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(NEW YORK) -- Pregnant women with COVID-19 had a higher risk of complications and death than those who did not contract the virus, adding further evidence to the increased risks the virus poses during pregnancy, according to a new study.

The global study, published Thursday in JAMA Pediatrics, found that pregnant women who contracted COVID-19 were 22 times more likely to die than pregnant women who did not contract the virus. They also were found to have an increased risk of severe pregnancy complications, including preeclampsia, preterm birth and intensive care unit admission. Individuals who were symptomatic or had comorbidities, such as diabetes or were overweight, had a greater risk of complications and death, researchers said.

Pregnant women who had asymptomatic infections had a higher risk for preeclampsia, though otherwise had similar outcomes to pregnant women who were not diagnosed with COVID-19, researchers said.

Newborns of the women diagnosed with COVID-19 were more likely to be born preterm and have severe complications, including NICU stays of seven days or longer, the study found.

"The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures," the authors said.

Doctors from the University of Washington School of Medicine and the University of Oxford led the research. The study enrolled 2,130 pregnant women from 43 maternity hospitals in 18 countries and was conducted from April to October of 2020.

"I would highly recommend that all pregnant women receive the COVID-19 vaccines," Dr. Michael Gravett, a professor of obstetrics and gynecology at the UW Medicine and one of the study's lead authors, said in a statement.

There is limited data on the safety of COVID-19 vaccines in pregnant people. A study published in the American Journal of Obstetrics & Gynecology in March found the Pfizer and Moderna vaccines are safe and effective in pregnant and lactating people.

The U.S. Centers for Disease Control and Prevention advises that pregnant people "might choose to be vaccinated." Pregnancy is classified as a high-risk medical condition by the CDC, which notes that "although the overall risk of severe illness is low, pregnant people are at an increased risk for severe illness from COVID-19 when compared to non-pregnant people."

The World Health Organization recommends that pregnant women at high risk of exposure to COVID-19 or who have comorbidities that would increase their risk of severe disease get vaccinated in consultation with their health care provider.

The UW Medicine and University of Oxford study enrolled 706 women with a COVID-19 diagnosis. Each woman diagnosed with COVID-19 was compared to two uninfected pregnant women who gave birth at the same hospital around the same time, according to UW Medicine.

Among the women diagnosed with COVID-19, 13% of infants tested positive for COVID-19 at birth. Cesarean delivery increased the risk for a positive COVID-19 test in infants, though breastfeeding did not, researchers found.

Shortness of breath, chest pain and cough with fever were associated with a "substantial" increase in the risk of complications for the mother and preterm birth, the study found.

Under 2% of those enrolled in the study who had a COVID-19 diagnosis died. Of those 11 women, four had severe preeclampsia, five had respiratory failure before the birth, and two died within a week of delivery after being admitted to the ICU. One woman who did not have a COVID-19 diagnosis died due to preexisting liver cancer and cirrhosis.

The study mostly included women in their third trimester. Further research of the effect of COVID-19 earlier in pregnancy "needs urgently to be studied," the study's authors said.

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(NEW YORK) -- A 14-year study comparing the diets of American children and adults showed that food from schools actually came out on top.

In looking at diets from 2003-04 to 2017-18, a study by the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University analyzed meals eaten by thousands of American children and adults in a range of sociodemographic groups. They analyzed the overall nutritional quality in meals served at locations such as restaurants, workplaces and schools.

More than 20,000 children ages 5 to 19 and nearly 40,000 adults 20 or older were included in the study.

An overall quality score was calculated using the American Heart Association diet score and the Healthy Eating Index 2015. Using those calculations, diets were classified as poor (less than 40% adherence), intermediate (40-79.9% adherence) or ideal (80% or more adherence).

Dr. Amanda Benarroch, a resident in the ABC News medical unit, explained that "children had worse overall diet quality than adults with the notable exception of schools, which had the highest overall diet quality of any source included in the study."

The study's authors suggested that improving access to grocery stores remains a top priority when it comes to improving Americans' diets, especially as the pandemic limited children's access to meals at school.

The study also showed that restaurants needed to improve, with 65% of adult meals and 80% of meals served to children considered nutritionally poor. Over the course of the study, restaurant meals for children improved slightly while adult means remained basically stagnant -- the worst overall in diet quality.

Most of the improvement seen in school meals occurred after 2010, which the study attributed to increased offerings of whole grains, fruits, greens and beans, as well as eliminating more sugar-sweetened beverages, refined grains, added sugar and saturated fats.

Benarroch pointed out that that change "coincided with the 2010 Healthy, Hunger-Free Kids Act, which mandated nutrition standards."

The diet quality observed at locations for entertainment, sports or recreation, including food trucks, appeared to worsen over the course of the study.

