SART生育专家 - 特别节目：疫苗、不孕症与怀孕

大家好，欢迎收听本期播客。

Hi everybody, and welcome to the podcast.

今天这期节目让我特别兴奋，因为我们请来了一位好朋友，阿西姆·贾尼医生。他是内科医生，拥有公共卫生硕士学位，还是美国内科医师学会的会士。

I am very excited about today's program because we have a dear friend, Asim Jani, who is a physician, a master's of public health, and a fellow of the American College of Physicians.

今天的话题非常及时，对大家获取这些信息非常重要，我们很幸运能请到一位专家。

Today's topic is so timely and so important for all of you to gain this information, and we're very fortunate to have an expert.

贾尼医生

Doctor.

是顾问和医学流行病学家。

Jani is a consultant and medical epidemiologist.

他的专长包括内科、传染病、公共卫生以及一般预防医学。

His specialties are in internal medicine, infectious diseases and public health, and general preventive medicine.

他在美国疾病控制与预防中心工作了十年，包括担任预防医学住院医师和研究员项目的主任。

He was at the CDC for ten years, including being the director of the CDC Preventive Medicine Residency and Fellowship.

他在佛罗里达中部担任临床教育者和公共卫生医生已有十五年，同时在南佛罗里达大学和佛罗里达州立大学医学院担任兼职教职。

He's a clinician educator and public health physician in Central Florida for fifteen years and has adjunct faculty appointments at both the University of South Florida and Florida State University Colleges of Medicine.

贾尼医生。

Doctor.

贾尼医生，欢迎来到播客。

Jani, welcome to the podcast.

非常感谢，马克。

Thank you so much, Mark.

好的，今天我们有很多信息要分享，我就直接进入正题了。

Well, lots of information that we have today, and I just want to get right to it.

关于疫苗接种，我们不会马上深入讲新冠，但显然那会是我们讨论的一大块内容。

Vaccinations, we're not going to go right into COVID, but obviously that's going be a large section of what we talk about.

但作为妇产科医生，如果我们有幸在患者怀孕前见到她们，我们会给她们做筛查，最常见的病毒检查包括风疹，也就是德国麻疹，水痘，也就是水痘带状疱疹病毒，还有麻疹，虽然麻疹不是常规筛查项目，但也可以讨论一下。

But as an OB GYN, screen our patients if we're fortunate enough to get them before they conceive, and the most common viruses that we check for are rubella, which is the German measles, varicella, which is the chickenpox, and you know, you can make an argument for the measles, although that's not routinely screened for all people.

其他我们做的检查包括破伤风，现在也应该筛查新冠，当然还有流感。

Others that we do are for tetanus, we should screen for COVID now, and of course the flu.

所以我最初的问题是，接种这些疫苗，风疹和麻疹的疫苗叫MMR，还有水痘疫苗。

So I guess the question that I initially had is in getting these vaccines, the ones for rubella and the measles is called MMR, and then for varicella.

那为什么我们打这些疫苗的时候要等呢？

So why are we waiting when we get these vaccines?

建议等一等，有些地方说三个月，有些说一个月，但流感疫苗不用等。

It's advised to wait, some sites say three months, some sites say one month, and not the flu.

流感疫苗和新冠疫苗在怀孕期间都可以打。

You can get the flu vaccine during pregnancy and COVID vaccine during pregnancy.

那这些病毒有什么区别呢？

So what's the difference between these viruses?

对，没错。

Yeah, absolutely.

这个问题问得好。

It's a great question.

你知道我们有很多不同种类的疫苗产品。

So you know that we have many different categories of vaccine products.

它们的制作方式各不相同。

They're made in different ways.

绝大多数疫苗都是我们所说的灭活疫苗，基本上就是取病毒的一部分，可能是整个病毒或者病毒的一部分，然后用一种在极少量下非常安全的化学物质处理它，这样基本上就让病毒失去引起感染的能力。

The vast majority of vaccines are what we call inactivated, where basically we take a portion of the virus, perhaps the whole virus or a part of the virus, and we essentially treat it with a chemical that is otherwise very safe in minuscule amounts, but it essentially deactivates that virus from really causing infection.

