Pregnancy and childbirth with Dr Greg

In episode 6 of the Pregnancy and Childbirth podcast, Dr Greg discusses COVID-19 and pregnancy.

When the pandemic first started, there were many questions surrounding Coronavirus (COVID-19) and pregnancy, with very little research or information to answer them. Over 12 months later and we now have some answers.

Join Dr Greg, Head of Department of Obstetrics at Westmead Hospital, the designated COVID-19 obstetrics and gynaecology hospital for Western Sydney, as he reveals the implications of COVID-19 and pregnancy. With pregnant women now eligible for the Pfizer mRNA COVID-19 vaccine, Dr Greg also shares his thoughts and recommendations regarding vaccination.
Listen to the podcast to learn about:

• The impact that pregnancy has on COVID-19 illness (how is COVID-19 illness different if you develop a COVID-19 infection and you happen to be pregnant)
• The impact that COVID-19 can have on the progress and outcome of your pregnancy
• The implications for the baby if you have COVID-19 during pregnancy, or if you happen to be COVID-19 positive around the time of birth
• COVID-19 vaccination in relation to pregnancy

• Click here to read Dr Greg’s ‘COVID-19 and pregnancy’ blog
• Pregnancy and Childbirth podcast episode 8: COVID-19 and Pregnancy update

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

0:00
Hi, I'm Dr. Greg, and welcome to this edition of my pregnancy and childbirth podcast. This edition is about pregnancy and COVID. It's an episode I've been thinking about doing for quite some time, but I've been putting it off because I felt that the information was still evolving in such a way that the content could well be redundant within a few weeks of me releasing a podcast. So it's probably worth date stamping this episode, I think. So today is the 25th of July 2021, we're in the midst of a fairly significant wave of Delta variant COVID virus spreading across Sydney and it's having a wide variety of impacts.
0:43
So I'm not really going to talk about COVID in general. I'm going to talk about the implications around COVID and pregnancy. And of course, I'm going to talk about COVID vaccination in pregnancy. I appreciate for a lot of pregnant women and their partners, the big question is going to be, should I get COVID vaccinated during pregnancy? It is the issue that I'm going to talk about in more detail at the end of this podcast, there are a few things that I think provide useful background that I'm going to go through first. But if vaccination is what you want to hear about, feel free to jump to the end of the podcast. Or I can tell you now that my recommendation is going to be that all pregnant women and women planning pregnancy should get a COVID vaccination.
1:33
Now, as well as the Delta variant sweeping across Sydney at the present time, there's a couple of other things that have changed in the last few weeks that make me think that this is a good time to put out a podcast around COVID and pregnancy. The first of these was a few weeks ago, when ATAGI, which is the advisory group on vaccination in Australia, and RANZCOG which is the College of Obstetricians and Gynecologists for Australia and New Zealand put out a joint statement recommending that Pfizer vaccination in pregnancy and breastfeeding should be considered safe and that pregnant women should consider vaccination.
2:13
The other thing that's happened just in the last few days, is that pregnancy is now considered part of the eligibility criteria for vaccination. So regardless of your age group, regardless of your health status, and regardless of anything else, just being pregnant, makes you eligible for Pfizer vaccination in Australia. So I think both of those things are really important developments and they have changed the discussions around COVID and COVID vaccination with regard to pregnancy.
2:49
In this podcast, I'm not going to talk about COVID in general, but I'm going to talk about the impact that pregnancy has on COVID illness. So how is COVID illness a little bit different if you develop a COVID infection and you happen to be pregnant. Then I'm going to talk about the impact that COVID could have on the progress and outcome of your pregnancy. I'll say a few words about the implications of this for the baby, if you have COVID during pregnancy, or if you happen to be COV...

In episode 3 of the Pregnancy and Childbirth podcast, Dr Greg talks all about epidurals. An epidural is a local anaesthetic, injected into the spinal nerves of your lower back. Its purpose is to block the pains associated with labour and birth. Join Greg and discover what it’s like to have an epidural, what the procedure involves, what the pros and cons are and how it can impact labour and birth.

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In episode 8 of the Pregnancy and Childbirth podcast, Dr Greg, obstetrician and gynaecologist, provides an update on the developing COVID-19 situation (as at 29 August 2021).
Listen to this episode to learn about:

• What's happening with COVID-19 in Western Sydney
• New recommendations regarding COVID vaccination and pregnancy
• New recommendations regarding COVID vaccination in breastfeeding
  

• Pregnancy and Childbirth podcast episode 6: COVID-19 and Pregnancy

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

00:00:00

Hi, I'm Greg Jenkins and welcome to this episode of My Pregnancy Podcast. Today is the 29th of August 2021 and this episode is going to be an update on COVID and pregnancy. Now if you haven't had to listen to my previous episode on pregnancy and COVID.

00:00:20

It would be worthwhile doing so because I'm not going to recap on the things that I discussed in that episode, but I'm going to provide an update with respect to things that have changed since I recorded that episode. So what has changed in a few weeks since I recorded my episode on COVID and Pregnancy?