"By 2017 to 2018, diet quality of foods from schools increased significantly and equitably and provided the highest mean diet quality of any major food source," the study concluded. "Modest improvements were identified in diet quality for foods consumed from grocery stores, small improvements for foods consumed from restaurants, and stable or worsening diet quality for foods consumed from other sources, all with persistent or increasing disparities."

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(FORT MADISON, Iowa) -- Dozens of inmates at an Iowa prison were given overdoses of a COVID-19 vaccine, officials said.

Two medical staff members from the Iowa Department of Corrections incorrectly administered the vaccine -- developed by U.S. pharmaceutical giant Pfizer and its German partner BioNTech -- to 77 inmates at the Iowa State Penitentiary, a maximum-security prison for men located in Fort Madison, about 90 miles southeast of Iowa City. The dosages given exceeded the amount recommended by the vaccine manufacturer, according to Cord Overton, spokesperson for the Iowa Department of Corrections.

Upon learning of the error, the Iowa Department of Corrections immediately contacted Pfizer and the Centers for Disease Control and Prevention for guidance. Both Pfizer and the CDC said not to expect any major side effects but that the affected inmates should be closely monitored for at least 48 hours, according to Overton.

ABC News has reached out to Pfizer, BioNTech and the CDC for comment.

The affected inmates have been notified of the error and are being closely monitored by medical staff. The Iowa Department of Corrections plans to conduct medical wellness check-ups routinely for several days. So far, the only side effects that the inmates have experienced are those commonly associated with the Pfizer vaccine, Overton said.

The Iowa Department of Corrections has temporarily halted administration of the two-dose vaccine at the Iowa State Penitentiary pending an investigation into the matter. The two staff members who made the error have been placed on administrative leave in the meantime, according to Overton.

Currently, 200 inmates at the Iowa State Penitentiary have received their first shot and 48 inmates have received their second shot. Across the entire Iowa Department of Corrections, 1,964 inmates have received their first dose and 214 inmates have received their second dose, according to Overton.

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(NEW YORK) -- On April 13, the Centers for Disease Control and Prevention and Food and Drug Administration recommended temporarily pausing use of the Johnson & Johnson vaccine after six women experienced a rare blood clot out of nearly seven million shots given.

While some vaccination clinics were able to quickly pivot to using vaccines from Pfizer and Moderna, the impact was felt acutely at more than 7,000 sites that were only using the Johnson & Johnson vaccine at the time.

According to the CDC's website, approximately 10 million Johnson & Johnson shots are now sitting at pharmacies, waiting for the pause to be lifted.

But now, more than 10 days later, public health experts are increasingly critical of the move, pointing out that the nation-wide pause may be causing more harm than good -- especially in communities that benefited most from the convenient single-shot vaccine.

With the CDC's advisory committee set to meet again on Friday, the risk of this rare type of blood clot following the Johnson & Johnson vaccine still appears to be extraordinarily small -- less than one in a million.

Meanwhile, the risk of developing a blood clot from a COVID-19 infection -- or dying of the illness -- is exponentially higher.

Because the Johnson & Johnson vaccine is highly effective at preventing COVID-19, many experts argue that withholding this particular vaccine may put unprotected people at even greater risk of harm.

And like so much else in this pandemic, the temporary pause may be having a disproportionately negative impact on less privileged communities.

Unlike the Pfizer and Moderna vaccines, which both require two doses and ultra-cold storage, the Johnson & Johnson vaccine provides COVID immunity with just one dose and can be stored at regular refrigeration temperatures. These uncomplicated logistics made it a gamechanger for anyone without easy access to a vaccination center.

“It just makes it more feasible for people in rural areas, people without a car or good public transportation, also prisoners and homebound populations,” said Dr. Amesh Adalja, FIDSA, infectious disease specialist and senior scholar at the Johns Hopkins University Center for Health Security.

Adalja adds that Johnson & Johnson’s “one-and-done” dosing means that it only takes two weeks to reach COVID immunity. With Pfizer or Moderna vaccines, it takes five to six weeks to get there.

“The longer it takes for individuals to be immunized, the more risk there is for suffering severe consequences from infection. So, if the Johnson & Johnson vaccine was the only path to certain demographic groups being vaccinated, I think the pause will translate into hospitalizations and some level of death overall,” Adalja said.

The risks of contracting COVID or suffering severe complications of a COVID infection, including death, are “probably even greater than that for the individuals who will be most affected by the J&J pause,” said Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital. That’s because the hard-to-reach populations who stood to benefit from the more easily accessible Johnson & Johnson vaccine are also populations with disproportionately high rates of disease, hospitalization and death, he explained.

“The J&J vaccine was an important tool for vaccinating especially vulnerable and hard-to-reach populations, including homeless persons and migrant workers,” said Dr. Celine Gounder, infectious disease specialist and member of the Biden-Harris Transition Team COVID-19 Advisory Board, in an email to ABC News.