有少数疫苗，比如你提到的麻腮风疫苗、水痘疫苗，甚至流感疫苗中也有一种类型是活疫苗。

There are a few vaccines, like you mentioned, the MMR vaccine, the varicella vaccine, even influenza has one type of an influenza vaccine that is what we call live.

这些是活病毒疫苗，基本上有可能引起一些感染症状。

And these are live viral vaccines that essentially can have the potential to cause some symptoms of infection.

对于免疫系统有问题或者怀孕的患者，考虑的是最好在怀孕前就接种疫苗。

And in patients who are otherwise having immune system issues or are pregnant, the consideration is that you ideally want to vaccinate pregnant people certainly well before they conceive.

这是因为在研究中发现，自然感染或接触病毒后大约三个月内，没有证据表明孕妇会受到任何伤害。

Now that is on the basis of the fact that generally when they did studies, they found that within a period of about three months after natural infection or, or, exposure to the virus, there may be some evidence that, you know, there was no evidence really that pregnant women were in any way, harmed.

但为了保险起见，人们说，好吧，我们为什么不先接种这些疫苗，然后等一个月再怀孕呢？

But to be conservative, you know, people said that, okay, why don't we just give these vaccines and then wait for a month for conception?

如果在那段时间里，有人不知道自己怀孕了，或者不知道已经感染了，这些都是理论上的风险。

And if in fact, during that period of time, someone did not know, right, they got pregnant, they didn't know that they got it, These are theoretical risks.

所以这些风险并不一定在主要数据中得到证实，表明存在伤害。

So they are not necessarily born out in any major data that would say that there's harm.

对。

That's Right.

所以现在，怀孕期间，人们无意中接触了这些疫苗，也没出什么问题，对吧？比如麻疹、腮腺炎、风疹疫苗或者水痘疫苗。

So right now, right now during pregnancy, you know, the inadvertent exposures that people have gotten no problems with the MMR or the chickenpox, right?

无意接触的话，理想情况下，你最好提前计划，如果可以的话，至少等四周，CDC的文献里也是这么说的。

Inadvertent exposures, Ideally, what you want to do is you want to plan, if you can, to make sure that you at least wait, again, four weeks is what the CDC has said in the literature.

这可以追溯到差不多2001年的论文了。

And this goes back to almost, gosh, papers back in 2001.

所以这已经是二十年前的信息了。

So this is like twenty year old information.

尽管如此，我们还需要知道的一个重要事情是，绝大多数人真的应该在怀孕期间接种疫苗。

That said, the important thing that also we should know is that people are really, really, they should get vaccines during pregnancy, vast majority.

重要的是，患者要意识到，如果不接种疫苗，万一在怀孕期间感染了风疹，虽然不常见，但确实可能导致宝宝出生缺陷，包括心脏问题、视力问题、耳聋、智力障碍、低出生体重。

And the important thing is that for patients to realize that without being vaccinated, if they ever got, now it's not common, but if they ever got rubella during pregnancy, it can actually cause baby to have birth defects, including heart problems, vision, deafness, intellectual disability, low birth weight.

这就是先天性风疹综合征。

So there's a congenital rubella syndrome.

所以，对于想怀孕的人来说，除了当然要补充叶酸来降低脊柱裂和神经管缺陷的风险之外，这一点也很重要。

So it is important for people that are interested in getting pregnant, in addition to being on, of course, folic acid to reduce the risk of spina bifida and neural tube defects.

但我也想提一下水痘，妈妈可能会得一种叫水痘肺炎的病，这实际上可能危及生命。

But I also wanted to touch base with chickenpox is that mom can get something called varicella pneumonia, and that can be actually life threatening.

所以有一种先天性水痘综合征，也就是水痘，它可能导致严重的出生缺陷，比如皮肤疤痕、手臂、腿、大脑的问题，确实如此。

So there's a congenital varicella syndrome, which is chickenpox, and that can cause serious birth defects, scars in the skin, problems with the arms, legs, brains, Absolutely.

还有眼睛。

And eyes.

所以我们不能对这些特殊问题掉以轻心。

So we don't want to take, you know, we don't want to be cavalier about these particular problems.

