, so eventually we’ll be able to look at DNA methylation in these different stages, as well as a range of other -omic profiles.

What impact do you hope to see with this work in the long term?

Not only is the prevalence of MS increasing worldwide but so is the female-to-male ratio. I hope that research focuses more on the female-specific aspects of the disease, which is still very understudied. Although there’s strong evidence that pregnancy is beneficial before onset, and some evidence of a beneficial long-term effect, , it’s surprising to me that we still don’t know how or why. Detangling this will not only be beneficial to women but also more individualized therapeutic targets benefit men as well. Another frontier in MS research that I would like to see more of is the impact of menopause. For example, we still don’t know if the disease gets worse after menopause, how estrogen loss interacts with disease-modifying therapies, or whether they’re as effective. Understanding the clinical aspects of menopause and subsequently, the biological aspects of menopause is an important route to take moving forward.

Where can people learn more about your work?

Twitter: @PiaCampagna
Personal website: piacampagna.com
Lab website: Jokubaitis group

Behind the Science: Designing for Pregnancy After Loss, With and Through Technology

Interviewee: Kamala Payyapilly Thiruvenkatanathan, PhD candidate, Pennsylvania State University. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: October 21tst 2022.

Could you briefly explain your research?

My research is situated at the intersection of women’s health and technology with a specific focus on pregnancy after loss. There has been a rising emphasis on designing technology for women’s health and this has led to the growth of the FemTech industry. FemTech is an abbreviation for “Female Technology” and is inclusive of a plethora of women’s health systems ranging from menstrual and fertility trackers to smart wearables that track women’s intimate health data to artificial intelligence based diagnostic devices. Among women’s health issues addressed, there has been an increasing focus on the pregnant body as a site of research and intervention. And yet, the pregnant and the maternal body are used interchangeably, neglecting a common but an unpleasant outcome of pregnancy loss and the associated felt experiences of women navigating pregnancy after loss. Pregnancy loss which encompasses miscarriage and stillbirth is incredibly common and approximately 80% of women get pregnant again after loss. However, their pregnancy journey is never the same given the physical and the emotional trauma they experienced during pregnancy loss. Attending to the rising interest in designing interventions for pregnancy and maternal health, alongside the ongoing call to question the stigmatization of women’s bodies, my research centers a common but tabooed experience of pregnancy after loss.

What got you interested in this research?

As a human, I seek fulfillment in making a positive impact in the lives of the underserved, those who are truly in need. At a young age, I was not aware of a career that allowed me to embrace my personal value of wanting to serve the underserved. Parking it aside, I decided to step into a typical, professional career journey that would eventually fetch me a job. Before setting foot into my doctoral path, I was a trained computer science engineer, with my understanding of technology limited to its functionality. I considered my ability to comprehend technology’s inner workings as my strength. A few years later, during my attempt to make a career detour in search of fulfillment, I was introduced to the domain of Human Computer Interaction (HCI). I always had a passion for design and HCI revealed ways through which I could combine my technological strength with that of design. More importantly, HCI rekindled my yearning to help those in need, by exposing me to the world of humanistic research. Reflecting on my personal values and my positionality as a woman led to the pursuit of research on women’s health, acknowledging women’s lived bodily experiences. My stumbling upon the world of FemTech by chance also enabled ways to reinforce my ability to comprehend (and perhaps design) technology. My observations along with a critical reflection of my personal values, of wanting to design for the margins, motivated me to design for the neglected felt experiences of women navigating pregnancy after loss, with and through technology.

What impact do you hope to see with this work years from now?

The ultimate goal of my research is to bring to the forefront the lived bodily experiences of women navigating pregnancy after loss. Discussing pregnancy loss and pregnancy after loss continues to be a taboo. I hope for my research to contribute to the emancipatory research agenda within women’s health in HCI, bringing to the fore a stigmatized and yet common experience of pregnancy loss. Additionally, as a part of my research process, I aim to design with women that could lead to concrete design implications on tangible FemTech systems that employ emerging technologies to support the unique needs of women experiencing pregnancy after loss. Ultimately, I hope for my work to contribute to the de-stigmatization of pregnancy loss and reimagining the pregnant body, considering unique unheard experiences of women navigating pregnancy after loss.

