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A podcast by millennials, for millennials, covering health challenges unique to Gen Y. Get expert insights, practical patient advice, and inspiring survivor stories to help you make informed healthcare choices. Empower your journey with YMyHealth!
Melissa Schenkman (00:40)
So for a lot of us, know that preventive care, it's not always the easiest thing. And preventive care in pregnancy, which requires so many different things that you're trying to keep track of, is even a little bit more complicated. And at YMyHealth, we always like to stay cutting edge on things. And one of those cutting edge topics has to do with RhoGAM, the RhoGAM shot, which there's kind of a trend that...
people in their pregnancy now are refusing to get the RhoGAM shot. And so we wanted to explore what this is all about. And we're very fortunate to have Katie Shanahan with us. She is a nurse practitioner, a mom, and she went through alloimmunization during her first pregnancy and then became the director of development for Allo Hope Foundation, which is an incredible organization, bringing education awareness to moms during alloimmunization, but also wanting to bring that
preventive knowledge ahead of pregnancy to those of us who are of childbearing age, which are part of our YMyHealth community. So I want to welcome you, Katie.
Katie Shanahan (01:45)
Thank you. Thank you for having me.
Melissa Schenkman (01:47)
Thank you so much for joining us. If you could kind of start a little bit, we'll kind of back up from the beginning with all immunization, just what that is exactly because we hear these terms and we don't always know.
Katie Shanahan (01:45)
Yeah. So, alloimmunization is a rare pregnancy condition and it's where the mother's body creates antibodies, which is a normal process of the immune system. But when you're pregnant, it can be an issue because it can attack your baby's red blood cells and destroy them and cause the baby to become anemic in utero, which is something that needs to be treated. And that disease is called hemolytic disease of the fetus and newborn or HDFN.
And if a baby does become anemic in utero, the only treatment is a blood transfusion called an intrauterine blood transfusion where they deliver blood to the baby in utero, which is medically incredible, but very scary. And this is the rare pregnancy disease I had with my son and with the right monitoring and care was able to have a positive outcome.
Melissa Schenkman (02:49)
That's absolutely wonderful and why we are so fortunate that you are sharing your story with us and helping educate others. For this particular condition, there is something that can make a big difference and that's this RhoGAM shot. You could tell us a little bit what RhoGAM is, how it works, and what role does it play in alloimmunization?
Katie Shanahan (03:13)
Yeah, so RhoGAM is actually the brand name. The drug itself is Rh immune globulin, but we will call it RhoGAM just for ease because that's what most people know it by anyways. It's a medication used to prevent women who are Rh negative from becoming sensitized or allo immunized, which means developing antibodies. So there are over 50 types of antibodies, but RhoGAM only helps prevent against the development of one, which is called anti-D. So sometimes you'll hear a RhoGAM referred to as the anti-D injection.
And once you have these antibodies, you'll have them for the rest of your life. So there's no going back, which is why prevention with this medication is so important. The medication itself is actually created from human blood plasma. It's made from other people's anti-D antibodies, which is crazy, but basically...
The small amount of anti-D antibodies that's injected into a mom tricks their immune system into thinking it's already producing antibodies so that it doesn't need to make more. But in reality, these injected antibodies will eventually die off and it protects the mom from developing them in the future when they might affect her future pregnancies.
Melissa Schenkman (04:25)
So that makes a lot of sense and is really, I think, interesting as we kind of put into perspective the importance of this shot. So how does RhoGAM fit into what the standard of care for pregnancy is?
Katie Shanahan (04:41)
RhoGAM is given to all or should be given to all Rh negative women during pregnancy. So it's routinely given at 28 weeks gestation within 72 hours after birth. And then with any miscarriage, abortion, vaginal bleeding during pregnancy, invasive testing like an amnio, any major things that go on with your pregnancy if you're Rh negative.
Melissa Schenkman (05:04)
That's very helpful to know. There has been this ongoing trend of pregnant women refusing to get the program shot when it's offered to them. When did this start about, would you say?