The CDC's advisory committee (ACIP) will meet Friday, April 23, to discuss the small risk of a rare blood clot and the nation's top infectious disease doctor, Dr. Anthony Fauci, has predicted that the committee will make a decision about whether to lift the pause.

“At the same time, it's important not to create the impression that we are using an inferior vaccine to vaccinate vulnerable people. It's essential that the FDA and CDC review the data carefully before lifting the pause, and I anticipate that they will do so after the next meeting of the ACIP,” said Gounder.

“Hopefully we can overcome all of this and the pause will end soon. Hopefully we can meet those higher-risk people that need to be vaccinated right now with the Moderna and Pfizer vaccines. We’ll need to come up with innovative ways to bring those vaccines into harder-to-reach communities,” said Adalja.

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(NEW YORK) -- Three million Americans are getting vaccinated against COVID-19 every day and half the country has received at least one shot. Cases of the deadly virus are well below peak levels.

Doctors and scientists agree that, at least for the foreseeable future, indoor masking is here to stay. Vaccines may not offer complete protection and contagious variants continue to pose a risk. Masks remain an important tool in preventing spread, both indoors and outdoors. But experts suggest that when you are alone outdoors and far from others you may not need to wear your mask. But definitely keep it handy.

Even when outside, “the risk is not zero,” said Dr. Jay Bhatt, an internist in Chicago. “With people that you're not sure if they're vaccinated or not, then you have to consider masking.”

It’s important to think like a doctor would -- consider the amount of time you’ll be in a specific place, what’s the air flow like, how many people are around you and the amount of COVID cases in your area.

The spread of more contagious variants also remains a concern.

“The enhanced contagiousness of these variants means, obviously, that we should take greater care. We should be more careful than carefree,” said Dr. William Schaffner, an infectious disease and preventative medicine specialist at Vanderbilt University.

But experts suggest that the data guiding masking policies outdoors is limited.

Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital, said wearing masks outdoors gained momentum when “we were in the height of surges, when there was not a huge amount of insight into how transmission was occurring.”

As we’ve gathered more data, Brownstein said “the bulk of all transmission events are taking place indoors and outdoor transmission is very low.”

So when can you consider going mask-less outside?

When you are alone outside or with your household, you may not need to mask up, although you’ll want to keep your mask handy, experts suggest. Even if you don’t expect to run into other people, you can’t plan for everything -- and it’s better to be safe.

“If you're out walking your dog, do I think you need to wear a mask? No. Should you have your mask with you? Yes,” said Dr. Mary Beth Graham, medical director of infection prevention and control at Froedtert Hospital in Wisconsin.

And it’s important to keep local laws in mind regarding mask use, even if you are alone outside.

“We do have to comply with local rules and laws so it's most important to make sure you know what the rules are, wherever you happen to be,” said Dr. Nirav R. Shah, a senior scholar at Stanford University.

For outdoor locations with lots of people, wearing a mask is still recommended.

“We know that these infections can be transmitted outdoors with large gatherings of people in proximity such as rallies, parties and concerts,” said Bhatt. "Even a socially distanced concert or socially distant event. I would mask.”

Also, in areas where the overall rates of COVID-19 infection remain high, taking your mask off may not be the best option.

“There's contexts in which we may want to keep masking outdoors, especially if there's a major surge, like a place like Michigan,” said Brownstein.

Despite ongoing vaccination efforts, we still have a ways to go before we reach the herd immunity that may be needed so we can stop wearing masks altogether, said Schaffner.

Getting to “that level of community protection, where we can all go back to what looks like an old normal, that's going to be very, very difficult unless we get very, very much increased participation,” Schaffner added. “Supply of vaccine now exceeds demand. We have vaccine in the refrigerator, waiting for arms to show up to go into. And vaccine in the refrigerator never prevented any disease.”

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(NEW YORK) -- The daily pace of vaccinations nationwide appears to be flattening out and could be on the decline, suggesting that America is moving from a phase of desperate vaccine searches to one of aggressive government outreach and education to sway those who have not yet scheduled an appointment.

More than half of U.S. adults have had at least one vaccine shot. But according to data on daily vaccinations from the Centers for Disease Control and Prevention, the seven-day average count of people receiving their first dose of the COVID-19 vaccine started dropping slightly nine days ago.

While an average of nearly 1.9 million people a day came in to get their first dose of the vaccine during the week of April 11, the average for the week of April 16 was around 1.47 million. The total doses the U.S. has administered nationwide since vaccines were first authorized has also flattened out over the past few days, CDC data show, interrupting the exponential growth of the last few months.

And on Wednesday, a daily update from the Department of Health and Human Services showed numbers were down this week to an average of just over three million shots administered a day, when on Friday, the country was averaging about 3.35 million a day.

The decline started one day before the Johnson & Johnson vaccine was suspended, suggesting the nationwide "pause" might not be the primary factor, even if it may have contributed.

