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Article ; Online: Safety and Efficacy of Coronavirus Disease 2019 (COVID-19) mRNA Vaccines During Lactation.

Shook, Lydia L / Edlow, Andrea G

2023 Volume 141, Issue 3, Page(s) 483–491

Abstract: In this review, we summarize the data on the safety and side-effect profile of coronavirus disease 2019 (COVID-19) vaccines during lactation to date, review what is known about mRNA vaccine components in breast milk, and discuss the efficacy of COVID-19 ... ...

Abstract	In this review, we summarize the data on the safety and side-effect profile of coronavirus disease 2019 (COVID-19) vaccines during lactation to date, review what is known about mRNA vaccine components in breast milk, and discuss the efficacy of COVID-19 vaccines in providing immune protection for the breastfeeding infant. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend that lactating individuals receive COVID-19 mRNA vaccines and stay up to date on booster doses, including the bivalent COVID-19 booster. The lack of serious side effects in mothers or infants across numerous large studies and registries of COVID-19 vaccination in pregnancy and lactation is reassuring. Although small quantities of mRNA may be transiently detectable in breast milk after maternal vaccination, there are no data demonstrating that vaccine mRNA can survive the infant gastrointestinal tract and no evidence that breast milk from lactating individuals who have received a COVID-19 mRNA vaccine can cause harm to breastfeeding infants. In contrast, numerous studies demonstrate that the breast milk of vaccinated individuals contains severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific functional antibodies and T cells, which benefit the breastfeeding infant's developing immune system. Transfer of SARS-CoV-2-specific antibodies from mother to infant is highest when vaccination occurs during pregnancy compared with lactation, because the breastfeeding infant receives both long-lasting antibodies through the placenta and breast-milk antibodies through breast milk. With clear data demonstrating efficacy and safety and no data demonstrating harm to mother or infant after COVID-19 vaccine administration during lactation, any recommendations to avoid vaccination while breastfeeding or to withhold breast milk from the infant for any period of time after vaccination are not supported by available evidence.
MeSH term(s)	Female ; Humans ; Infant ; Pregnancy ; Antibodies, Viral ; Breast Feeding ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Lactation ; Mothers ; RNA, Messenger ; SARS-CoV-2
Chemical Substances	Antibodies, Viral ; COVID-19 Vaccines ; RNA, Messenger
Language	English
Publishing date	2023-01-18
Publishing country	United States
Document type	Review ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000005093
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Article ; Online: A blood test to predict complications of pregnancy.

Shook, Lydia L / Edlow, Andrea G

Nature

2022 Volume 601, Issue 7893, Page(s) 319–320

MeSH term(s)	Female ; Gene Expression Profiling ; Hematologic Tests ; Humans ; Pregnancy ; Transcriptome
Language	English
Publishing date	2022-01-05
Publishing country	England
Document type	News ; Comment
ZDB-ID	120714-3
ISSN	1476-4687 ; 0028-0836
ISSN (online)	1476-4687
ISSN	0028-0836
DOI	10.1038/d41586-021-03801-y
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Article ; Online: Immune Responses to SARS-CoV-2 in Pregnancy: Implications for the Health of the Next Generation.

Shook, Lydia L / Fourman, Lindsay T / Edlow, Andrea G

Journal of immunology (Baltimore, Md. : 1950)

2022 Volume 209, Issue 8, Page(s) 1465–1473

Abstract: Widespread SARS-CoV-2 infection among pregnant individuals has led to a generation of fetuses exposed in utero, but the long-term impact of such exposure remains unknown. Although fetal infection is rare, children born to mothers with SARS-CoV-2 ... ...