Can you tell us about any barriers you’ve faced advocating for women’s health in the human-computer interaction field?

Despite a growing trend in HCI towards experience, embodied interactions, and leisure technologies, some topics related to the body, such as women’s health and human sexuality, remain to be a taboo. Given the taboos associated with designing for women’s bodies, it takes extra efforts and often an activist stance, to invoke discussions related to the need to design considering women’s embodied, lived experiences. Additionally, with the emergence of women’s health technologies, there is a need to understand how technology conditions women’s bodies and generate implications towards designing better women’s health technologies. However, as a woman, my own subjectivity and positionality often meddles with my interpretation and critique of women’s health technologies and it often gets challenging to convey the same in an acceptable form, to the research community.

What is the best way for people to learn more about your work?

You can find more about my work on my website.

Why Should We Pay More Attention to the Placenta?

Author: Jasmin Wächter, Master’s student, Department of Obstetrics and Gynecology, UBC | Editors: Negin Nia, Arrthy Thayaparan (Blog Coordinators) & Shreya Sharma

Published: December 10th, 2021

The placenta is, arguably, the most important yet continuously under-appreciated organ in the body. The placenta not only determines the outcomes for pregnancy and later life for the mother, it also impacts the life of the child. A healthy placenta is a bonus to the child’s health across mental, metabolic, and cardiovascular functions. Unfortunately, very little is known about this crucial organ. This is changing with new initiatives focusing on understanding placental health and its outcomes.

Before we dive deeper into the importance of this organ, let’s get to know it better.

During pregnancy, the placenta grows and develops alongside the baby. This disk-shaped organ forms the barrier between the maternal and fetal blood circulation.

Throughout pregnancy, the placenta releases important chemical messengers called hormones. Hormones signal to the mother’s body that there is an ongoing pregnancy and instruct it to make nutrients available for the growing fetus. As internet science and pop culture continuously remind us, hormones are essential to an optimally functioning body.

Its tree-like protrusions deeply embed themselves into the mother’s womb and selectively allow the transport of nutrients, oxygen and waste products across. Moreover, the placenta can also filter compounds that may have negatively affected the pregnancy such as stress signals.

The function that most excites me, is the placental cells’ ability to make their presence known in the womb — which is what my research is focused on. They detach themselves from the placenta’s tree-like protrusions and invade, in a cancer-like manner, deeper into the mother’s womb to adapt it for a successful pregnancy. It’s them declaring their arrival in the body!

When it comes to the mother, the placental cells communicate with the immune cells to ensure the growing fetus isn’t mislabeled as a “foreign invader” and rejected or even attacked by the resident immune system. These adaptations are crucially important to ensure the health of the baby and mother throughout pregnancy and in the future.

Now that we know what a placenta is, let’s see what can happen when things take a wrong turn. And why it is important to educate ourselves on this organ.

Inadequate placental development can lead to a range of complications.

For instance – the fetus could experience a lack of growth and small size. This can exacerbate early delivery, infections and even stillbirth. These impacts stay with the babies as they grow into adults. Conditions such as obesity, diabetes, cardiovascular disease, autoimmune disease, allergies, neurodegenerative disease and mental health challenges have all been linked to inadequate placental function.

And it’s not just about the child being born. Placental malfunctions also put pregnant mothers at risk. Preeclampsia is one such condition that occurs when the mother’s body is unable to support the needs of the growing fetus. This condition causes the body to overcompensate and exert itself leading to tiredness, pain, high blood pressure and even organ damage. If left untreated, this may lead to seizures or even death. The influence of the placenta seems to extend beyond birth; mothers who’ve had placental complications are more likely to develop diabetes or cardiovascular and metabolic diseases.

So despite the influence of placental health on life, why is effective research yet to be done?