In fact, most experts say there is no sole factor. The drop in the weekly average could be because most Americans who were actively seeking out the vaccine already got their shot and the remaining millions of people are taking a wait-and-see approach or have outstanding concerns about the vaccines. It could be because elderly people -- the highest risk demographic -- have largely been vaccinated and young people are less eager to get the shot. Or it could be because access to the vaccine -- whether it's proximity, taking time off work or finding transportation -- are all barriers for people who want a shot. Likely, it's a combination of it all and then some.

"What happened is we had this initial big wave of demand, especially among people that were most vulnerable," said Dr. John Brownstein, an epidemiologist at Boston Children's Hospital and an ABC News contributor.

But the desire to get a vaccine is less among young people, "so even if eligibility opens up, there's potentially less demand," he added.

At the same time, any inconvenient hurdles during the process of getting a shot could compound any lingering reluctance.

"Not everyone can get to a mass vaccination site; not everyone can use the existing web tools," Brownstein said. "Even though we may see a map that has a lot of sites, it's not necessarily the most convenient, especially for those that are essential workers who can't take the time off work."

President Joe Biden, during a speech on Wednesday to celebrate his administration getting 200 million shots into arms since he's been in office, acknowledged that there's still a lot of work to be done to smooth the vaccination process in a way that encourages the rest of the country to step up for a shot.

As of Wednesday, 26% of the population was fully vaccinated and 40% had at least one shot. Experts predict the U.S. will need 70-90% of people to get vaccinated before the country can reach herd immunity, although they say it's hard to know for sure how many vaccinations will be enough.

"The vaccine is free. It's convenient. And it's increasingly available. But I know that isn't enough," Biden said.

Biden listed some policy solutions, like increased vaccine supply to local pharmacies and federally run clinics so that 90% of Americans are within 5 miles of a vaccination site. He also called on all businesses to give employees paid time off when they get their shots or need to recover from any side effects. Biden announced a new tax policy that would allow all small and medium-sized businesses to apply to be reimbursed for the time off they give their employees.

But Biden's administration also said on Wednesday that it's not using the pace of shots to try to determine vaccine acceptance because there are so many variables.

"We don't think that we're talking about a group of people that are quote, unquote 'vaccine hesitant,'" an administration official told reporters ahead of Biden's speech, speaking on condition of anonymity.

"People have questions about the vaccine. Those questions need to be treated legitimately instead of casting them in a broad pool of people and saying, 'hey you're 'vaccine hesitant,'" the official said. "We're confident that people are going to end up making the right decisions. So we're not really measuring all that by the pace."

At the same time, a new report Wednesday from the Kaiser Family Foundation, a non-partisan resource on national health issues, found the country appears "quite close to the tipping point where demand for, rather than supply of vaccines is our primary challenge."

"Federal, state, and local officials, and the private sector, will face the challenge of having to figure out how to increase willingness to get vaccinated among those still on the fence, and ideally among the one-fifth of adults who have consistently said they would not get vaccinated or would do so only if required," according to the report.

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Kelly McCarthy

(NEW YORK) -- Rediscovering a healthy relationship between food, mind and body is no small task, but one expert has an approach that makes you the expert -- with principles adhering to your body's instincts.

Award-winning dietitian and celebrated author Evelyn Tribole shared her wealth of knowledge on intuitive eating with ABC News' Good Morning America, offering tips for those looking to try out the lifestyle change that ends the legacy of diet culture in your own kitchen.

"Elyse Resch and I created the Intuitive Eating framework over 25 years ago as a solution to our patients who were trying to lose weight," the MS with a specialty in eating disorders said. "We were doing the traditional food plans and it wasn't working so we dove deep into research, considered our experience, the consumer world and came up with these principles."

The idea was to end a legacy of diet culture to help bring trust back to the way we eat and approach fueling our bodies.

"There's a big myth out there that dieting works -- it's actually one of the biggest predictors for gaining more weight -- and the harm that it causes in terms of increased risk of depression, weight stigma and eating disorders, it's not this innocuous thing," Tribole said.

What is intuitive eating?

"Intuitive eating is a compassionate self-care eating framework that's rooted in dignity and respect for all bodies," aimed to self-connect the mind and body while encouraging a healthy relationship with food. "In order to self connect through intuitive eating that allows you to connect with other people and your quality of life, improves, whatever that is for you so that you can flourish."

In her latest book, Intuitive Eating for Every Day: 365 Daily Practices & Inspirations to Rediscover the Pleasures of Eating, Tribole offers practical guidance with "little practices, inspirations and a little solace away from diet culture" to make the program easy to incorporate in everyday life. "It includes 10 principles of intuitive eating with all kinds of other things like trust disruptors, how do you let go of the legacy of diet culture? What are some positive things that you can say to yourself? And how do you steer clear of some of these diet cultural conversations."

The 10 principles explained

While there are 10 key points to the concept, Tribole said you can go in any order that feels right.