00:00:43

There are 3 things that I'm going to touch on today. One is what's happening with COVID in Western Sydney, which as you may be aware, is where my work is based. The 2nd is the new recommendations regarding COVID vaccination and pregnancy, and the 3rd relates to COVID vaccination in breastfeeding where there are some new recommendations as well.

00:01:07

So firstly, what's happening with COVID in Western Sydney at the moment, as you may be aware, Western Sydney is pretty much the epicenter of COVID in Australia at the present time, and unfortunately we're seeing lots of pregnant women being diagnosed with COVID.

00:01:24

Now, as we're seeing and as I mentioned in my previous episode, most of these women are experiencing quite a mild illness, are and are not requiring hospitalization. However, we are seeing quite a number of women admitted to hospital and a small number of women admitted to intensive care and occasions have even occurred where pregnant women have required ventilation.

00:01:50

As the number of pregnant women diagnosed with COVID in Western Sydney continues to increase I expect that we will see a greater number of hospitalizations and unfortunately we will probably see a greater number of women admitted to intensive care with severe COVID illness.

00:02:08

For any women who are pregnant or wishing to become pregnant, my advice to you would be to get vaccinated as soon as you possibly can. And the other really important piece of advice, whether you're vaccinated or not vaccinated is to ensure that you are complying with the public health recommendations.

00:02:28

So, with respect to vaccination in pregnancy, what's changed in the last few weeks? Well, at the time when I recorded my previous episode, the Moderna vaccine was not available in Australia at that time.

00:02:40

Now the Moderna vaccine is similar to the Pfizer vaccine in that it is an mRNA vaccine. It's not identical to the Pfizer vaccine, there are some slight differences, but it is a vaccine which has also now been approved by ATAGI and recommended by RANZCOG as being safe for use in pregnant women.

00:03:04

So as a pregnant woman or a woman who is trying to fall pregnant, either the Pfizer or Moderna vaccines would be suitable.

00:03:14

In terms of evidence supporting the safety of COVID vaccination in pregnancy, there have been some new studies published looking at quite large numbers of women are again confirming the vaccine is safe in pregnancy based on all the information that we have currently available with no serious adverse pregnancy events associated with mRNA vaccination that is either Pfizer or Moderna are when given in pregnancy.

00:03:44

The other new piece of information which has come out since I recorded my previous episode relates to COVID vaccination in breastfeeding. So at the time of my last episode, the recommendation from RANZCOG and ATAGI was that Pfizer was the preferred vaccine for our breastfeeding women. This is now being expanded to include the AstraZeneca vaccine.

00:04:10

I should state that at the time I recorded the previous episode, there were no safety concerns around the AstraZeneca vaccine for breast feeding. It was...

In episode 4 of the Pregnancy and Childbirth podcast, Dr Greg discusses pregnancy related nausea and vomiting.

Nausea and vomiting are common symptoms that affect many pregnant women, particularly during the first trimester. This condition is often referred to as morning sickness, although this is misleading as symptoms can occur at any time. Join Dr Greg as he discusses how to manage pregnancy nausea and vomiting so that they have a minimum impact on your day-to-day function and on your general well-being.

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

0:01
Hi, I'm Greg Jenkins and welcome to this edition of my pregnancy podcast. Today, we're going to be talking about nausea and vomiting in pregnancy. This is a really common symptom. It affects a large proportion of women and predominantly is confined to the first trimester or the first 12 weeks of pregnancy. It's also commonly referred to as morning sickness, although typically for a lot of women, the symptoms are not confined to the morning and can occur at any time during the day.
0:34
In most women, the symptoms are bothersome, but not a major concern to their health. However, for a small group of women, they develop a more severe version of nausea and vomiting in early pregnancy, and this is called hyperemesis gravidarum, or often referred to as HG. In the symptoms are severe enough to cause significant weight loss and or dehydration. In these women, periods of hospitalisation may be required for administration of intravenous medications and intravenous fluids. And at the more severe end of the spectrum, this can have a significant impact on health and well being.
1:19
For most women however, their symptoms are more mild than this and can be managed without the need for admission to hospital. And there are usually measures involving lifestyle and dietary modification and simple medications, which will keep the symptoms reasonably well controlled.
1:40
So what causes nausea and vomiting in early pregnancy? Well, it's undoubtedly related to pregnancy hormones. And the higher the pregnancy hormone levels, for example, in multiple pregnancies, women tend to have more severe symptoms than in women with single pregnancies. It's not clear, however, why some women develop quite severe symptoms, and other women very mild symptoms, and some women no symptoms at all. The trajectory of symptoms does, however, follow reasonably well, the rise and fall in the pregnancy hormone level through the first trimester of pregnancy. So it's reasonably predictable, that symptoms of nausea and vomiting and pregnancy reached their worst by about 9 to 10 weeks. And after this time, in the vast majority of women, they gradually improve over the next few weeks. There are, however, a small group of women who experienced persistent nausea and vomiting for much longer than the first trimester, and very occasionally, throughout the entire duration of pregnancy.
2:47
So how do we manage nausea and vomiting and pregnancy? Well, unfortunately, the bad news is, there isn't anything we can do that's going to make it go away. So the key is to find a way to manage the symptoms, so they have a minimal impact on your day to day function, and on your general well-being. Now the majority of women find that the longer they go without having anything to eat or drink, the worse they tend to feel. So it's a little bit paradoxical. In order to not feel sick, you need to eat or drink something. Most women this is reasonably predictable. Now it doesn't really matter what you eat or drink. However, most women find that foods that are fairly bland, are carbohydrate rich, and easily digestible, are the things that work best. Similarly, with fluid, it doesn't especially matter what you drink. Some women find water to be not particularly palatable in the early trimester of pregnancy, and things like dilute fruit juice, even soft drinks, sports drinks, Hydralyte, any of those sorts of things can help to manage the symptoms and also provide carbohydrates that provide fuel and energy for your body. In terms of foods, small bland snacks, so crackers, sugary lollies, sometimes, dry toast, all of those things can be helpful, and it's a matter of experimenting with a few things and see what works best for you. You might even find that carrying snacks around. Some women find that having a snack by their bedside. So as soon as they wake up in the morning, they can have something to eat before they get out of bed that can help with the feelings of nausea and vomiting first thing in the morning.
4:33
You need n...