Abstract	Widespread SARS-CoV-2 infection among pregnant individuals has led to a generation of fetuses exposed in utero, but the long-term impact of such exposure remains unknown. Although fetal infection is rare, children born to mothers with SARS-CoV-2 infection may be at increased risk for adverse neurodevelopmental and cardiometabolic outcomes. Fetal programming effects are likely to be mediated at least in part by maternal immune activation. In this review, we discuss recent evidence regarding the effects of prenatal SARS-CoV-2 infection on the maternal, placental, and fetal immune response, as well as the implications for the long-term health of offspring. Extrapolating from what is known about the impact of maternal immune activation in other contexts (e.g., obesity, HIV, influenza), we review the potential for neurodevelopmental and cardiometabolic morbidity in offspring. Based on available data suggesting potential increased neurodevelopmental risk, we highlight the importance of establishing large cohorts to monitor offspring born to SARS-CoV-2-positive mothers for neurodevelopmental and cardiometabolic sequelae.
MeSH term(s)	COVID-19 ; Cardiovascular Diseases ; Child ; Female ; Humans ; Immunity ; Infectious Disease Transmission, Vertical ; Placenta ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; SARS-CoV-2
Language	English
Publishing date	2022-09-24
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	3056-9
ISSN	1550-6606 ; 0022-1767 ; 1048-3233 ; 1047-7381
ISSN (online)	1550-6606
ISSN	0022-1767 ; 1048-3233 ; 1047-7381
DOI	10.4049/jimmunol.2200414
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Article ; Online: Cardiac Surgery During Pregnancy.

Shook, Lydia L / Barth, William H

Clinical obstetrics and gynecology

2020 Volume 63, Issue 2, Page(s) 429–446

Abstract: The need for cardiac surgery during pregnancy is rare. Only 1% to 4% of pregnancies are complicated by maternal cardiac disease and most of these can be managed with medical therapy and lifestyle changes. On occasion, whether due to natural progression ... ...

Abstract	The need for cardiac surgery during pregnancy is rare. Only 1% to 4% of pregnancies are complicated by maternal cardiac disease and most of these can be managed with medical therapy and lifestyle changes. On occasion, whether due to natural progression of the underlying cardiac disease or precipitated by the cardiovascular changes of pregnancy, cardiac surgical therapy must be considered. Cardiac surgery is inherently dangerous for both, the mother and fetus with mortality rates near 10% and 30%, respectively. For some conditions, percutaneous cardiac intervention offers effective therapy with far less risk to the mother and her fetus. For others, cardiac surgery, including procedures that mandate the use of cardiopulmonary bypass, must be entertained to save the life of the mother. Given the extreme risks to the fetus, if the patient is in the third trimester, strong consideration should be given to delivery before surgery involving cardiopulmonary bypass. At earlier gestational ages when this is not feasible, modifications to the perfusion protocol including higher flow rates, normothermic perfusion, pulsatile flow, and the use of intraoperative external fetal heart rate monitoring should be considered.
MeSH term(s)	Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/methods ; Female ; Heart Diseases/diagnosis ; Heart Diseases/surgery ; Humans ; Life Support Care ; Mortality ; Postoperative Complications/mortality ; Postoperative Complications/prevention & control ; Pregnancy ; Pregnancy Complications, Cardiovascular/diagnosis ; Pregnancy Complications, Cardiovascular/surgery ; Pregnancy Outcome ; Risk Adjustment/methods
Language	English
Publishing date	2020-04-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000533
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Article ; Online: Offspring cardiometabolic outcomes and postnatal growth trajectories after exposure to maternal SARS-CoV-2 infection.

Shook, Lydia L / Castro, Victor M / Herzberg, Emily M / Fourman, Lindsay T / Kaimal, Anjali J / Perlis, Roy H / Edlow, Andrea G

Obesity (Silver Spring, Md.)

2024 Volume 32, Issue 5, Page(s) 969–978

Abstract: Objective: The objective of this study is to determine whether in utero exposure to SARS-CoV-2 is associated with increased risk for a cardiometabolic diagnosis by 18 months of age.: Methods: This retrospective electronic health record (EHR)-based ... ...