1. Reject the diet mentality

"Recognize that diet culture is not the boss of you," she said, adding, "only you know your experiences and what satisfies you."

"Intuitive eating is an inside job," she continued, "and our culture today commonly entertains the idea of changing your body. Just like on your computer you can have many, many programs open, but only have one active screen, so in this case the active screen is pursuing intuitive eating and recognizing the harm that's been caused in order to have sustainability."

2. Honor your hunger

"It sounds really basic, but it can be really nuanced -- honoring and responding in a timely manner to the signs of hunger in your body," the author and co-founder said. "People really underestimate the power of primal hunger, the food drive when you're not getting enough to eat -- people misinterpret that intensity and think 'something is wrong with me' when the antidote is actually just honoring your hunger."

3. Make peace with food

This is probably one of the misunderstood principles, but also one of the most joyful, Tribole explained. The concept that calls a truce to stop the food fight and give yourself permission to eat.

"This is about psychological health. It has to do with the phenomenon of when you're creating a lot of food rules and you break those rules and finally get to eat [that food] it's not just one or a few, it becomes the whole sleeve or package," she said. "We also call that 'the last supper effect.'"

4. Challenge the food police

"This has to do with the rules you've collected over time around eating and looking at what's true and how it's serving you," she said. "Who says this is how you should eat?"

Tribole explained that the food police are the voices that "monitor the unreasonable rules that diet culture has created deep in your psyche," and pushing that aside becomes a critical step for intuitive eating.

5. Discover the satisfaction factor

"What feels satisfying to you in a meal or a snack? What sounds good and how do you want to feel? Ultimately, it doesn't feel good to undereat and it doesn't feel good to overeat to the point of discomfort," she said. "This helps strike that balance on a very personal level."

Tribole added that discovering satisfaction is an actionable and personal step "that's about getting curious" and said this step is at the hub of the entire practice.

6. Feel your fullness

"Feeling full is normal. Our culture has demonized feeling full, but it's actually a sign from our body that 'Hey, I've had enough fuel,' and it's time to stop," she said. "Look at what your body does with the information, maybe, if you felt like you ate too much at lunch let's see what happens mid afternoon let's see what happens with dinner, maybe you'll discover you naturally don't want as much food."

7. Cope with your emotions with kindness

"Eating in and of itself can be emotional if you think about most life events from birth to death -- what we find is when people cope with their emotions with eating, it adds problems," she explained. "Ultimately this principle comes down to then is expanding your toolbox for coping techniques."

8. Respect your body

Tribole said the key here is to "move away from the idea that the size of your body automatically tells you what your health is, which is not true."

"Every body is worthy of dignity and respect -- in spite of what diet culture tells you, study after study has shown that trying to shrink the size of your body results in harm and is not sustainable," she said.

9. Movement -- feel the difference

"Movement for the enjoyment of moving your body in a way that feels good, as opposed to going for the burn just for the sake of it," she said. "Really having fun and connecting with your body to the degree that you want to."

10. Honor your health with gentle nutrition

"This is last for a reason," Tribole said. "Nutrition has been so weaponized in our culture and if nutrition sounds scary or intimidating, it's OK to put a pause on this and come back when you actually feel ready [and] at peace with your eating and your body."

Top tips and other helpful information

"This is just taking off worldwide, we now have over almost 1,400 certified intuitive eating counselors in 37 countries. There's 300 million hashtags on TikTok alone which is just amazing," she said. "It's wild to see the popularity, it feels like a success overnight, just 25 years later."

However, Tribole explained that "sometimes with all of that popularity comes a little confusion" when the work gets co-opted in ways that she didn't intend, so she offered some red flags "straight from the source."

"For example, if anyone is having you count or measure things, like tracking macros, or if it's keto where there's windows of timing -- those are red flags. That's not connecting to your body. If anything that has you disconnect from your body, which is a huge red flag," she said.

"You really can't fail at intuitive eating because it's a constant journey," she said. "All are welcome, no matter where you're at -- come check it out and see if it makes sense for you. This is about flourishing and the quality of your living and enjoying your eating."

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(NEW YORK) -- Messenger RNA vaccines for COVID-19, such as those produced by Moderna and Pfizer, showed no obvious safety concerns for pregnant women, according to a preliminary report published Wednesday in the New England Journal of Medicine.

Researchers looked at real-world data from more than 35,000 pregnant women who received an mRNA vaccine between Dec. 14, 2020, and Feb. 28 and found there were no major health-related issues for the mothers or the newborns, according to the study. Pfizer and Moderna are the only two mRNA COVID-19 vaccines currently granted emergency use authorization by the Food and Drug Administration.

The study utilized data from several federal health sources, including the U.S. Centers for Disease Control and Prevention's V-safe After Vaccination Health Checker, V-Safe pregnancy registry and the federal government's Vaccine Adverse Event Reporting System.