Katie Shanahan (05:17)
Yeah, I think there has been and will always be people who have been weary of preventative medicine, especially when it comes to routine vaccines or medications. We see this very unfortunately with childhood vaccines, but really in the last few years since the COVID pandemic, we've seen increasing numbers of vaccine hesitancy since the development of the COVID vaccine. And unfortunately, that's included RhoGAM.
I also think over the last couple of years, women have felt a lot of external pressure about external medical decisions and what they can and cannot do with their bodies. And while pregnant women have every right to refuse medically recommended treatment, they also really carry the responsibility of understanding why that treatment is being recommended in the first place and what the true consequences of refusing that treatment are.
Melissa Schenkman (06:11)
That's an excellent point and it's interesting because I think a lot of people will be hearing for the first time when they listen to this that the vaccine hesitancy extends to this because I don't think people know that. And also to your point that the kind of change in a lot of different parts of the country and our autonomy with our healthcare decisions, people might not recognize that it's playing a role here as well. What kind of have you been hearing? from women as to what their reasons are, other than the broader public health perspective you were providing.
Katie Shanahan (06:49)
Yeah. One of the main things we see is that women want to have a more natural pregnancy and completely understandable. But the truth is not getting RhoGAM and having an allo-aminase pregnancy is the most unnatural pregnancy you could possibly have. If you skip RhoGAM, you do have a very high possibility of becoming sensitized. And I experienced this condition myself after not being offered RhoGAM when I should have been.
and it's truly something I wouldn't wish even on my own worst enemy. For me, just to explain how unnatural these pregnancies are, I had weekly ultrasounds, invasive procedures, epidurals with each procedure so that I didn't move, I was induced, I had a two-week stay with my baby in the NICU where he got all sorts of unnatural, quote unquote, unnatural therapies.
He had multiple blood transfusions, weekly labs. I mean, the list just goes on and on. And so really the best way to protect your natural pregnancy, if you want an intervention-free pregnancy or you want that home birth, is to get RhoGAM. The side effect profile is very minimal compared to other vaccines. It has a short half-life, so it means it's in your body for a very short period of time.
And this isn't a medicine that's preventing something that's very unlikely to happen or something that isn't very deadly like, you know, the chickenpox vaccine. You carry a 20 % chance of becoming sensitized if you don't receive the medication and the consequences of HDFN can be so, so severe. And I think another thing that we hear a lot is it's just medicine or science, technology, pharma, what have you driving this rogue am agenda.
And I'm not going to say there aren't issues when it comes to some of these things, but if it really was all about the money, they would actually stop giving RhoGAM because these aluminized pregnancies are so expensive and lucrative financially for the medical system. I mean, we totaled some of my son's medical bills and he like pre-insurance and it was almost a million dollars. So if they really wanted to make money, they would stop giving it.
Melissa Schenkman (09:07)
Seriously, my gosh, that definitely puts that into perspective for sure.
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Melissa Schenkman (10:06)
So for those who are concerned about getting the real game shot and they're on the fence, what would you recommend that they do?
Katie Shanahan (06:49)
Yeah, and I want to say that I'm like slightly biased because I've experienced this disease because I didn't get it when I should have. But I also want people that are listening to understand like it's your body and you can make the medical decisions that are best for you. But I also want people that understand truly what that consequence could be. So to answer this question, I think it's helpful to briefly touch on the reasons you wouldn't need RhoGAM. So there's only a few reasons.
The first is if you're Rh positive. So if you're a positive blood type, you don't need RhoGAM. It's only for women with a negative blood type. You also don't need RhoGAM if you've developed anti D antibodies. But this third group of people are my main recommendation, which you do not need RhoGAM if you are Rh negative and you're carrying an antigen negative fetus. So.
