E07: Ask an MD: COVID-19 vaccines Genetic Prenatal Screening
What prenatal screening do you need? And does a vegan diet lead to miscarriage?
In Episode 7, Professor Eitan Friedman MD, PhD (and Maya's dad!) shares his insight with you as a physician and researcher working in the field of oncogenetics..
In this episode we cover:
- What the risk for birth defects and premature birth
- Why your vegan diet isn’t to blame for a miscarriage
- Is the COVID-19 vaccine safe during pregnancy
Taking an evidence-based approach, he's bringing his wealth of knowledge and expertise with the voice of a trusted dad. Reach out with your follow-up questions & they'll be answered in future episodes!
Connect with Maya:
Website: The Vegan Pregnancy Collective
Instagram: @vegan.prenatal.nutrition
Transcript
Hi friends. Welcome to the Vegan Pregnancy Podcast. I'm your host, Maya Bach, prenatal dietitian, fellow vegan and founder of the Vegan Pregnancy Collective from food to fitness. You'll hear from vegan moms to be just like you and other healthcare professionals. The goal is to empower, support and inspire you as you navigate your vegan pregnancy.
Now let's dive in.
Maya: Welcome back to the vegan pregnancy podcast. On today's episode. I'm so excited to be welcoming. My dad, professor Aton, Friedman coming all the way from Tel Aviv, Israel. Daddy, if you want to. Share with the listeners a little bit about you and what you do.
Eitan: All right. Well, thank you, Maya, for having me on this podcast, I'm excited to share some of the knowledge that I've acquired. And just to give you a brief background of my professional background. I am a graduate of this Tel Aviv university medical school, this Atlas medical school way back in 1977. I have a PhD from the Karolinska Institute in Stockholm, Sweden, which is a whole different story. And I’m an Israeli board-certified doctor of internal medicine and clinical genetics and medical genetics.
Since 1994, I've established and I was running until very recently the anchor genetics unit, which is part of the genetics Institute at the Sheba medical center, the largest medical center in the middle east, and that the unit concentrated in. On identifying individuals who are at high risk for developing cancer based on their family history.
At times, we accompany that with genetic testing to define germline mutation mutations that are inherited from generation to generation, which would define women and men at a higher risk for developing cancer. My passion is the impact of genetics on the population at large. And, but my most coveted achievement is being the father to Maya.
Maya: Thank you for sharing that. For those of you who are listening, my dad is a pioneer in the field of genetics and it's been incredible to watch him and follow his journey. He is also an incredible father for a variety of reasons. I wanted to bring him on the show today. When we're talking about that myth, truth angle, what is the prevalence of something, quote unquote, going wrong with your baby vegan women. They're being told, and they hear whether it's from their provider, their friends or family, your vegan diet is going to cause preterm birth, your baby’s brain isn't going to develop properly, you're not going to get enough iron to support his or her development. There's a lot of things it wrapped up in this. Can you talk to me? I know we talked a little bit yesterday about quote unquote, “going wrong.” What does that mean? And what is the prevalence?
Eitan: These numbers have not changed since the late seventies, the chances of being born with a congenital anomaly can range from a webbed toe to anencephaly. Namely, is born without a brain has not actually changed over the course of the years. The one thing that has changed by the way is neural tube defects that the failure to close the neural tube, which can lead to myeloma Ningo cell.
This is preventative. Primarily since the introduction of folic acid, prenatal folic acid consumption, and has reduced neural tube defects by more than 90%. I know there are a lot of myths out there and I've looked at the recommendations of the NHS, which is the British equivalent of the health ministry.
I've looked at the CDC, I've looked at the Israeli recommendations, and nowhere did I find evidence that vegan puts the woman, if it is balanced if it is monitored if the woman gets enough, and again, if there are enough micronutrients and it's monitored and tailored to the needs of that particular woman, there is no evidence that any of these myths do exist or originally when it was not well monitored, women were getting less iron and it's a well-known fact.