麻疹在怀孕期间也可能引起问题，比如流产和死产。

Measles can actually cause problems during pregnancy as well, like miscarriage and stillbirth.

那么，阿西姆，为什么接种流感疫苗是安全的呢？

So why is it safe, Asim, to have the flu vaccine?

我们稍后会单独讨论新冠，但为什么流感疫苗是安全的呢？

We'll talk about COVID separately, but why is it safe for the flu vaccine?

流感疫苗其实非常有效。

Well, influenza vaccine is incredibly effective.

我们知道，孕妇如果得了流感，风险是很严重的，对吧？

We know that the risks that pregnant women have when they in fact get the flu are serious, right?

我们知道她们更容易出现并发症。

We know that there's an increased susceptibility to complications.

她们住院的风险也会增加。

They can have increased risk of hospitalization.

你也知道，甚至还有流产、早产和婴儿低出生体重的风险。

As you know, there's even some risk of spontane abortion and preterm labor, low birth weights, infants.

自然感染是有风险的。

There's risks for natural infection.

而且我们知道，灭活流感疫苗，也就是IV，可以在怀孕期间的任何时候给孕妇接种。

And what we know is that the inactivated influenza vaccine or IV can be really administered to a woman anytime during the time that they're pregnant.

理想的情况是，你大体上要看看疫苗是否能预防通常在孕早期对妈妈造成的疾病负担，还是主要针对宝宝的，对吧？

The ideal situation is that you kind of look at vaccines in general as to whether or not they're going to prevent the disease burden that generally happens early to the mom, or is it really to the baby, right?

所以这就会决定接种的时机。

And so that'll determine sort of the timing of it.

我们接下来可能会聊聊百日咳，但考虑到婴儿感染百日咳并发症的风险非常高，这就意味着比如百白破疫苗的接种时间要往后推，推到孕27到32周左右。

So we're going to talk about perhaps pertussis in a minute, but the idea that infants, right, can be at very high risk for pertussis complications suggests that you push the vaccination for Tdap, for example, farther down the road, you know, twenty seven to thirty two weeks, etcetera.

而流感就不一样了，包括新冠在内，这些情况女性在整个孕期都可能遇到麻烦。

Whereas influenza, you certainly like in a sense, Covid, these are situations that women can get into trouble throughout.

我觉得有很好的数据表明，流感疫苗可以将住院风险降低差不多40%到50%。

I think that there's really good data that influenza vaccine can reduce hospitalization risk by almost forty-fifty percent.

孕期接种是安全的。

Safe for during pregnancy.

美国妇产科学院也建议所有孕妇接种破伤风、白喉和百日咳疫苗，所以百白破疫苗也非常非常重要。

And the American College of OBGYN is advising all pregnant women that they should receive tetanus, reduce the diphtheria toxoid and pertussis, so the DTaP vaccine is also very, very important.

一部分特定的孕妇群体应该接种肺炎球菌疫苗或脑膜炎球菌疫苗，还有甲肝和乙肝疫苗。

A select population of pregnant women should get pneumococcal or meningococcal, as well as hepatitis A and B.

这取决于个人的暴露情况和风险因素，但怀孕本身就是一种免疫抑制状态，正因为如此，孕妇更容易感染疾病，所以我们可能应该谈谈那个显而易见的问题，也就是新冠。

This is based on the individual exposures and risk factors, but pregnancy is an immunocompromised state, and I guess with that statement, which makes them more susceptible to disease, we should probably move on to the elephant in the room, as it were, and talk about COVID.

最新的数据显示，目前只有大约三分之一的孕妇真正接种了新冠疫苗。

The most recent data right now is that only close to a third of pregnant women have been actually vaccinated against COVID.

有症状的孕妇感染新冠后，死亡风险比非孕妇高出约百分之七十。

Symptomatic pregnant women with COVID have about a seventy percent increased risk of death compared to non pregnant women.

所以我告诉我的病人，怀孕期间感染新冠，住院、进ICU、上呼吸机和死亡的风险都显著更高。

So, you know, what I counsel my patients on is that COVID during pregnancy has a significantly higher risk of hospitalization, ICU admission, ventilator, and death.