After receiving the vaccine, pregnant women reported pain at the injection site more frequently, and headaches, chills and fevers less frequently than nonpregnant women, researchers said.

There were 721 women who were in the V-Safe pregnancy registry who had live births during the study period, according to the paper. There were no reported neonatal deaths, researchers said.

While some women experienced miscarriage, premature birth and babies that were small, the frequency of these events was similar to studies before the pandemic, the study said.

The CDC says getting vaccinated is a personal choice for pregnant women and they should discuss the risks and benefits with their doctors.

Pfizer is conducting a clinical trial in pregnant women, but the results won't be available until later this year.

Dr. Sara Yumeen, a preliminary-year internal medicine resident at Hartford Healthcare St. Vincent's Medical Center and contributor to the ABC News Medical Unit, contributed to this report.

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(NEW YORK) -- At the start of the coronavirus pandemic, pictures of smog-free skies circulated social media from Los Angeles to New Delhi. With more people staying at home, it seemed one silver lining was the positive impact it was having on the environment.

But now, a little over a year later, the pandemic persists and a new environmental issue has emerged: the rise of personal protective equipment pollution.

It is estimated that 129 billion face masks and 65 billion gloves are being used monthly. Unfortunately, while PPE is a necessary tool, its increased use is having detrimental effects on the environment, especially our oceans.

Nearly 1.56 billion face masks entered our oceans in 2020 alone, during the onset of the pandemic, according to a December 2020 report published by Hong Kong-based ocean conservation group, OceansAsia.

Andriana Fragola, a marine biologist and shark safety diver with One Ocean Diving, a Hawaii-based shark diving excursion company, sees firsthand the impact discarded PPE is having on the ocean.

"There's definitely been a rise in overall what we see of masks," Fragola told "GMA." "We're at a tipping point right now. There are estimates that say by 2048 we are going to have more plastic in our oceans than fish. ... With all of the plastic that has been used, especially with the pandemic going on, it is just overwhelmingly approaching, and it is coming fast."

What makes face masks so dangerous and problematic to marine life are the microplastics that are generated from disposable face masks, Britta Baechler, senior manager of ocean plastics at Ocean Conservancy, told "GMA."

"Microplastics are tiny pieces of synthetic material that are either manufactured to be intentionally small or they break down from larger plastic items," she said. "They're such a problem because they're persistent in a whole bunch of different environmental media ... and they just cycle through different environments, and different animals for very long periods of time and never really go away."

Ocean Conservancy is an American nonprofit organization advocating for clean oceans. The group runs an annual International Coastal Cleanup with volunteers from around the world. Recently, the group analyzed the items found from their latest cleanup and reported their volunteers removed 107,219 PPE items from beaches and waterways worldwide in just the second half of 2020. Items their volunteers found and logged included face masks, gloves, face shields and sanitizing wipes.

However, the group said that the report represents a vast undercount and Baechler estimates the global count is likely closer to the "low millions."

"Unfortunately, as evidenced by the data we collected through our international coastal cleanup, these disposable PPE items are making their way into the environment," Baechler said.

Like other forms of plastic, PPE is a threat to marine life. Entanglement in masks, microplastic ingestion and entrapment by the fingers of medical gloves are just a few of the issues PPE pollution can cause for marine life.

But PPE isn't only negatively affecting marine life, explained Christine Dell'Amore, a senior editor at National Geographic. It is impacting wildlife, too.

"Examples include some birds that have gotten the loops of the face mask stuck on their bodies. Birds using face masks and other equipment to line their nests," she told "GMA."

Dell'Amore also noted that single-use plastic has significantly increased during the pandemic, and that's still making its way into our oceans.

"A lot of the focus on reducing single-use plastic that were part of a lot of campaigns like bringing your own cutlery, straw, etc., that has gone out the window during the pandemic. People are obviously trying to stay healthy and not get infected, so a lot of the actions they were taking to be kinder to the environment have taken a backseat," Dell'Amore said.

Amid an ongoing pandemic, the need to continue using PPE and following Centers for Disease Control and Prevention guidelines is necessary to help reduce the spread of COVID-19.

So, what are the steps we can take to continue to stay safe against the coronavirus while also reducing the burden of pandemic-related waste on the environment?

1. Wear a reusable mask

"There's the great option of reusable masks that are able to be washed. You can use that same one over and over again. ... Get a few of them so you can rotate through the week and then you can wash them whenever it's your week to do laundry," said Fragola.

2. Cut the loops of your single-use masks with scissors

"If you're using a disposable face mask, you can simply snip the ear loops off of those masks, just for good measure, to lessen the wildlife entanglement threat," Baechler said.

3. Try a face mask made from more-sustainable materials

"There are also some masks that are single-use that are created from things like hemp or bamboo, so it is compostable, not made out of different types of plastics," Fragola said.