Various barriers prevent effective placental research, primarily funding. This may be attributed to the historical underfunding of research topics categorised into “women’s issues”. Moreover, the transient nature of the placenta makes it an especially difficult organ to target. To achieve a thorough understanding of the placental process, it is imperative to examine its development throughout the first, second and third trimesters. This is not always possible due to governmental restrictions imposed on abortions and the laws surrounding embryonic and fetal research.

However, all is not doom and gloom as the scientific community continues to work on new initiatives in the field.

Recent years have brought initiatives such as the Human Placenta Project which aims to develop new tools to study the placenta, in real-time. Improved ultrasound and magnetic resonance imaging (MRI) techniques are aimed to track the structure and blood, oxygen and nutrient flow throughout the placenta. This would allow for earlier discovery and monitoring of at-risk pregnancies.

Scientists are also investigating ways to collect information about placental health, function and genetic make-up by tracking placental components such as proteins, lipids and RNA present in the mother’s bloodstream.

Other approaches include creating mini-placentas, called organoids. These three-dimensional clusters of cells recapitulate the cellular organisation and developmental trajectory of the placenta, allowing researchers to study the interactions of different cell types throughout development. Future research may even allow for the inclusion of blood vessels in the system as seen in other mini-organ structures.

Another approach to studying placental function includes so-called placentas on a chip. This model is constituted of 2 human placental cell layers surrounded by fluid channels. The setup recapitulates the placental barrier between the fetus and the mother. This allows scientists to investigate how different compounds are transported or filtered across the placenta.

Let me beat the drum, again.

The placenta is a crucial organ for a successful pregnancy and a healthy life. Historical underfunding and barriers to placental research are being met with new initiatives and technologies such as the human placenta project, mini-placentas and placentas on a chip. Any findings generated could allow us to develop improved treatments for pregnancy complications in the future and allow people to have healthier pregnancies and a better start to their life.

Experience with COVID-19 Vaccine While Pregnant

Authors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) | Interviewing: Dr. Cindy Barha, PhD, Department of Physical Therapy; Dr. Chelsea Elwood, PhD, Department of Obstetrics and Gynecology

Published: October 9th, 2021

To go along with our latest blog looking at research and effects of the COVID-19 vaccine on pregnant women, the Women’s Health Blog spoke to Dr. Cindy Barha to hear her personal experience with receiving the vaccine during pregnancy.

While the information mentioned in this Q&A is the personal anecdote of Dr. Barha, everything mentioned has been verified and additional reading has been listed along with this blog.

When did you decide to get your vaccine?

I got pregnant in September of last year, a few months after COVID had hit, and the first wave was just ending. I had already decided that I was going to get it as soon as I was eligible to get the vaccine.

Why did you get vaccinated while pregnant? What was your thought process going into that?

I kept a close eye on data coming out of the United States and the UK. They were the only countries at the time that I could find that were actually keeping track of COVID infections in pregnant women. Everything I’d seen was pointing towards COVID symptoms being much more serious in pregnant women, compared to non-pregnant women of the same age.

So if you were pregnant and got COVID, you’d be at higher risk for being hospitalized and being put on a ventilator, compared to a woman that was not pregnant and the same age as you. So that just kept coming up every time I looked to see if any new data had been published.

As soon as I became eligible, and I had the opportunity in my second trimester, I jumped on it. I had no reservations about getting the vaccine. Nothing had come out in any of the studies I had seen to suggest that the vaccine was unsafe during pregnancy. I was always going to get the vaccine and I was actually really happy to receive it during my second trimester, because I was really hopeful that Baby would receive some protection. And this is exactly what is being seen in more recent studies, COVID antibodies are found in umbilical cord blood!

Other than your research, who did you go to for advice on informing your decision?

I had two excellent OBs (obstetricians) at BC Women’s hospital, Dr. Chelsea Elwood is one of them and she is an infectious disease expert. I had a couple of conversations with her, I was curious what experts thought [about getting the vaccine, while pregnant].

Around the same time, I had a family member and a friend who were also pregnant, and were both skeptical about getting the vaccine. So, I shared my experiences and the knowledge that I’ve been able to gather from the data with them. But I also asked Dr. Elwood if she had anything to share that I could pass on to them and she pretty much echoed everything I’d seen in studies looking at vaccine safety and efficacy.