今天的话题就是疫苗接种、不孕和怀孕。

And so the topic of today's conversation being vaccinations, infertility, and pregnancy.

我们之前提到的那些病毒当然和不孕没有关系，但正如我们所说，感染这些病毒可能会增加流产和死产的风险，所以你需要保护自己。

The viruses that we've talked about so far have not been associated with infertility, of course, although as we mentioned, getting these viruses could increase the risk of miscarriage and stillbirth, so you wanna be protected against them.

但大约一半或略多一点的人口接种了新冠疫苗，还有很多人没接种，很多孕妇也没接种。

But, you know, roughly half or maybe a little bit more of the population being vaccinated against COVID, it's a lot of people that are not, and a lot of pregnant women that are not.

我们今天能告诉她们什么呢？

What can we tell them today?

我知道你一直在关注这方面的文献，也参加网络研讨会，那我们现在是怎么跟病人说的呢？

And I know that you keep up on this literature and attend webinars, and what are we telling our patients?

最新的信息是什么？

What's the latest information?

为了彻底澄清这个问题，我现在就明确说，绝对没有任何可信的证据表明新冠疫苗会导致不孕或流产。

To put this to rest, and I'll say it right now that there's absolutely no credible evidence for any risk of the vaccine, for Covid, to cause infertility or miscarriage.

那么，Asim，请谈谈你所了解的关于新冠疫苗对生育和怀孕的影响。

So speak about what you know about COVID vaccine for fertility purposes and pregnancy, Asim.

是的，当然，这是个好问题。

Yeah, absolutely, great question.

首先，即使到今天，根据过去二十四小时的最新信息，我们已经知道，加强针已经被推荐并肯定推广给所有之前接种过疫苗的人。

So, you know, first of all, even as of today, we know based on the latest information in the last twenty four hours that boosters now have been recommended and certainly promoted to all people who've been previously vaccinated.

那么，我们稍微谈谈新冠疫苗。

So let's talk about Covid vaccine a little bit.

正如你所说，新冠疫苗非常安全且高效。

As you said, Covid vaccine is incredibly safe and highly effective.

我们有研究表明，在我们可用的这些不同类型的疫苗中，有效性高达百分之九十五。

We have studies that suggest that we have up to ninety five percent effectiveness across these different types of vaccines that we have available.

说实话，很多信息出来的时候，甚至是在德尔塔之前，而德尔塔是目前正在传播的病毒，但这些信息依然站得住脚，你知道吗？

Admittedly, a lot of the information that came out was even before Delta, which is the circulating virus right now, but that's holding a ground, you know?

所以这些疫苗非常有效，事实上，它们是我们拥有的最有效的疫苗之一。

And so these vaccines are of highly effective, some of the most effective vaccines that we have, in fact.

它们就是我们所说的mRNA疫苗，而强生是另一种类型的疫苗。

They are what we call mRNA vaccine or the Johnson and Johnson is a different type of vaccine.

不管怎样，这些都不是活病毒疫苗。

Either way, these are not live viral vaccines.

首先，疫苗不会让你感染。

The vaccines cannot give you the infection, number one.

它们不会导致不孕问题。

They cannot cause problems with infertility.

它们可以和其他疫苗同时接种，特别是如果你在之前十四天内已经接种了另一种疫苗，比如流感疫苗或百白破疫苗，也是可以的。

They can be given with other vaccines that they can be simultaneously given, especially even if you have gladly gotten a vaccine, another type of vaccine in the prior fourteen days, including influenza and Tdap, for example.

有些情况下，在接种辉瑞或BioNTech或莫德纳疫苗大约六个月后，你现在可以接种加强针，而且你不必属于某个特殊风险群体。

There are situations in which after some six months of getting either of the Pfizer or the BioNTech or the Moderna vaccines, you can get a booster now and you don't have to be in some special risk group.

强生疫苗的情况也是一样的。

The same applies for the situation with respect to the Johnson and Johnson vaccine.

你也可以打加强针。

You can also get a booster.