4. Make sure your trash can is properly secured

"Always make sure to dispose of your PPE in a secured, covered bin," said Baechler. "That's to make sure that it's not accidentally going to get leaked into the environment if the bin tips over or wind comes and picks up the PPE in the bin."

5. Reduce your overall single-use plastic consumption

"Try to reduce your single-use plastic footprint and that's to help keep plastics, in general, out of our ocean and simultaneously reduce the burden of pandemic-related waste on our broader waste management systems," Baechler said. "As individuals, we can make smart choices related to PPE and single-use plastics and all of that will be in service of helping to minimize the effects of plastic on our ocean and our environment."

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(NEW YORK) -- A lack of sleep can increase the risk of dementia, a new study has found.

Specifically, sleeping less than six hours a night in midlife can raise the risk of dementia -- the loss of cognitive functioning, like thinking, rememberingand reasoning -- by 30%, according to the new study, published Tuesday in the journal Nature Communications.

"According to this study, quantity [of sleep] really matters," said Dr. Jennifer Ashton, ABC News chief medical correspondent and a board-certified OBGYN, who was not involved in the study.

The study followed nearly 8,000 people in Britain for more than two decades, beginning when they were 50 years old.

Researchers found that most rates of dementia occurred in people who slept on average about seven hours a night, but that the rates of dementia increased by 30% for those who got six hours of sleep or less per night.

"Measurement of sleep duration at age 50, 60, and 70 years along with change in sleep duration over this period provides consistent results for increased risk of dementia in those with short sleep," researchers wrote. "A further key finding is that the association between short sleep duration and dementia is not attributable to mental health."

"Public health messages to encourage good sleep hygiene may be particularly important for people at a higher risk of dementia," the researchers concluded.

How much sleep people should get is not a "one-size-fits-all" answer, according to Ashton, who noted that Americans in particular have historically not put enough emphasis on sleep.

"We’ve said before that sleep has a [public relations] problem in this country," she said. "We think of it as a luxury but it’s really a medical necessity."

According to the U.S. Centers for Disease Control and Prevention, infants and toddlers should get between 11 and 16 hours of sleep per night, depending on age.

Elementary school children should get between nine and 12 hours of sleep per night, according to the CDC.

Teenagers should get eight to 10 hours of sleep per night, according to the CDC.

Adults ages 18 and over should get a minimum of seven hours of sleep per night, according to the CDC.

"What’s really important is that you can’t make up for [sleep] on the weekend," said Ashton. "So it really has to be every single night."

Getting enough sleep and getting a good night's sleep can be difficult for many people, data shows.

Some steps, known as sleep hygiene, can help, according to Ashton.

She recommends keeping a consistent routine and making sure the area where you sleep is cold, dark and quiet. Anything with a screen -- like cellphones and televisions -- should be left out of the bedroom, according to Ashton.

Things that should also be avoided close to bedtime include caffeine, large meals and alcohol, all known sleep disrupters, according to Ashton.

Ashton also noted that getting regular exercise can also help improve sleep.

Read more here for tips on how to get a good night's sleep.

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(PARIS) -- It might be one of the most peculiar symptoms of mild COVID-19 infection: the loss of taste or smell, or both, that persists long after the virus has passed.

The phenomenon has prompted some former COVID-19 patients to make light of their situation on social media through videos where they munch into everything from raw onions to wasabi Oreos. However, the phenomenon is no joke for those who’ve now been deprived of these senses for up to a year.

“It’s annoying. Life is very boring,” said Laurent Brossard, of Paris, who lost his sense of smell over five months ago when he contracted COVID-19.

“I miss smelling my children, my husband’s cologne. I miss the smell of nature,” said Corinne Prudhomme, a doctor who caught COVID-19 during France’s first wave last year and has been dealing with the loss of smell, also known as anosmia, ever since.

Prudhomme says it’s also been frustrating being unable to determine how she herself smells, and that the anosmia has also affected the way she eats.

“I use a lot more salt, and I eat more than I used to. I can’t taste anything, so I just eat more,” she said.

While the data is limited, a study of about 200 COVID-19 patients last year found that nearly half reported a loss of taste or smell. While most of them regained their senses within four weeks, roughly 10% reported their condition had been unchanged or worse.

Doctors are still learning about COVID-19-related anosmia and possible treatments, and some have begun studying the benefits of steroids and olfactory implants.

For now, however, Dr. Hakim Benkhatar, an ear, nose and throat specialist at the Centre Hospitalier de Versaille, says olfactory training is most likely to treat anosmia related to COVID-19. It involves patients picking out a few scents and setting time aside at least twice a day to practice smelling them in hopes that it will reawaken their senses.

It was at Paris’ Institut Superieur du Parfum where Brossard began his olfactory training. The institution was built on the idea that scent can be learned, and it’s where the country’s future “noses” learn to hone their senses.