Did you have any side effects after the vaccine?

I had very few side effects. In fact, I think I only had a sore arm for maybe 12 hours, and I think that was because I slept on that side. But I didn’t get a fever, or any aches or pains. It was basically like getting the flu shot at that point for me, and I don’t normally get any side effects from that either.

I mentioned this to Dr. Elwood and she told me about some data suggesting that women that are pregnant are suffering from less side effects from the COVID vaccine. My personal experience echoed what she was seeing in the data, that side effects seemed to be blunted in women that were getting their shots during pregnancy. I had the same experience from my second shot when I was breastfeeding. I had almost no side effects whatsoever.

How did you feel about any effects to your baby?

When I got my first shot during my second trimester, researchers had just started to see that the antibodies that were being produced from mRNA vaccines were crossing the placenta.

So Baby got some protection from my first shot. I got my second shot when i was about 3 months postpartum so Baby got antibodies from my second shot, as well through breastmilk.

In a way this was a good sort of vaccine schedule for me, because the baby got antibodies through the placenta and through breastmilk.

On a more cheerful note, how’s your baby now?

He’s great. He’s protected from COVID as far as I know. He’s four months old now and just living his life.

Is there anything you would like to share to people who are or looking to get pregnant and trying to decide whether they should get the vaccine?

I think what I would say is, don’t think only about yourself, but also think about your baby. The vaccine has been given to over 6 billion people, and a portion of those people were pregnant. There’s been no negative outcomes in terms of pregnancy or fertility in any of these cases.

So think about yourself, think about your baby. The vaccine is our best chance of getting through this pandemic. Without it, pregnant people are at a higher risk for being hospitalized, and that will potentially be harmful for your baby.

The Women’s Health blog also reached out to Dr. Chelsea Elwood, a clinical assistant professor at the University of British Columbia in the department of Obstetrics and Gynecology, to hear her recommendations.

What is the recommendation right now?

So we recommend, in line with the Society of Obstetricians and Gynecologists of Canada, and a large number of other international bodies, that persons who are pregnant, persons who are breastfeeding, and anyone planning a pregnancy get the COVID-19 vaccine.

Is there a certain time period when women should receive the vaccine?

As soon as it’s available. So we recommend that at any time in pregnancy, first trimester, second trimester, third trimester, they should get the vaccine, including postpartum.

When it comes to the different vaccines, is one better than the others? Is mixing vaccines an issue?

We recommend any of the COVID-19 vaccines in pregnancy. There is currently more published data, generally on Pfizer and Moderna, although we are expecting much more data from the United Kingdom on AstraZeneca. There’s no safety signals related to pregnancy with any of those vaccines. So we actually recommend any of them.

The data around vaccine mixing is continuing to be studied and emerging. To be honest, at this point in time, we recommend any of them as long as patients are fully vaccinated and can’t make a preferential recommendation of vaccine mixing versus not in pregnancy.

With the talk about boosters, do you think pregnant women should be getting a booster shot?

At this point in time, there’s no data to suggest that pregnant women respond any differently than their non-pregnant counterparts. So a woman who is pregnant and has, for example, an autoimmune disorder and would normally qualify for a booster, then they should get their booster. Pregnancy, in and of itself, is not a reason at this point in time to get a booster.

What do you have to say to folks worried about their babies and the vaccine?

Maternal vaccination for infant protection is a very well established modality to get babies protected from infectious diseases. We have traditionally seen that in the influenza vaccine, where moms are protected, babies are provided antibodies through placental transfer, as well as through breast milk afterwards.

We actually use maternal immunization for infant protection as a very good strategy to protect babies from whooping cough in the first couple of months after they’re born. And we recommend routinely the whooping cough vaccine in pregnancy for that reason. The COVID-19 vaccine is recommended primarily for maternal benefit. Meaning the outcomes that are being prevented by our mums getting COVID-19 vaccine, are ending up in the ICU hospitalized or having preterm birth by being vaccinated.