How do you find this out? There's testing available called cell-free fetal DNA testing in pregnancy. This is something that's pretty commonly drawn already on pregnant women at 10 to 12 weeks to see people try to find out if there's any major chromosomal abnormalities or find out their gender early. But they can actually now test the blood type and antigen status of the baby. So if the baby is also negative, then mom doesn't need RhoGAM.
So it's a wonderful test. It's just a blood drawn mom. It tests circulating fetal DNA. It's available pretty much anywhere in the U.S. And if a mom is on the fence, it's really a great way to determine if RhoGAM is even indicated in the first place. And it also helps with supply issues. I mean, you're keeping doses for Rh negative women that are carrying a positive fetus. And this is actually something that's done routinely in other countries and the U.S. is integrating it more and more. Now, so that there's been a shortage of RhoGAM recently.
Melissa Schenkman (12:02)
That's extremely interesting to think about. And when we think about preventive care, because preventive care, the concept, the term, it's something that's so important to our generation across the board. So why would you say is the RhoGAM shot a crucial piece of preventive care in pregnancy?
Katie Shanahan (12:27)
Yeah, I mean, the bottom line is RhoGAM has really dramatically decreased our immunization rates. It's gone from 20 % from when we didn't have the drug to 1%. So we hear a lot of people say, well, this disease is so rare, I don't need it. But this disease is rare because RhoGAM exists, which in itself should be enough evidence to show that it's working, but it's truly saved so many lives. Like it's one of the most miraculous medical interventions of our time.
And I don't think people understand what our world was like 60 years ago before this medication existed. So to kind of like paint a picture of this, I want people to understand that there still is a reality where RhoGAM doesn't exist, and this is in developing countries. So the Allo Hope Foundation, which is who I work for now, we do a lot of work in sub-Saharan Africa, and they don't have routine blood typing in pregnancy, and they don't have access to RhoGAM.
So they're living in a world that we experienced 60 years ago without RhoGAM, and we've seen women who have lost six, seven, eight babies because they don't have access to this medication. So the more and more women who start to refuse this medication, I think we're reverting back to what our world was like before it existed. And we're really lucky to live in a place where we have access to it and would really be taking it for granted if we didn't receive it.
Melissa Schenkman (13:59)
Absolutely, absolutely. And I think that really helps to understand how incredibly valuable it is for people.
Katie Shanahan (14:06)
Yeah, yeah. And I mean, I understand people's hesitancy and I understand wanting more information about something that you're putting into your body when you're pregnant. Absolutely. That's completely valid. But in doing so and having this hesitancy and questioning this, I just want women to make sure they're finding trusted, reputable, evidence-based resources. Absolutely. And for me, this wouldn't include like Reddit posts or bias groups.
Melissa Schenkman (14:48)
It's really so important for women to have the right information and all of their information they need to make their own informed decisions about their own health care and the health care of their babies. So just finding trusted resources.
And we're going to put in the show notes, we'll have the link to The Allo Hope Foundation.
Katie Shanahan (14:54)
We're actually in the process of creating an entire page about RhoGAM. awesome. And I'm hoping that it can be very unbiased. I know we're coming from a biased place, but I just want to, I want people to have all the information that they need when they're trying to make this decision.
Melissa Schenkman (15:10)
Absolutely, I think that's incredibly important. I think that'll really make a difference in the current trend they are seeing because so many of us, it's really just a matter of finding that information, that perspective. What you were saying before about the difference in the percentage of the population who had alloimmunization before RhoGAM's existence, now, mean, the numbers speak for themselves. And I think that's incredibly important to hear.
So I want to thank you so much, Katie for joining us and I want everyone to know that if you'd like to learn more about Katie's story in full and her experience and her journey to working with The Allo Hope Foundation and providing the incredibly helpful information she has with us in this episode. You can check out the other full episode with her story as well. So thank you so much, Katie, for joining us.
Katie Shanahan (16:03)
Great. Thank you for having me. Thanks for tuning into the YMyHealth podcast. We hope you're leaving inspired and important.
Melissa Schenkman (16:04)
You're so welcome.