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Brain Lehrer: Brian Lehrer on WNYC. One of the most vaccine reluctant groups of Americans is people who are pregnant, not wanting to put anything they don't feel they need into their bodies while carrying their fetuses, but listen to this, people who are pregnant or breastfeeding really should get vaccinated according to the CDC. This new message they say is an urgent one, and here's why. For people who are pregnant and unvaccinated, COVID infection poses much more significant risk, and in some cases, it can lead to stillbirth.

The data is now showing the risk to you and your baby of COVID is much worse than any risk from the vaccine, the CDC concludes. Still, only 31% of pregnant people are vaccinated, a figure that also varies noticeably by race. Around 46% of pregnant Asian Americans are vaccinated. For pregnant white Americans, that figure stands down at 35%. For Hispanics or Latinos, 27%. For Black people who are pregnant, the vaccination rate hovers around 16%, according to the CDC stats.

Let's talk about the CDC's plea to pregnant Americans with Dr. Uché Blackstock, emergency medicine physician, founder and CEO of Advancing Health Equity, and an MSNBC medical contributor, and Dr. Veronica Maria Pimentel, attending physician of OBGYN, specialist in maternal-fetal medicine, and assistant professor of OBGYN at Quinnipiac University. Dr. Blackstock, Dr. Pimentel, good morning, thank you for doing this.

Dr. Uché Blackstock: Hi, Brian. Thank you.

Dr. Veronica Maria Pimentel: Good morning.

Brain Lehrer: Listeners, we can take your calls on this topic. If you're pregnant or breastfeeding, or planning to become pregnant, and you have COVID questions, now's your chance to talk to an obstetrician and gynecologist who has had a COVID era pregnancy, Dr. Pimentel. Tweet @BrianLehrer or call 646-435-7280, 646-435-7280. Dr. Pimentel, do you want to expand on the risk of COVID infection, the infection itself if someone who's pregnant gets it and they're unvaccinated?

Dr. Veronica Maria Pimentel: Absolutely. First, good morning, and thank you so much for having me here. The risk of COVID-19 in pregnancy is actually more alarming than I think the general population perceive. There is three times increased risk of women ending up in the ICU, two to three times more risk of women being intubated, and that's putting a tube down the throat to help them breathe, and there is also increased risk of dying.

Those are the maternal risks, and associated with that, there are some fetal or baby risks. The woman is at risk of having a miscarriage, at risk of delivering premature, and the baby is also at risk of dying. Then, prematurity is something that should not be taken lightly because once a baby's born premature, depending on how early the baby is born, there's increased risk that the baby may stay in the NICU and have to be intubated. Also, increased risk that the baby may have long-term issues, including neurological issues. These are serious potential consequences.

Brain Lehrer: As an obstetrician and gynecologist, are you having conversations with people who are pregnant or planning to become pregnant, or have recently given birth and are breastfeeding and expressing what might be considered vaccine hesitancy at a higher rate than others?

Dr. Veronica Maria Pimentel: Absolutely. In fact, the way that we have changed our clinic is that every patient that we see in our ultrasound clinic, so we do prenatal diagnosis with ultrasound, and we see patients that are considered clinic patients, patients who come from private offices, patients that come from the community. We see every single patient that delivers in our hospital, no matter who their provider is, and we have a chance to talk to them.

With every single patient, we ask them,"Are you vaccinated?" If they are not vaccinated or they received only one dose, we have an opportunity to talk to them about this risk, and we address whatever concerns that they have, we explain to them what the recommendations are at this point in time. On top of that, we actually have a vaccine clinic available in our unit. At this point in time, once a week that we can sign them up, make them an appointment to either get the appointment or to get the vaccine that same day, or come back and get it for the next available day.

Brain Lehrer: That's a Quinnipiac University Hospital, right? Hello, Connecticut.

Dr. Veronica Maria Pimentel: Just clarification, this is at St. Francis Hospital and Medical Center, which is the teaching hospital for Quinnipiac at this point in time.

Brain Lehrer: Got it, and Dr. Blackstock, are there similar programs going on around the region that you're familiar with?