Being vaccinated in pregnancy, and the degree of which that is going to protect the baby from COVID-19 has yet to be seen, because we simply don’t have enough data at that point in time. But we would expect it to be protective in the same way that any other vaccine in pregnancy does, in that it would confer some protection for babies after they are delivered and through breast milk.

What would you like to say to the folks deciding whether they should get vaccinated?

I’d encourage them to reach out to their maternity care provider and have that conversation. The Society of Obstetricians and Gynecologists of Canada and most of the provinces have great resources available to help patients and practitioners have the conversation.

But again, we’re very clear about the recommendation because of the potential harm of COVID-19, the clear harm of COVID-19 if you get it in pregnancy, and the safety data we have now around vaccination in pregnancy.

I would also discourage people around the social media that’s going around about the risk of infertility. There’s no data that the COVID-19 vaccine causes infertility. In fact, the studies actually oppose this. There’s no theoretical reason why the COVID-19 vaccines would cause infertility. And so we do recommend that people who are trying to get pregnant get fully vaccinated before they get pregnant, so that they’re protected during their pregnancy.

So we recommend again that persons who are pregnant, persons who are breastfeeding, and anyone planning a pregnancy get the COVID-19 vaccine.

COVID-19 Infection and Vaccination During Pregnancy

Authors: Jennifer Richard, PhD, Department of Psychology, UBC; Liisa Galea, PhD, WHRC Lead | Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators)

Published: October 8th, 2021

Pregnancy is a vulnerable time for infection due to dynamic changes to the immune system leading to reduced immunity. This also implies an increased risk of people becoming severely sick after contracting COVID-19 (SARS-CoV-2) while pregnant. In fact, COVID-19 infection during pregnancy increases the risk of intensive care (ICU) transmission for the mother, preterm birth, caesarean (c-section) delivery, and admission to neonatal care for the baby. These risks are worsened by the Delta variant, currently the most common variant in Canada, which is up to twice as contagious as previous variants. The rise in Delta variant infections has increased the proportion of pregnant people with severe infection compared to previous variants. More specifically, Delta increases the risk of pregnant people requiring respiratory support, contracting pneumonia, and being admitted to intensive care.

How can we protect pregnant people from COVID-19 infection and related complications?

The best protection, whether you’re pregnant or not, is getting vaccinated. However, the Center for Disease Control and Prevention (CDC) reported that only about 25 per cent of pregnant people in the U.S. have received at least one COVID-19 vaccine dose. Several studies have demonstrated that two doses of AstraZeneca-Oxford and Pfizer-BioNTech COVID-19 vaccines are still effective in preventing severe disease, hospitalization, and death, even against Delta.

Recent studies suggest that two doses of these vaccines provide between 88–95 per cent effectiveness in protecting against the Delta variant. Whether one dose of COVID-19 vaccine is sufficient to protect against Delta is inconclusive. One study reported barely detectable levels of neutralizing antibodies against Delta after one dose of vaccine. On the other hand, a Canadian paper, that has yet to be peer-reviewed, states that one dose of Pfizer-BioNTech, Moderna or AstraZeneca-Oxford provides “good to excellent protection against symptomatic infection and severe outcomes” against Alpha, Beta, Gamma and Delta variants. However, the study also reported reduced protection against Delta compared to the other variants.

Vaccination is also recommended for individuals who have been infected by COVID-19. The vaccination provides superior protection compared to previous infection by another COVID-19 variant. So, despite the Delta variant affecting vaccine effectiveness, vaccinations still remain our best form of protection for severe illness, hospitalizations, and death. This is along with maintaining social distancing, masks, indoor ventilation, and hand hygiene.

COVID-19 vaccine hesitancy and safety in pregnancy

Women tend to be more hesitant towards COVID-19 vaccination than men or gender diverse individuals, with pregnant people reporting an even lower intention of getting vaccinated. The greatest concerns of pregnant people regarding the vaccines are a lack of data on pregnancy safety regarding the vaccines and/or that the vaccine may be harmful for their baby. So what do we know about the safety of COVID-19 vaccines in pregnancy? Can it cause pregnancy loss, affect your chances of conceiving, or alter your genes or the genes of your baby?