关于孕期接种新冠疫苗，重要的是，马克，你知道，有非常多做得非常好的研究，覆盖了几十个国家，尤其是在美国，这些研究表明孕妇面临很高的并发症风险。

The important thing with COVID vaccine in pregnancy is that, as you know, Mark, there have been incredibly well done studies across dozens and dozens of countries, and especially even in The United States that suggest that pregnant women are at such high risk for complications.

但现在我们知道，根据常规监测，也就是追踪并发症情况，没有发现安全风险或流产风险的增加，也没有不孕不育的问题。

But right now we know that based on routine surveillance, which means tracking the complications, There is no increased risk of safety concerns or miscarriage, no issues around infertility.

这些mRNA疫苗无法整合到你的DNA或基因中，从而引发问题。

These mRNA vaccines cannot integrate into your DNA or your genetics and cause problems that way.

我们知道，疫苗产生的抗体会通过胎盘，保护婴儿，特别是如果你在接近分娩时接种，那么通过胎盘和脐带传递给婴儿的母体抗体就会更多。

We know that the vaccine antibodies that are produced cross the placenta, they protect the infant, especially if you happen to get it closer to the time of delivery, then there's even greater maternal antibodies that are sort of transferred to the infant via the placenta and of course via the cord.

最后，我们知道疫苗抗体也存在于母乳中。

And then ultimately, we know that vaccine antibodies are present in breast milk.

所以这是一种安全的疫苗，即使从……

So it's a safe vaccine even from Is

等到怀孕后再接种疫苗，让抗体更安全地传给宝宝，这样有好处吗？还是说在怀孕前接种了抗体，宝宝就能得到保护？

there any advantage to actually waiting for the pregnancy to get antibodies that would be safer to cross over to baby, or once they get antibodies pre pregnancy, the baby's gonna be protected?

我觉得是这样。

I think so.

我认为目前的逻辑并不是一定要等到孕晚期。

I think the logic right now is not necessarily to wait until the third trimester.

关键是，在怀孕期间接种疫苗，因为我们知道孕妇本身有风险，对吧？

The idea is to just give it during the course of the pregnancy because we know that there's a maternal risk, right?

如果孕妇住院、死亡和并发症的风险增加，比如子痫前期。

If you have increased risk of hospitalizations and deaths and complications, preeclampsia.

所以既要保护妈妈，也要保护宝宝。

So you want to protect the mom as well as you want to protect the baby.

而且我们知道，这些疫苗产生的抗体可以持续存在好几个月。

And we know that based on the antibody sustainability of these vaccines, they are present for months.

所以我认为，如果孕妇在怀孕早期接种疫苗，她们仍然能够让孩子受益。

So I think that if you get, if a pregnant woman gets the vaccine during their pregnancy earlier, they will still be able to benefit the child.

医生。

Dr.

怀孕前。

Pre pregnancy.

所以我的最后一个问题，阿西姆，就是根据你目前对这种疾病的了解，有没有什么现实中的适应症或禁忌症，让某些人不应该接种新冠疫苗？

So, you know, my last question that I have for you, Asim, is that is there realistically any indication or contraindication for someone to not get the COVID vaccine in your understanding of the disease to date?

所以有一些非常罕见的情况，就是人们之前对疫苗中的某些特定成分有严重反应。

So there are very rare situations in which people have had prior severe reactions to any components specifically of the vaccine.

这些疫苗非常简单，但如果对疫苗的某些部分有反应，那就是我们所说的禁忌症。

These are very simple vaccines, but if there are reactions to portions of the vaccine, those are what we call contraindications.

这种情况非常非常罕见，而且真的很难提前知道。

Those are very, very rare and that would be, there would be really very little way to sort of know.

有些人对mRNA疫苗产生了我们所说的过敏性休克反应。

People have had reactions to the mRNA vaccines of what we call an anaphylaxis.

这是因为疫苗中含有一些防腐剂或化学物质，用来确保疫苗的稳定性。

And that's because of some of the preservatives or the chemicals that are present to sort of, you know, make sure that the vaccine is stable.

但我要说的是，没有禁忌症。

But I would say there are no contraindications.

这些疫苗非常有效，我觉得大家应该充分利用。

These are incredibly effective vaccines and I think people should they should take full advantage.