Dr. Uché Blackstock: Hey, Brian. I know that based here in New York City, a few of the FQHCs are offering vaccines to pregnant people but not as targeted as what Dr. Pimentel is mentioning. I think what we've seen in terms of the vaccine rollout is that pregnant people really were not prioritized initially. Understandably, we had the data coming in more slowly that pregnancy was a risk factor for severe COVID-19 illness. This urgency we're seeing issued by the CDC yesterday is really based on seeing more and more pregnant people winding up in the ICU, and August being a record number for COVID-19 deaths among pregnant people.

Brain Lehrer: People who are anti-vax or severely misinformed, have said even on our air, that the COVID vaccines increase the risk of miscarriage. Dr. Pimentel, would you do a little myth-busting on that?

Dr. Veronica Maria Pimentel: My pleasure. Absolutely. There's a lot of misinformation out there which is putting our patients' lives and their babies' lives at risk. When it comes to miscarriage, data from the CDC show that there has been less than 14% of pregnancy loss, and that's about the rate of background miscarriage in the population, meaning that the rate of pregnancy loss in those who actually received the COVID-19 is no higher than what we expect someone to have at any given time.

Brain Lehrer: This information is so infuriating, Dr. Blackstock, isn't it? We busted another myth yesterday with Dr. Scott Gottlieb, the former head of the FDA, one that goes around that says that thousands of people have died from the vaccine. He pointed out the exact same thing that Dr. Pimentel just said about miscarriages, which is that there's a percentage of the people who are going to have miscarriages. There's a percentage of people, especially older people who are going to die at any given time, and the percentages of those who died in short order after getting the vaccine or now Dr. Pimentel is telling us or who had miscarriages in short order after getting the vaccine are the same rates as in the general population. The vaccines are not tied to this, but the disinformation junkies use the proximity of the death or the miscarriage to make a false comparison. I think that's pretty clearly stated, but it's outrageous, isn't it?

Dr. Uché Blackstock: No, I absolutely agree, Brian. I think that throughout the pandemic, we've probably very much underestimated the role and impact on misinformation, especially in communities of color. I think that what we probably didn't realize is that there were organized people out there, for example, RFK Jr's organization that has been around for quite a while, putting out this information about vaccines even before there was a COVID-19 vaccine. His organization, in particular, targets communities of color and uses this idea of medical racism. They use these terms, medical racism, to attract communities of color's attention and then present them with this disinformation about vaccines.

I also think that even the wellness movement has also perpetuated a lot of vaccine misinformation, and that was even before this pandemic happened. These really organized bodies were at work, putting out this information, and we know that social media really has enabled that to happen even faster. Here we are with people who are still believing this misinformation despite having this objective data to the contrary.

Brain Lehrer: Let's take a phone call from Michelle in Westchester. You're on WNYC. Hi, Michelle.

Michelle: Hi, how are you?

Brain Lehrer: Good. You're on with Dr. Blackstock and Dr. Pimentel. Hi.

Michelle: Hi, doctors. I am absolutely pro-vaccine. I am vaccinated at this time. The only question I have is more focused about the booster because I did experience a miscarriage two days after getting the first shot. Whether it's correlated or not, I don't know, but of course, it's giving me some hesitation as to whether or not I should get the booster, which I am eligible for due to my job, while pregnant, or if that is something you think could wait.

Dr. Veronica Maria Pimentel: I can answer the question. I completely understand your concerns. A miscarriage is traumatic. I speak from a professional and personal experience, and we all want to do everything to safeguard our pregnancies. When it comes to getting the booster, pregnancy is not a reason not to get the booster. Meaning that if you qualify, if you're eligible, you should get your booster.

Michelle: You think just as much as you are pro for the first two shots, it's the same level of risk and protection.

Dr. Veronica Maria Pimentel: We have no reason to think that would be otherwise. The nice thing is that having been vaccinated before, you still have a level of protection against severe disease. You are in a different boat than someone who's not vaccinated at all. Your risk of getting sicker is less. However, if you are in an environment where you are exposed to more people, you're high risk to getting COVID when you have to weigh the risk-benefit, and the risk of getting COVID is much higher than any potential risk from the vaccine itself.

Brain Lehrer: Michelle, thank you for your call, and good luck to you and your family. Dr. Blackstock, following up on that, some people are concerned that pregnant people weren't included in the clinical trials for the COVID vaccine. That's true, right? In fact, they're often left out of clinical trials. What would you say to that concern, which leads some people to conclude that they really don't know the effects on people who are pregnant?