Is it safe to get vaccinated against COVID-19 while pregnant?

Pregnant people weren’t included in the initial COVID-19 vaccine trials. However, over 156,000 pregnant people have now been vaccinated with Pfizer-BioNTech or Moderna vaccines in the U.S. with no raised safety concerns. More specifically, the risks for adverse effects relating to pregnancy, including pregnancy loss, birth defects or effects on birth weight, were the same, or lower, than risks reported prior to the pandemic.

Importantly, while the risk of preterm birth was not increased after vaccination against COVID-19, this risk was increased in non-vaccinated pregnant people infected by the COVID-19 virus. As for the more immediate side effects after vaccination, pregnant people reported having a slightly sorer arm (around the injection site). But otherwise, pregnant people actually reported having milder side effects than non-pregnant people, for side effects such as headaches, muscle soreness and fever.

But are COVID-19 vaccines effective in pregnant people?

Although pregnancy causes changes to your immune system, COVID-19 vaccination in pregnant and lactating people provides the same level of immunity against the COVID-19 virus compared to vaccination in non-pregnant people. The level of protection is equal across all three trimesters, as vaccination during the first, second and third trimester gives rise to the same level of antibodies produced against COVID-19. In addition, the level of protection in all vaccinated individuals (non-pregnant, pregnant and lactating) was higher than levels observed in pregnant people who had previously been infected by the COVID-19 virus, indicating that even those who have previously been infected by COVID-19 should get vaccinated.

Can COVID-19 vaccines affect your risk of becoming pregnant?

There is no evidence that vaccination against COVID-19 would affect fertility. In males, COVID-19 vaccination does not result in a reduction in semen volume, sperm concentration or motility. In females, embryo implantation rates were the same as in non-vaccinated individuals. In addition, COVID-19 vaccines can not reach or cross the placenta, they act in the muscle where the vaccine is given. And even if the vaccines could reach the placenta, they can not induce antibodies against, affect or injure the placenta. However, placentas from people who tested positive against the COVID-19 virus during pregnancy showed abnormal blood flow between mother and baby. These data indicate that vaccination during pregnancy is safer than getting infected with COVID-19 during pregnancy.

Since the vaccine rollout, thousands of individuals included in the V-safe Pregnancy Registry have reported becoming pregnant after vaccination. In addition, the rate of accidental pregnancies in vaccinated and unvaccinated individuals were reported at equal levels — showing that vaccines don’t impact pregnancy.

Can the vaccines alter your DNA or the DNA of your baby?

No, vaccines cannot alter your DNA. Pfizer-BioNTech and Moderna are the two most common COVID-19 vaccines given to pregnant people. They are referred to as mRNA vaccines, which carry information (mRNA) to make a part of the COVID-19 virus (spike protein). They can only make a part of the virus, and not the complete virus. The components of the vaccine can’t cause infection in the mother or baby. Neither can they alter your DNA, or the DNA of your baby (mRNA does not alter DNA). The vaccines don’t contain DNA and human cells don’t have the ability to transform RNA to DNA, only the other way around. Therefore, these vaccines are not able to integrate into your DNA, or the DNA of your baby, or cause long-term genetic changes. As an aside – if we could change DNA with mRNA we would already have cures for genetic illnesses such as cystic fibrous or Huntington’s disease.

Can vaccination benefit your baby?

The vaccine provides protection to the baby in the womb indirectly, by lowering the risk of severe sickness in the mother. In addition, COVID-19 vaccination can directly protect your unborn and/or newborn baby, because protective antibodies against COVID-19 cross the placenta, and provide protection against COVID-19 to the baby at birth. In addition, COVID-19-specific antibodies have been found in the umbilical cord of babies, and breast milk, of mothers who were vaccinated during pregnancy.