Many many generations now that women who are pregnant need more iron than just regular women. And regardless of their dietary habits, they need more iron. They need more, their specific needs are derived from the fact that they're women or pregnant. And the fetus totally depends on the supply of these micronutrients and essential elements to develop his brain properly, to develop everything.
The chances of something going wrong with a kid is about two and a half percent. And then out of stage, they say that it's two to 3% in England. It may be less. And there are three top congenital defect. Cardiac problems, neural tube defects and chromosome 11. And Molly's most commonly down syndrome in some cases because the technology has evolved so much.
We can do ultrasound early ultrasound and the 12th week of pregnancy and the 16th week of pregnancy and the 20th week of pregnancy. And by the way, in Israel, I think everybody from age 25 onwards gets early. And late ultrasonic evaluation. If most major cardiac anomalies can be detected by a single ultrasound around eight era, 16 or 18 weeks of pregnancy, most of them, the technology has so far evolved that it's possible to correct some of these anomalies in utero.
We do the surgery when the fetus is still in the womb and we can fix it in some cases. We can treat it as the baby is born and solve the problem. Neural tube defects. The rate has decreased from the 1990s to currently by fold. It's amazing. It's an amazing, very, very significant effect of folic acid, no neural tube defects, as far as down syndrome and other chromosomal abnormalities.
There are three major chromosomal abnormalities that are compatible with the fetus being born down syndrome, which has an extra chromosome 21 Edwards syndrome, which is an extra chromosome 18 and a thousand drone, which is an excess of chromosome 13 only kids with down syndrome, excess of chromosome 21 can live beyond the first.
There is a noninvasive way to detect these girls all abnormalities or originally you would have to do I'm new synthesis. You'd have to tap the theaters, go under vision with ultrasound and collect 10 20 AMLs of the amniotic fluid. And then look at the chromosomal structure of the fetus. It's. That's an invasive procedure.
It is associated based on old data on 0.5% pregnancy loss. This is a very old study from, I think, Denmark, but the number it's still, there is a very small yet and existing risk for losing the fetus. There is another version called CVS or an anecdotal sampling. Twice as hazardous to the fetus as that, but you can do it early on.
However, over the last five, maybe 10 years and new technology has evolved. It's called NIPT. Non-invasive prenatal testing. Basically, it's taking blood from the mother, taking it out, just like a blood test and looking for the fetal DNA and chromosomal testing. You can actually say it's a screening test without.
Except for a little blood drawn from the mother, you can say, what are the chances that it feeds us? Down's syndrome, but that was syndrome or Edwards syndrome or any chromosome 11 valley. It's very accurate. It's a good screening test. Now it is recommended for women at an older age of pregnancy defined as 35 or 37, depending on the country.
When the risk for having down syndrome increases over the risk of losing the pregnancy to do amniocentesis. I think in that category, Choosing NIPT is a better, less invasive, less hazardous choice. And it's a very good choice and more and more women in Israel are opting for that option. We have to realize that this is the good news.
The bad news is that in some cases there is no way that we can diagnose congenital anomalies, autism. For example, we cannot detect autism by any of genetic testings. We cannot detect several. Life-threatening disorders. There is a limit. There is a light at the end of the town when whole genome sequencing when we'll be able to analyze the entire genome on my nude amounts of DNA.
And it's a technical issue that would be solved and we'd be able to analyze it rapidly. We'll be in a position to decrease substantially decrease the rate of congenital anomalies and.
Maya: Yeah. Speaking of abnormalities, and you mentioned pregnancy loss for women who are also following a vegan diet. And this has happened with, with one of my clients recently, who did experience a miscarriage and feels like.
Eitan: No. I mean, I'm not arguing with feelings, feelings are legitimate and whenever something bad happens to you, you're trying to think what have I done wrong? Am I responsible for that? And again, you know, the story that your grandfather, my father died when he was 56 years old. And for years I blamed myself for his death, which was unavoidable, even though I was a physician I'm already.