另外，确实有一些合理的担忧，比如所谓的神经系统风险，或者心肌炎，或者感染，或者心肌炎症。

The other thing is that there are some concerns legitimately about so quote neurological risks or myocarditis or infection or inflammation of the heart muscle.

再说一次，如果某人之前有过这些疾病的情况，他们可以和医生讨论疫苗的相对风险。

Again, if somebody has had a prior condition in which some of those diseases have been present, then they can talk with their doctor about the relative risks of the vaccines.

但再说一次，这些疫苗的不良事件极其罕见，非常罕见。

But again, these vaccine adverse events are extremely rare, very rare.

它们发生在数百万剂疫苗中的几十例或几十例。

They're happening in numbers of tens or twenties among millions of vaccine doses.

所以总结一下，当然，新冠疫苗绝对没有证据表明会导致不孕或妊娠并发症，而且如果有的话，我们当然看到它大大降低了母婴受到伤害的风险。

So to summarize, of course, the COVID vaccine, absolutely no evidence that it causes infertility or complications in pregnancy, and if anything, of course, we're seeing that it dramatically reduces the risk of harm to mom and baby.

我们没谈到的，Asim，简单说一下，是对婴儿的风险。

What we didn't talk about, Asim, just briefly, is the risk to baby.

妈妈在怀孕期间感染新冠，特别是出现症状时，宝宝的情况怎么样？

How are these babies doing when mom gets COVID during pregnancy and particularly symptomatic?

对，和百日咳或流感这类疾病不同，那些病可能会让婴儿病得很重，但一般来说，我们知道儿童的整体发病率和死亡率一直都非常低。

Right, so unlike other diseases like pertussis, where infants can actually get really, or influenza where they can really get ill, in general, we know that the overall morbidity and mortality to children has been extremely low.

不过，随着德尔塔变异株传播加剧，儿童住院人数出现了前所未有的增加，尤其是五岁及以上的孩子。

That said, with the increased transmission of Delta variant, there have been an unprecedented overall number of hospitalizations with kids, especially five of ages five and up.

现在幸运的是，我们也有疫苗来保护他们。

Now we fortunately have the vaccine to protect them as well.

所以我认为对婴儿本身的风险并不算严重，但话说回来，我们也不希望孩子成为传播者。

So I don't think that the risk to infants per se is of any serious magnitude, but that said, we don't want children to be spreaders.

很多时候，他们常常是无症状的病毒传播者，会把病毒传给别人。

And a lot of times they are often asymptomatic spreaders of virus to others.

阿西姆，关于新冠和疫苗接种，我们真的可以一直聊下去，这对我们国家和全世界来说都是非常重要的话题。感谢你抽出时间来和我们交流。

Well, Asim, you know, we could just keep talking and talking about COVID and vaccinations, such an important topic for our country and the world, and I thank you for the time that you took out of your day to meet with us.

刚才和我对话的是医生。

I've been speaking with Doctor.

阿西姆·贾尼，他不仅是我的好朋友，还是一位传染病和医学流行病学专家，他为我们提供了很多关于怀孕前接种疫苗的深刻见解，特别是我们谈到的风疹、水痘、甚至麻疹、破伤风，当然还有流感和新冠。

Asim Jani, who is not only a dear friend, he is an infectious disease and medical epidemiologist specialist who has provided us with tremendous insights over the need for vaccinations for the diseases prior to pregnancy, particularly we talked about rubella, varicella, even measles, tetanus, and of course the flu and COVID.

如果你有兴趣怀孕，请咨询你的妇产科医生，以保护你和宝宝。

Please speak with your OB GYN if you are interested in getting pregnant to protect you and baby.

所以感谢你的收听，下次再见，我是医生。

So I thank you for listening, and until next time, this is Doctor.

马克·查尔斯。

Mark Chrales.

保重。

Take care.

谢谢。

Thank you.

本播客中表达的信息和观点不一定代表ASRM及其附属机构的观点。

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates.

这些内容仅供参考，不能替代医生的咨询。

These are provided as a source of general information and are not a substitute for consultation with a physician.