Abstract	Objective: The objective of this study is to determine whether in utero exposure to SARS-CoV-2 is associated with increased risk for a cardiometabolic diagnosis by 18 months of age. Methods: This retrospective electronic health record (EHR)-based cohort study included the live-born offspring of all individuals who delivered during the COVID-19 pandemic (April 1, 2020-December 31, 2021) at eight hospitals in Massachusetts. Offspring exposure was defined as a positive maternal SARS-CoV-2 polymerase chain reaction test during pregnancy. The primary outcome was presence of an ICD-10 code for a cardiometabolic disorder in offspring EHR by 18 months. Weight-, length-, and BMI-for-age z scores were calculated and compared at 6-month intervals from birth to 18 months. Results: A total of 29,510 offspring (1599 exposed and 27,911 unexposed) were included. By 18 months, 6.7% of exposed and 4.4% of unexposed offspring had received a cardiometabolic diagnosis (crude odds ratio [OR] 1.47 [95% CI: 1.10 to 1.94], p = 0.007; adjusted OR 1.38 [1.06 to 1.77], p = 0.01). Exposed offspring had a significantly greater mean BMI-for-age z score versus unexposed offspring at 6 months (z score difference 0.19 [95% CI: 0.10 to 0.29], p < 0.001; adjusted difference 0.04 [-0.06 to 0.13], p = 0.4). Conclusions: Exposure to maternal SARS-CoV-2 infection was associated with an increased risk of receiving a cardiometabolic diagnosis by 18 months preceded by greater BMI-for-age at 6 months.
MeSH term(s)	Humans ; Female ; COVID-19/epidemiology ; Pregnancy ; Retrospective Studies ; SARS-CoV-2 ; Prenatal Exposure Delayed Effects ; Infant ; Adult ; Male ; Pregnancy Complications, Infectious/virology ; Pregnancy Complications, Infectious/epidemiology ; Massachusetts/epidemiology ; Infant, Newborn ; Body Mass Index ; Cardiometabolic Risk Factors ; Child Development ; Metabolic Diseases/epidemiology ; Metabolic Diseases/etiology
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2230457-5
ISSN	1930-739X ; 1071-7323 ; 1930-7381
ISSN (online)	1930-739X
ISSN	1071-7323 ; 1930-7381
DOI	10.1002/oby.23998
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Article ; Online: Countering COVID-19 Vaccine Hesitancy in Pregnancy: the "4 Cs".

Shook, Lydia L / Kishkovich, Thomas P / Edlow, Andrea G

American journal of perinatology

2021 Volume 39, Issue 10, Page(s) 1048–1054

Abstract: Despite evidence to support the safety and efficacy of COVID-19 vaccination in pregnancy, and clear recommendations from professional organizations and the Centers for Disease Control and Prevention (CDC) for pregnant people to get vaccinated, COVID-19 ... ...

Abstract	Despite evidence to support the safety and efficacy of COVID-19 vaccination in pregnancy, and clear recommendations from professional organizations and the Centers for Disease Control and Prevention (CDC) for pregnant people to get vaccinated, COVID-19 vaccine hesitancy in pregnancy remains a significant public health problem. The emergence of the highly transmissible B.1.617.2 (Delta) variant among primarily unvaccinated people has exposed the cost of vaccine hesitancy. In this commentary, we explore factors contributing to COVID-19 vaccine hesitancy in pregnancy and potential solutions to overcome them. KEY POINTS: · Low COVID-19 vaccination coverage in pregnant people is a major public health problem in the United States.. · COVID-19 vaccine hesitancy in pregnancy is multifactorial.. · The "4 Cs" framework may be useful in countering COVID-19 vaccine hesitancy..
MeSH term(s)	COVID-19/prevention & control ; COVID-19 Vaccines ; Female ; Humans ; Pregnancy ; Pregnancy Complications, Infectious/prevention & control ; SARS-CoV-2 ; United States ; Vaccination ; Vaccination Hesitancy
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-10-19
Publishing country	United States
Document type	Research Support, Non-U.S. Gov't ; Editorial ; Research Support, N.I.H., Extramural
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-1673-5546
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Article ; Online: COVID-19 in pregnancy: implications for fetal brain development.