I could not prevent his death and it's normal. It's human to try and find a reason. Have I done something wrong because of this horrible result? However, looking at the science and not the feelings of it, there is no reason to suspect the major reasons for an early pregnancy loss are. Genetic abnormalities or mutations that are not carried by either parent, but occur in the fetus at an early stage of development.
For some reason, something horribly grows around the body is very, very, very capable of detecting these banalities. And as a defense mechanism that has evolved through. The years of us being human beings have decided to stop these pregnancies. Okay. I'll give you a specific example. Pregnancy losses, the most common chromosomal Lebanon in children or born is trisomy 21 down syndrome.
The most common chromosomal anomaly in fetal losses at the end of the first trimester is trisomy of chromosome 16. The body just tells the fetus, you cannot develop, this is incompatible with life. So the fact that she's vegan, the fact that she's vegan in all likelihood did not contribute anything to the fact that she had a pregnancy loss.
However, I also should remind them of the stats. I'm a numbers guy, the chances of a single miscarriage to everyone. Once in her lifetime is close to 30%. It's 29%. Two miscarriages in a woman is about 10%. Three is 0.8%. Again, these are old numbers, but these numbers still.
So there is in. One in almost one-third of women were pregnant, will have at least one pregnancy loss. And it's not because they're thinking because not 30% of women are vegan.
Maya: Yeah. Hopefully one day. I appreciate you sharing that for anyone who's listening, who might be questioning themselves or have experienced pregnancy loss.
Eitan: It's important to keep in mind that. It does happen and the rate is higher than you think. It's just, we don't talk about it as openly and its perception. It's totally understandable, but I have to stress to those who listen to us. It's not because you've done something wrong. You think of it as a protective mechanism of the body telling the fetus you're not fit to develop, let's give it another shot.
Maya: And then there's a process. Obviously, I've never been pregnant or experienced that, but there is something we talk about in a group mindset shift and how shifting from blaming yourself and also focusing on the positive everyone.
Eitan: There's no magic wand to take away the pain of women who experienced pregnancy loss. I've known many, a woman who have had pregnancy loss and they each carve their own path. They each found their own way. And for the most part, after the initial period of grief. Very understandable. Most of them rebounded and had beautiful multiple babies, I should say. And I think the process should be anything that works for a specific person is welcome.
And anybody should look at. Or seek other individuals who have experienced that and should rely on the group experience and the group support. And as I said, the spouses, the husbands be good, be good kids support your wives and mothers to be.
Maya: Yeah. Thank you. Switching over to a topic that I know you have been both personally and professionally passionate about over this past year and a half in the pandemic with COVID-19.
With the development of the various vaccines. Some of my clients in the program have opted to not get vaccinated during their pregnancy. Wait until after delivery, others have been anxiously waiting to get vaccinated. So there is a mix. Can you share your professional insight into the value of vaccines in general?
Eitan: How'd you get vaccinated during pregnancy. Let's zoom out for a second and look at the steps and what have vaccines in general are, not a little COVID-19 vaccine talking about the vaccine in general. I've done for the human race. It has been estimated that since the introduction of vaccines, the mandatory vaccines for kids for the age of six months, all the way to 18 years with various booster shots.
A hundred million lives of kids, just kids have been saved. And if you save a kid's life, you extend the lifespan. And part of the extension of a lifespan from around 40 years in 1900 to around now, it's about 75 worldwide, but in Western countries, it's around 80, the highest country, by the way, is Japan.
It's around about 87 and invariably women outlive men. But that's just another issue. Part of that. Fewer kids dying because of infectious diseases, viral diseases, not bacterial diseases for that we have under the Arctic. So vaccines overall are great. Specifically for women. Women have lost children because they contracted rubella during pregnancy.