Dr. Uché Blackstock: Right. That has been the challenge, Brian, that because pregnant people are a protected group, often, they haven't been included in these clinical trials. We essentially have to go based on the evidence that we have thus far. What we have thus far is that there were no safety concerns noted during the animal studies in pregnant animals or their babies. There were no adverse pregnancy-related outcomes in prior trials that have used the same platform as the Johnson & Johnson vaccine. There were large Ebola studies that were done previously, and there were no pregnancy-related outcomes.

We know also that there are monitoring systems, like Dr. Pimentel mentioned, and that have been collecting a lot of data, and there have been no safety concerns detected, there were safety signals. Then there's also the v-safe registry. Looking at individuals who have been vaccinated in less than 20 weeks of pregnancy, and there's been no-- showed no increased risk of miscarriage. We're using all of this data that we have together to show that really, as Dr. Pimentel mentioned, the risk from COVID is much, much higher than the risk from these vaccines.

Brain Lehrer: Jared in Jersey City, you're on WNYC with Dr. Pimentel and Dr. Blackstock. Hi, Jared.

Jared: Hey. Good morning, Brian. Big fan.

Brain Lehrer: Thank you.

Jared: It's the perfect show I've been dying to-- this is a subject that me my wife have been wrestling with since the beginning of pandemic. We had our son last June in the midst of it, and I was almost left out of the room. They almost didn't let me in there actually. It was so hectic at the time. Now she's due in two weeks with our second child. I've been watching the research, seeing the things come out, and there's a couple of questions that I haven't necessarily been able to answer for her because she's a little fan of a causality effect. She reads these articles and says, "Oh, look, these people died." I said, "Well, a lot of people die. You go to a grocery store, you die after, doesn't mean it was a vaccine." She's on the margin.

I have a couple of questions. What was the size of the research and the racial makeup? She does cater to a little bit of the race issue and vaccines in the history of the medical industry. Also, what are the side effects for a woman, because she doesn't feel good all the time. I don't know how we would tell her she had the side effects, and she's worried about that.

Brain Lehrer: Dr. Pementel, can you talk to Jared?

Dr. Veronica Maria Pimentel: Jared, thank you. Congratulations, first of all, and I hope that this time around, you have a much pleasant experience. In terms of the data from the v-safe, there are over 5,000 pregnant women have been followed, and the data that we have in terms of miscarriages coming from approximately at this point in time, 800 women. Now, that may not sound like a lot, but actually, we make decisions in medicine in studies with much fewer patient population than this number, just to put in perspective.

With regards to side effects, the side effects to pregnant women are actually very similar to non-pregnant women. Pain in the arm where the injection went is actually the most reported side effect. You may feel a little bit tired, a little bit run down, but who's not feeling that way when they're pregnant? Then, one of the side effects that people seem to be a little bit more concerned is actually the side effect of potential fever. A small percentage of people get, probably about 3% or so, get fever with their first vaccine, and then a little bit more, maybe up to 15% may get fever with the second dose.

We have usually talked to our patients say fever in pregnancy is not good. Well, first of all, if you have COVID, you're going to have fever for a much longer period of time if you get really sick. Second of all, some of the studies that looked at fever in pregnancy that showed that there were some issues with neural tube defect actually did not account for the fact that the women were deficient in folic acid. When you account for that, we are not really worried about a transient fever, and on top of that, you can take Tylenol to suppress the fever. The side effects tend to be mild, and they're very mild in comparison to the side effects of COVID. At some point in time--

Jared: Was there any racial breakdown? I'm sorry. I didn't mean to interrupt. I was wondering about there's any racial breakdown of the 800 women that participated.

Dr. Veronica Maria Pimentel: I don't know at the top of my head right now, but I can look that up, but I don't know the top of my head. Dr. Blackstock, are you familiar with the racial breakdown?

Dr. Uché Blackstock: No. I actually don't know if they disaggregated the data by racial and ethnic groups.

Brain Lehrer: Jared, I've got one piece of advice though, which comes from the director of-- well, let's say it comes from somebody who is a mother with two very young children who may or may not be the director of the segment and says, "Tell your wife you'll take the day off work the day after she gets her shot, so she's not worried about taking care of her toddler too if she does feel a little sick."