While cases in babies and small children reported so far have been uncommon, and often cause mild to moderate symptoms, the Delta variant has proven to be more harmful to children. In the U.S., COVID-19 hospitalization rates in children and adolescents increased nearly 5-fold in late summer, a time in which Delta has been the predominant circulating variant. In a recent study from Israel, over 10 per cent of children who were diagnosed with COVID-19 reported symptoms of long COVID, such as continued illness, fatigue or breathlessness. In addition, 30 per cent of parents of affected children reported a decline in “neurological, cognitive, and mental health abilities” compared to prior to COVID-19 infection, for example disturbed sleep and concentration problems. Furthermore, we do not yet know potential long-term effects on children whose mothers were infected while pregnant. Although rare, there are a few cases of newborns born to COVID-19 positive mothers that were tested positive for the virus at birth.This indicates that transmission of COVID-19 from mother to child during pregnancy is possible. Furthermore, the fetus can still be affected by stress, restricted oxygen, reduced placental function and sickness in the mother infected by COVID-19, in addition to the increased risk of preterm birth and c-section delivery.

Taken together, the vaccines provide great protection against symptomatic infection and severe outcomes. Recent data indicates that you are almost 30 times more likely to end up in the ICU if you are unvaccinated. Furthermore, vaccination against COVID-19 during pregnancy is effective, and far safer than the risk of contracting the virus itself, which, while rare, has a 15 times greater risk of death during pregnancy. Vaccination during pregnancy can also benefit the baby by protecting them from indirect effects of disease in the mother, and by providing antibodies against COVID-19. Not to mention it will protect you after giving birth and protect your community. The data overwhelmingly support vaccination during pregnancy as safe and effective.

So, the bottom line is: if pregnant people are concerned about their safety or the safety of their unborn child, getting the shots (of COVID-19 vaccine) is their best shot.

Feature image by Dr. Jennifer Richard

Behind the Science: Postpartum Care in China and Canada

Authors: Alex Lukey, Arrthy Thayaparan and Negin Nia (blog coordinators) | Interviewing: Kejia Wang, BSc, University of Pennsylvania, MA, University of British Columbia

Published: September 24th, 2021

For the next post in our Behind the Science series, we speak to Kejia Wang on her masters work at the University of British Columbia and career journey. In our discussion, Wang takes us through her work in women’s health research, and defines what postpartum confinement care is in China and how that differs from western systems of care.

How did you become interested in women’s health research?

I earned my undergraduate degree in the United States, where I was a bioengineering major. After that, I came to UBC to do a master’s in English, specifically rhetoric. My focus at UBC were rhetoric and Science and Technology Studies. Combining the two topics allowed me to make use of my existing knowledge from STEM while learning more about how scientific ideas are debated and disseminated in the public sphere.

After coming to UBC, I met Professor Judy Segal, who became my supervisor and mentor. She is an expert on the rhetoric of health and medicine. In Judy’s classes, we talked a lot about women’s health research. As a woman myself, I am interested in how women’s health is talked about and understood, and wanted to study women’s health from an intercultural and multidisciplinary lens.

How did you decide to make the leap from bioengineering to english?

It was very interesting! I was always interested in both science and english as a child. I went into science thinking that was what I wanted to do. But after a few years of working in science, I realized that I preferred talking about science rather than actually doing science. I want to be that person who can take an engineer’s work and explain to the lay public what it actually means. I am interested in the perception of scientific (or pseudoscientific and science-adjacent) ideas by the public and how different communities use these ideas to improve their lives.

How did that journey lead you to where you currently are in your career?

The engineering degree gave me a solid STEM foundation. The rhetoric at UBC gave me the foundation to understand how STEM and STEM-adjacent ideas are talked about in a public sphere. Now I’m doing work at the Resident Doctors of BC, where I am able to combine my abilities.

So now I’m looking at both in considering policy. How do we take the data and concerns that people have and use that to draft policies that make sense from the scientific perspective, but also benefit the patient and the provider?

Regarding your thesis work, could you explain what you did in simple terms?

When I started my master’s at UBC, I decided to do a thesis. We settled on postpartum care in China, because it ticked a lot of boxes in terms of what I was interested in.