And you have to be vaccinated yourself which is a vaccine that you get as a kid in order to avoid any ill effects on your infant. We talk about COVID-19 vaccines and vaccines have changed this pandemic. Now we're experiencing many more confirmed individuals. They're not affected. They don't have symptoms.
They're not sick. They are confirmed COVID-19 individuals in the United States in England, by the way, in England, over the last 10 weeks, they have increased the number of positive COVID 19 from blowout 2000 a day to about 50,000 a day yet. The number of severely affected individuals and the number of deaths then I've worked at the laser patients remained pretty stable, and this is thanks to the vaccination in England, about 55% of the entire population, and about 70% of the adult population in Israel.
It's 60% of the population and 85% of individuals over the age of 40 are fully vaccinated. And we're seeing exactly the same pattern. So vaccines have been proven both in clinical trials, which have been published December 31st, nine to 2020, and then the England journal of medicine, both for the Moderna and the Pfizer vaccine, not only in a clinical trial setting but in the real world setting has been proven effective.
Achieving one goal to prevent the serious disease from the individuals who have been vaccinated. They're still carriers, but they're not sick. Exactly. It's preventing severe disease, hospitalization, ICU, admissions, ventilator, ECMO deaths. It has no serious disease. It is less effective. And as time goes by becomes even less effective in terms of transmission of the disease, especially with the Delta variant, but this is a whole different ball game for the person.
I care that the person is not hospitalized. I care that the person is not intubated and ventilated or die because of COVID-19. I don't really care if he or she has a little upper respiratory infection and sneezes and feels bad for a couple of days with a little fever and loses some sense of taste and smell that doesn't bother me.
We'll never be able to get rid of that. The original trials have excluded pregnant women and children under the age of six. The original clinical trials. There was some luminary evidence starting from Israel to showing that women in the third trimester of pregnancy are more susceptible to severe disease.
This is why recently the new England journal of medicine, which is the leading clinical journal in the world has published a study from the United States that details the outcome of 35,000 pregnant women. We've been vaccinated. And it clearly shows that it's very effective. It prevents serious disease and it is safe.
Like any other vaccine, there are side effects. Some women have a fever or something going to have chills. Some women have sore shoulder after the vaccination, no medicine, vaccines included is side effect free. Is it a serious side effect? No. Is it associated with trauma and potential loss of life? Know that Johnson and Johnson, the J and J vaccine is rare.
About one to four in 1 million vaccinated individuals, but especially in younger women is associated with a rare from Boses and thrombocytopenia of the veins in the brain. But it's 1, 2, 4, and 1 million, depending on the study that you read, it is out there. Young men under the age of 30, it may be associated with a slightly increased risk for developing inflammation of the heart muscle marker.
It is on the leaflet. You should read the leaflet, but overall, in the balance between getting vaccinated, especially in the third trimester and not getting vaccinated, the jury is not out. The jury is in and you should get vaccinated. It's very effective. It's also a very well-traveled path of getting our lives back to.
Maya: To a new norm living with COVID-19 and not under its influence. I love that. What about vaccines for children? Is that something that's coming? Will we need a third vaccine? Do you have any insight into
I'm fighting a long battle with ignorant decision-makers. It's two separate issues. Let's start with the second one. Should we get a third vaccine? The CDC has spoken the, who has spoken Anthony Fauji. Who's a proponent, a strong proponent of the vaccine. We don't know, we may need them women up need them. The lab evidence still very, very strongly supports as sustained.
Even those slightly diminished capability to control severe infection, even with the rise of the Delta variant in those who were vaccinated twice. Is it enough for life? I don't know. Should we get a boost? Was there vaccine probably is when we will have to wait if Pfizer wants to make money without doing a clinical trial, not on my watch.
I'm also the chair of the high ethics committee of the ministry of health in Israel. And they will not be able to pull a fast one on me. I can show you that. So as far as the booster that. We may need it. We may need to be vaccinated against COVID-19 with all its variants once a year, like we do for influenza.
