RSV protection, heartburn, and membrane sweeps

Welcome to the weekly ZIP - your Zenith Informed Pregnancy!

Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research. 

A quick note before we get into this week’s top questions: October is Pregnancy and Infant Loss Awareness Month, with a Remembrance Day held this week on October 15, and we honor the memory of all of the babies lost too soon. This kind of loss is deeply personal, yet far more common than many realize. Each year, millions of parents around the world grieve loss due to miscarriage, stillbirth, TFMR, SIDS, illness, or neonatal death. While often unspoken, know that if you are a mother experiencing or grieving a loss, you are not alone and that there are many resources available to support you and your family (some of our favorite organizations include Pregnancy After Loss Support (PALS), Postpartum Support International, and March of Dimes, among others).

This week's top pregnancy questions:

1️⃣ Pros/cons of the maternal RSV vaccine vs monoclonal antibody for infants?

2️⃣ Why do I get so much heartburn?

3️⃣ What’s a membrane sweep, and is it effective for starting labor?

Pros/cons of the maternal RSV vaccine vs monoclonal antibody for infants?

RSV season is picking up, and with both a maternal vaccine and infant antibodies available, many expecting moms are wondering which option best protects their baby.

📚The tl;dr from the evidence: The data shows that both can be very safe, effective choices. There haven’t been any head-to-head studies comparing the two approaches directly, although modeling studies and real-world data suggest that the infant antibody may provide slightly more consistent and higher levels of protection, especially for babies born early or outside of the RSV season. 

The maternal vaccine is effective when given between 32-36 weeks, and at least 2 weeks before the baby is born - so timing is an important factor. If given within this window, the baby is protected from birth for up to 6 months, and would not typically need an additional shot.  Alternatively, the infant antibody is given via an injection after birth, and provides immediate protection. It may not be available in all settings immediately after birth, so plan ahead and ask your provider early.

Ultimately, given the strong safety and efficacy of both, it’s up to your own preferences and personal situation to determine which is ‘best’ for you and your baby if you’ll be giving birth during RSV season (~September to ~January).

👀 Read Penny’s full summary of the evidence for more on protection against RSV

Why do I get so much heartburn?

Heartburn is one of pregnancy’s least fun (but most common) symptoms – and no, it’s not just the baby’s hair (despite the myth). Up to 80% of moms experience it, often turning every meal into a game of “is this worth the heartburn?” – so why is it so common, and what can you do about it?

📚The tl;dr from the evidence:  A combination of hormonal changes and the physical pressure of the uterus pushing on your stomach is to blame. The increased levels of estrogen and progesterone both relax the muscle that usually prevents stomach acid from rising up into your esophagus, AND slows down your digestion, so food and acid stays in your stomach for longer. All of these can result in an increased likelihood of stomach acid being pushed upward, resulting in heartburn.

There’s not a perfect “cure,” but small lifestyle adjustments (like smaller meals, limiting/avoiding spicy, fatty, or fried foods, and avoiding meals close to bedtime) can help improve symptoms. If needed, antacids containing calcium, magnesium, or aluminum are generally considered safe. If these interventions don’t work and your heartburn is severe, or disrupts your ability to sleep or eat, your doctor may also recommend medications like omeprazole or famotidine and can work with you on a specific and detailed plan for support. 

👀 Read Penny’s full summary of the evidence for more on heartburn and what you can do about it

What’s a membrane sweep, and is it effective for starting labor?

When you’re nearing your due date, few topics spark more curiosity (or mixed advice) than ways to try and induce labor, like membrane sweeps (or eating dates… check out last week’s feature if you missed it!). Membrane sweeps are often offered at or past 39 weeks, so here’s some of the context to help you decide if it’s right for you.

📚The tl;dr from the evidence:  A membrane sweep is a procedure performed by your doctor once your cervix has started to dilate, and involves manually separating the amniotic sac from the uterine wall. It can increase the likelihood of  spontaneous labor by up to 20% (although it will not result in labor for all women). 

There are some risks associated with the procedure, such as discomfort, irregular contractions, and less frequently, your water breaking prematurely, but is overall considered a low-risk intervention to help induce labor naturally for women who want to avoid a formal induction.

If your provider suggests it, you can always choose to decline - membrane sweeps are a medical procedure that should only be performed with your informed consent. If you have questions or concerns about a potential membrane sweep, make sure you have a proactive conversation to better understand the procedure and your preferences with your doctor. 

👀 Read Penny’s full summary of the evidence for more on membrane sweeps

🤓 Zenith's top read of the week

Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!

Women’s Health Should Be a Bipartisan Priority (Maria Shriver, Time) - Pregnancy health has been dominating major news cycles, with questions like “should pregnant women do X” becoming politicized with or without regard for the science and evidence behind the purported answers. This piece by journalist and women’s health advocate Maria Shriver argues for women’s health as a top priority across both sides of the aisle, and the consequences of not joining together across political divides to advance research and improve the health of women – in pregnancy and beyond. 

Key excerpt:

“...To millions of young mothers and pregnant women, the announcement landed like a thunderbolt—another reminder of how often women are told to “tough it out” rather than given real research, guidance, and support when it comes to their health…. It would be a great national service to provide women of all ages with medical information based on facts, science, and research so that they can make sound decisions about infertility, pregnancy, or menopause.”