Shook, Lydia L / Sullivan, Elinor L / Lo, Jamie O / Perlis, Roy H / Edlow, Andrea G

Trends in molecular medicine

2022 Volume 28, Issue 4, Page(s) 319–330

Abstract: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy on the developing fetal brain is poorly understood. Other antenatal infections such as influenza have been associated with adverse neurodevelopmental ... ...

Abstract	The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy on the developing fetal brain is poorly understood. Other antenatal infections such as influenza have been associated with adverse neurodevelopmental outcomes in offspring. Although vertical transmission has been rarely observed in SARS-CoV-2 to date, given the potential for profound maternal immune activation (MIA), impact on the developing fetal brain is likely. Here we review evidence that SARS-CoV-2 and other viral infections during pregnancy can result in maternal, placental, and fetal immune activation, and ultimately in offspring neurodevelopmental morbidity. Finally, we highlight the need for cellular models of fetal brain development to better understand potential short- and long-term impacts of maternal SARS-CoV-2 infection on the next generation.
MeSH term(s)	Brain ; COVID-19 ; Female ; Humans ; Infectious Disease Transmission, Vertical ; Placenta ; Pregnancy ; Pregnancy Complications, Infectious ; SARS-CoV-2
Language	English
Publishing date	2022-02-14
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2036490-8
ISSN	1471-499X ; 1471-4914
ISSN (online)	1471-499X
ISSN	1471-4914
DOI	10.1016/j.molmed.2022.02.004
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Article ; Online: COVID-19 Vaccination in Pregnancy and Lactation: Current Research and Gaps in Understanding.

Shook, Lydia L / Fallah, Parisa N / Silberman, Jason N / Edlow, Andrea G

Frontiers in cellular and infection microbiology

2021 Volume 11, Page(s) 735394

Abstract: The COVID-19 pandemic has demonstrated the urgent need to develop vaccine strategies optimized for pregnant people and their newborns, as both populations are at risk of developing severe disease. Although not included in COVID-19 vaccine development ... ...

Abstract	The COVID-19 pandemic has demonstrated the urgent need to develop vaccine strategies optimized for pregnant people and their newborns, as both populations are at risk of developing severe disease. Although not included in COVID-19 vaccine development trials, pregnant people have had access to these vaccines since their initial release in the US and abroad. The rapid development and distribution of novel COVID-19 vaccines to people at risk, including those who are pregnant and lactating, presents an unprecedented opportunity to further our understanding of vaccine-induced immunity in these populations. In this review, we aim to summarize the literature to date on COVID-19 vaccination in pregnancy and lactation and highlight opportunities for investigation that may inform future maternal vaccine development and implementation strategies.
MeSH term(s)	COVID-19 ; COVID-19 Vaccines ; Female ; Humans ; Infant, Newborn ; Lactation ; Pandemics ; Pregnancy ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-09-16
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2619676-1
ISSN	2235-2988 ; 2235-2988
ISSN (online)	2235-2988
ISSN	2235-2988
DOI	10.3389/fcimb.2021.735394
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Article ; Online: Fetal brain and placental programming in maternal obesity: A review of human and animal model studies.

Shook, Lydia L / Kislal, Sezen / Edlow, Andrea G

Prenatal diagnosis

2020 Volume 40, Issue 9, Page(s) 1126–1137

Abstract: Both human epidemiologic and animal model studies demonstrate that prenatal and lactational exposure to maternal obesity and high-fat diet are associated with adverse neurodevelopmental outcomes in offspring. Neurodevelopmental outcomes described in ... ...