I was interested in confinement because it’s sort of a peripheral health practice. As a practice and framework for postpartum care, it has not been validated by a randomized clinical trial (RCT), generally considered to be the gold standard of health research in the West. But since it’s still ubiquitous in Asia, it’s very much in the public consciousness. So I wanted to look at what it does, why it may be important to Chinese women as well as the Chinese nation. Which, from my research, has a vested interest in supporting this practice to support a particular conceptualization of motherhood. The “ideal Chinese woman,” so to speak. I was also interested in how this Chinese practice might inform a more global and holistic perspective on what is good for our health and wellness.

For those that don’t know, could you describe what postpartum confinement is?

The Chinese practice of postpartum confinement is an umbrella term for several different practices that Chinese women do right in the period after they give birth, usually for about one month.

There is a whole spectrum of possible practices, some more and some less popular, that women choose from. Usually, a woman will pick about three or four different practices with the advice and suggestions of her family and health care providers.

Some of these practices include consuming specialized meals intended to restore her vitality or avoiding certain environmental triggers. This can include anything, such as washing your hair to the overuse of electronic gadgets. In some cases, there are movement restrictions, such as not leaving the house for the first few days or longer. There is also the sense that the woman is supposed to be taken care of by others, either by the family and partner or by peripheral health professionals, such as a doula, postpartum nanny, or workers at postpartum centers.

What are some common misconceptions of postpartum confinement?

A big one is that since the English term calls it ‘confinement,’ there is a sense that women are locked up in their houses. This obviously sounds oppressive and knowing Chinese practices, like the one-child policy, you may think that is true.

In some cases, there is an element of coercion to it if the family members or centre has too much power dictating what the women should or shouldn’t do. Generally speaking though, the woman has a lot of power in choosing what she wants to do. All these things are still woman-centred and these practices are supposed to help the woman recover.

What do you think is the most important impact of your research?

I think one finding that I wasn’t expecting was the Chinese state’s investment in these practices and women’s health. In a way, that seems to run counter to how people might usually conceptualize the Chinese government. You hear about things like the one-child policy or the forced IUDs. That is considered to be quite invasive.

The state, in supporting this practice, positions itself more benevolently. This practice is framed as something that helps the woman recover, and even become a better woman. You are expected to not only recover the vitality and health that you had before, but there are these messages that encourage you to become an even more successful worker in your field, mother, and contributing female citizen.

Another thing was that I came to understand the practice of postpartum care in China as filling a niche for what the western medicine model is not providing to women who are going through childbirth and the postpartum. Western medicine provides many guarantees around health outcomes measured by quantitative parameters. But there are other measures of wellness and health, such as bonding with the infant and bonding with the family, and a return to the “normal” that is also very valued. So that’s why I think the practice has the reach and support that it has.

The other thing to add to what’s interesting is the western model seems to be more infant-centred in the postpartum. While the Chinese model is very much mother-centred, which really shifts the whole paradigm around which practices are prioritized.

Based on your work, what would you like to see adopted in the healthcare system?

So from a different culture’s, and dare I say EDI (equity, diversity and inclusion) point of view, especially in a city as ethnically diverse as Vancouver, it would be very helpful if a Chinese Canadian mother giving birth would have these kinds of support from her home culture.

Obviously, this is not unique to Chinese people. If it’s possible to have that kind of support, not in the sense that you would be offered the full Chinese postpartum experience in Canada, but if there is more familiarity with these ways of thinking and providing care.

The other thing, which is much more difficult, is for the health system to start considering other parameters in the outcomes when we talk about improving patient outcomes. This would mean incorporating other indicators, such as the time required for the mother’s general fitness level to return to her pre-childbirth baseline.

Why do you think we need to focus on women’s health in research?

If we have a very child-focused postpartum system, that means that the mother’s health is likely being overlooked. This is unfortunate, because the postpartum is a very important moment in a woman’s life – she is adjusting to her new role as a mother physically and mentally, both at home and in broader society. I think it’s important and good for there to be more attention brought to the mother during this developmental period in her life.