However, with influenza, the rate of acquiring mutations that makes this virus escape from the previous vaccine is twice as that. There's the, COVID-19 the surgical. So if once a year is good for influenza, maybe once every two years for COVID-19, it's very simplistic, but I'm just putting it out there. And what about children?
The facts are as follows in the United States since the start of the pandemic, less than 300 children under the age of 18 have died in England. Close to half a million children between the ages of zero to 18. Since the start of the pandemic, actually from a March 2020 to May, 2020 1, 490 1000 children have been confirmed of these 25 have died.
19 of the 25 have had serious problems, which would make them die anyway. So it's six children with no known underlying disorder. That's one factor. The second fact is that disease in and by itself, kids are not severely affected for the most part. There is asymptomatic. The third thing that we have to take into consideration is.
Really affecting the spread of the disease, will it enable us to get to herd immunity? This has not been proven. And lastly, if we extrapolate from the fact that men between the ages of 16 to 30. Are at a substantially increased risk for developing markers that is maybe the same would apply to children or younger.
There is a major drive in Israel to push for vaccination between the ages of 12 to 15, for reasons that are beyond me. I know that Pfizer and Moderna are engaged in a clinical trial vaccinating kids from the age of two or six months to 12. I'm not sure that this has really. I'm not sure that this is really needed from the clinical epidemiological aspect.
Instead of that, I would focus on adults or refuse to be vaccinated. These are the drivers of the epidemic. You should focus your efforts, explanations, deal with them, explain to them that this is a good thing. Instead of having 20 or 25% of adults, not vaccinated, you'd have only 15. You've increased your chances of living side-by-side with COVID-19 don't vaccinate the kids yet.
Maya: We may come to it, but right now it's pretty mature. And. I really liked that approach, looking at what the evidence says and appreciating that this is rapidly developing, and not drawing any strong conclusions yet. Well, thank you, Daddy. For your time. Insight, knowledge, expertise.
Eitan: I enjoyed it tremendously. I enjoyed it very much. And I urge everyone who listened to us, go with the evidence. Don't be misled by misinformation, by myths. But my neighbor said that, or my coworker I've had a cousin who told her that her cousin had something terrible happened to her. Look for the signs, rely on solid sources and not enough considerations.
This could make this world better and certainly enable us to move forward with our lives mess of the pandemic behind us. I hope. Do you want people to reach out to you? Do you want
people, if the listeners want to reach out to you, where is the best place to connect with? I can send you my email, my professional email, and they can look me up and send me, I'm usually a good responder.
Maya: Wait, can you talk about your swimming a little bit? Daddy, you're breaking my heart, you and a deer. My first love, the second love is swimming, and I just want to, you know, to be the first Israeli that ever swim the English channel way back in 1993 and the first Israelis discerning around the earth.
And in 1989, clarify.
Uh, probably the only person in the world have ever swung the lake of Galilee, you know, lengthwise sideways, and around it in 1997 claimed to be the oldest person to swim the English channel when I'm 75, it's only seven years or now, uh, my passion is truly swimming and they, that I haven't swung for me is a day.
I should not have woken up.
Maya: Yeah, your commitment to swimming and also the community that you've fostered there is really, really incredible. And you're getting ready to swim the English channel. Really a forum.
Eitan: Yeah. Well, if as of today, the government has decided that Britain is a country that you should be banned from flying too. We're looking for other options. Catalina island and maybe the length of lake DOE and other options, Europe training, it's probably gone down the tubes. It's okay. I said from the age of 75 and everything else, it just accumulated.
Maya: All right. Thank you, Daddy. I appreciate it. Thank you. I am. Thanks so much for listening to today's episode. If you're ready to go from feeling concerned to confident as a vegan mom, to me, send me a DM I'm on Instagram @vegan.prenatal.nutrition I'd love to hear from you and we can chat more and see if the vegan pregnancy collective is for you.
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