Abstract	Both human epidemiologic and animal model studies demonstrate that prenatal and lactational exposure to maternal obesity and high-fat diet are associated with adverse neurodevelopmental outcomes in offspring. Neurodevelopmental outcomes described in offspring of obese women include cognitive impairment, autism spectrum disorder (ASD), attention deficit hyperactivity disorder, anxiety and depression, disordered eating, and propensity for reward-driven behavior, among others. This review synthesizes human and animal data linking maternal obesity and high-fat diet consumption to abnormal fetal brain development, and neurodevelopmental and psychiatric morbidity in offspring. It highlights key mechanisms by which maternal obesity and maternal diet impact fetal and offspring development, and sex differences in offspring programming. In addition, we review placental effects of maternal obesity, and the role the placenta might play as an indicator vs mediator of fetal programming.
MeSH term(s)	Animals ; Brain/embryology ; Brain/growth & development ; Disease Models, Animal ; Female ; Fetal Development/physiology ; History, 21st Century ; Humans ; Male ; Neurodevelopmental Disorders/etiology ; Neurodevelopmental Disorders/metabolism ; Neurodevelopmental Disorders/pathology ; Obesity, Maternal/complications ; Obesity, Maternal/embryology ; Obesity, Maternal/metabolism ; Pregnancy ; Prenatal Exposure Delayed Effects/etiology ; Prenatal Exposure Delayed Effects/metabolism ; Prenatal Exposure Delayed Effects/pathology
Language	English
Publishing date	2020-05-17
Publishing country	England
Document type	Historical Article ; Journal Article ; Review
ZDB-ID	82031-3
ISSN	1097-0223 ; 0197-3851
ISSN (online)	1097-0223
ISSN	0197-3851
DOI	10.1002/pd.5724
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Article ; Online: Perinatal exposure to maternal obesity: Lasting cardiometabolic impact on offspring.

Kislal, Sezen / Shook, Lydia L / Edlow, Andrea G

Prenatal diagnosis

2020 Volume 40, Issue 9, Page(s) 1109–1125

Abstract: Evidence from epidemiological, clinical, and animal model studies clearly demonstrates that prenatal and lactational maternal obesity and high-fat diet consumption are associated with cardiometabolic morbidity in offspring. Fetal and offspring sex may be ...

Abstract	Evidence from epidemiological, clinical, and animal model studies clearly demonstrates that prenatal and lactational maternal obesity and high-fat diet consumption are associated with cardiometabolic morbidity in offspring. Fetal and offspring sex may be an important effect modifier. Adverse offspring cardiometabolic outcomes observed in the setting of maternal obesity include an increased risk for obesity, features of metabolic syndrome (hypertension, hyperglycemia and insulin resistance, hyperlipidemia, increased adiposity), and non-alcoholic fatty liver disease. This review article synthesizes human and animal data linking maternal obesity and high-fat diet consumption in pregnancy and lactation to adverse cardiometabolic outcomes in offspring. We review key mechanisms underlying skeletal muscle, adipose tissue, pancreatic, liver, and central brain reward programming in obesity-exposed offspring, and how such malprogramming contributes to offspring cardiometabolic morbidity.
MeSH term(s)	Animals ; Cardiometabolic Risk Factors ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/metabolism ; Female ; Humans ; Infant, Newborn ; Male ; Metabolic Diseases/epidemiology ; Metabolic Diseases/etiology ; Metabolic Diseases/metabolism ; Obesity, Maternal/complications ; Obesity, Maternal/epidemiology ; Obesity, Maternal/metabolism ; Pregnancy ; Prenatal Exposure Delayed Effects/epidemiology ; Prenatal Exposure Delayed Effects/metabolism
Language	English
Publishing date	2020-08-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	82031-3
ISSN	1097-0223 ; 0197-3851
ISSN (online)	1097-0223
ISSN	0197-3851
DOI	10.1002/pd.5784
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