Jared: Okay. Well, actually, I'm working because she's just stuck in the house for two years now. She doesn't go anywhere. I don't know if taking a day off is viable, but I'd really appreciate the information. Thank you very much. Oh, can I ask one more question?

Brain Lehrer: Real quick.

Jared: Is the point moot if she gives birth in two weeks? Does she have to get vaccinated after that? Does it matter?

Brain Lehrer: Dr. Pimentel.

Dr. Veronica Maria Pimentel: Yes. First of all, the earliest you get vaccinated, the better. You're passing, not you but your wife, will be passing protective antibodies via cord blood, and then if she breastfeeds, which I recommend, she will continue to pass these antibodies via breast milk that can protect the baby. As you know, at this point in time, there's no vaccines available for children under five for sure. For babies, I'm not seeing that anytime soon. She'll be passing some level of protection to the baby, and any level of protection to a newborn is good.

Brain Lehrer: Jared, thanks again. Dr. Pimentel, I saw your tweet, "Whoever said don't cry over spilled milk never broke a jar of a day's worth of COVID antibody-rich breast milk."

Dr. Veronica Maria Pimentel: It happened yesterday. Let me give a little background. I was pregnant during the pandemic. I found out six weeks before the pandemic started that I was pregnant. Throughout the whole entire last year, the first wave, I was pregnant. I now have been breastfeeding. I got my vaccine soon after delivering my baby because that's when it was available. I got my booster shot two days ago. I was a little tired yesterday, and I lost grip of the milk I had produced yesterday, and it was very upsetting.

Brain Lehrer: What do you do?

Dr. Veronica Maria Pimentel: Well, clean up to make sure that the housekeeping staff does not get cut from the glass. Then, I realized there are bigger problems in the world right now. I'll go on to producing more today to keep protecting my baby.

Brian Lehrer: There you go. Don't cry over even antibody-rich spilled milk. Before we run out of time, Dr. Blackstock it may be old news for a lot of the listeners, but a couple of weeks ago the rapper Nicki Minaj, what you described as a dubious thirdhand story about COVID vaccines more widespread. I saw that Washington Post op-ed that you and your sister, Dr. Oni Blackstock, wrote that had a really intriguing headline, "We're not calling out Nicki Minaj, we're calling her in." Want to explain it?

Dr. Uché Blackstock: Yes, exactly, Brian. Actually, that article that we wrote in that is pertinent for actually the rest of the pandemic and future. We think it's so important for people who have a large platform like musicians, hip hop artists. When they come out and say things that are perceived as misinformation that instead of the immediate response is to say, "What are you saying," really to call them in and say, "Look, we, especially as Black physicians, are interested in talking to you and making sure that you have accurate responsible information that you're putting out to your followers because they could potentially cause significant harm by putting out this misinformation to millions." She has about 22 million Twitter followers. A lot of her followers are people of color. People who are already maybe more likely to be vaccine-hesitant may see these stories and decide not to get vaccinated. Instead, we want to use empathy.

We want to call her in, and not just her, but even NBA athletes or any professional folks that have large platforms, and really talk to them and say that we are here as healthcare professionals of color to offer them the information that they need, so that they can put out correct information to the masses, because as you know, we've talked about before, we still are seeing profound racial health inequities in the pandemic in terms of who is being hospitalized and dying. We are seeing narrowing of the gap in terms of vaccine equity among different racial and ethnic demographic groups, but we still need to encourage communities of color to get vaccinated. What influential and famous people say about the vaccine is incredibly important.

Brian Lehrer: Did you get any response from Nicki Minaj after that widely circulated piece?

Dr. Uché Blackstock: [chuckles] No, unfortunately, we did not hear from Ms. Minaj or her agent, but just hoping that the message gets out there that when people are putting out this misinformation that even though the impulse is to get upset and angry at them, that shuts down the discourse. It shuts down the dialogue, and we really need to encourage a dialogue to get more people on board with getting vaccinated.

Brian Lehrer: There we leave it with Dr. Uché Blackstock, emergency medicine physician, founder and CEO of Advancing Health Equity, and an MSNBC medical contributor, and Dr. Veronica Maria Pimentel, attending physician of OBGYN, specialist in maternal-fetal medicine, and assistant professor of OBGYN at Quinnipiac University. Thank you both so much for your time this morning.

Dr. Veronica Maria Pimentel: Good day, Brian.

Dr. Uché Blackstock: Thank you.

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