In episode 5 of the Pregnancy and Childbirth podcast, Dr Greg discusses reproductive carrier screening.

Carrier screening involves testing parents prior to pregnancy, or in the early stages of pregnancy, to determine whether or not they are at risk of having a baby with a serious genetic condition.

It is recommended that all couples in Australia who are contemplating pregnancy, or who are in the early stages of pregnancy, are informed about their options in regard to reproductive carrier screening.

In this podcast you’ll discover how carrier screening works, what conditions we can test for and what your options are if your baby is found to be affected by any of these conditions.

• Mackenzie’s Mission will provide reproductive genetic carrier screening to 10,000 Australian couples who are either planning to have children or are in early pregnancy
• Sonic Genetics gives doctors and patients access to an extensive range of genetic tests, provided through Sonic Healthcare’s network of Australian and international laboratories
• NSW Health reproductive genetic carrier screening fact sheet

0:01
Hi, I'm Greg Jenkins, and welcome to this edition of my pregnancy podcast. Today we're going to be talking about a thing called reproductive carrier screening. This is testing that can be carried out, either prior to pregnancy or during the early stages of pregnancy to determine whether you and your partner, may be a risk of giving birth to a child, who could have a potentially serious genetic condition. It is recommended that for all couples in Australia who are contemplating pregnancy, who or who are in the early stages of pregnancy, that they be informed about their options in regard to reproductive carrier screening. You may choose not to pursue testing in this area but it is important part of your decision making to be informed about this and to give it some consideration.
0:53
So before we can talk about reproductive carrier screening, we need to understand a little bit about what it is that we're talking about. So this is not about testing for conditions like Down Syndrome, for example, these are chromosome conditions rather than genetic conditions. So what we're talking about in this case, is conditions that would usually be inherited from the parents. And the way that these are inherited is that in most instances, one or both of the partners are a carrier for this condition, and they pass the condition on to some of their children. There are quite literally 1000s of these conditions. And it's estimated that there may be something like a million people living in Australia, who are affected by a genetically inherited condition.
1:44
Some of these conditions are very serious, and have a major impact on both duration and quality of life. And some relatively minor with minimal impact on quality of life. The commonest of these conditions is something that you might be familiar with, is a condition called Cystic Fibrosis. Now in order to understand how this works, we need to have a bit of a chat about genetics. So genes generally occur in pairs. In order to inherit a genetic condition, you generally need to have both pairs of the gene for that condition. Now, we all carry faulty genes, on average, most of us carry at least two faulty genes. Now, if you happen to be having a baby with somebody who has the same faulty gene as you, then there's a possibility that some of your children will get both of your faulty genes, and therefore will actually have the condition that's related to these genes, and this is called autosomal recessive inheritance. So these genes are recessive. And in order to get the disease, which the gene is particular to, you need to have both of the faulty genes.
3:01
There's another way of inheriting a genetic condition, and that's called an X linked recessive condition. In these conditions, the faulty gene resides on the X chromosome. Now, you're probably aware that females have 2x chromosomes and males have an X chromosome and a Y chromosome. So for an X linked condition provided there is a normal X chromosome to balance out the gene on the faulty X chromosome, the condition won't generally occur. However, in boys, if they inherit the X chromosome with the faulty gene, they don't have an extra another X chromosome with a normal gene to cancel it out. So in X linked conditions, we normally say the visible nature of this disease, are much mor...