The school had previously developed its own kind of olfactory rehabilitation, known as the Olfactory Stimulation Therapy and Memory Reconstruction (OSTMR) method, which is now being used to help COVID-19 long-haulers experiencing anosmia.

The technique, fine-tuned by neuropsychiatrist and biochemist Olga Alexandre, draws on neurology, psychology, emotional intelligence and the personal history of each patient, she says.

“It’s like breaking your arm,” explained perfumer and OSTMR therapist Justine Legay. “You might need to go to physical therapy and work on it, but you’ll eventually be able to move it again. We do the same thing. Training your sense of smell means you can regain it.”

The training is crucial because losing one of the senses can lead to other health issues, Benkhatar says.

“Olfactory loss is something really distressful for patients because it impacts their daily life in many activities, such as cooking, and usually they have a loss of appetite,” Benkhatar said. “And they have more anxiety and depression because of the consequences on their social interactions.

“Finally, and most importantly, they lose their ability to detect hazards,” he added, pointing to potential hazards like gas leaks or smoke, which he says anosmic patients would likely fail to notice.

Brossard has been training with Legay once a week to recover his sense of smell.

“I exercise every day, every morning, every night,” said Brossard. “Five in the morning, five at night.”

“The sense of smell is something we really need,” said Legay. “We’re starting to realize it because of COVID. But up until now, we took it for granted.”

For the training, Legay prepares a personalized scent with special meaning to each patient. During a recent session with Brossard, she prepared the smell of orange juice, which Brossard said he used to enjoy every morning with his family.

Brossard closed his eyes as he leaned toward the swab with the orange scent on it. He inhaled deeply through his nose and subsequently tried to guess which scent Legay had offered him. At first, he suggested it could be something floral. But he quickly caught his error and identified a fruity scent, before narrowing it down to something citrusy.

When Legay asked him if he was able to recognize the orange scent, his face lit up.

For the first time in months, finally, Brossard caught a whiff of orange. Brossard says the training gives him hope that he’ll soon be able to recognize other scents.

He said, “I don’t imagine having anosmia forever.”

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(NEW YORK) -- "Nip/Tuck" alum AnnaLynne McCord is speaking out against the stigma surrounding mental health disorders and said on Tuesday she was diagnosed with dissociative identity disorder.

According to NAMI, the National Alliance on Mental Illness, dissociative identity disorder -- formerly known as multiple personality disorder -- is characterized by alternating between multiple identities.

McCord spoke about her diagnosis recently for Dr. Daniel Amen's blog, Amen Clinics, and expressed no reservation about opening up about her mental health or sexual trauma.

"The way this is talked about is there's so much shame. I am absolutely uninterested in shame," the 33-year-old actress explained. "There is nothing about my journey that I invite shame into anymore."

"That's how we get to the point where we can articulate the nature of these pervasive traumas and stuff, as horrible as they are," the former "90210" actress added.

McCord said she believes the sexual trauma she suffered as a young child and teen, and resulted in memory loss she was unable to recall until recently, triggered her mental health issues.

That segued into her opening up about what she said was being formally diagnosed by a doctor, telling Dr. Amen, "She said I had (DID) pretty seriously and my splits before my memories came back... I had definitive splits."

McCord explained her personality splits manifested as personas. "You’ll see me just show up with a black wig and a new personality. I was this tough little baddy, and then I’d be the Bohemian flower child," she said.

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(NEW YORK) -- After months of waiting, it may finally be your turn to get a COVID-19 vaccine.

Anyone 16 years old and older is entitled to a free vaccine that has been shown to be safe and effective at preventing severe illness and death from COVID-19.

Vaccine day comes with more than the shot itself -- including the potential for a wait in line, possible warm or cold conditions and a lot of emotions.

Half the country has already received at least one dose, so here are some quick pro tips about how to prepare when it's your turn:

What to do -- and what not to do

Dress for success: Put on those comfortable shoes as standing and walking throughout the process may be necessary. Also, be ready to expose your upper arm when it's time for the injection. Most people choose to get injected in the arm they do not write with in case they become temporarily sore.

Start your day off with a good breakfast. Come to the site well-fed, hydrated and bring an extra bottle of water, as sometimes the stress of the experience or all the waiting and up and down can make people lightheaded.

Doctors recommend avoiding over-the-counter medications like ibuprofen, acetaminophen or antihistamines before getting the shot.

"Some people are trying to lessen vaccine side effects, but we don't know how much these medications affect vaccine effectiveness. When you have side effects, what you're feeling is your immune system at work trying to build up that immunity," said Dr. John Brownstein, the chief innovation officer at Boston Children's Hospital and an ABC News contributor.

"After the vaccine, people may want to try and prepare to take a lighter day or two of work," added Brownstein.

If you develop side effects after the vaccine, it's OK to take a Tylenol, Advil or some other over-the-counter medication.

What side effects are typical?

"The most common side effects are the ones you can also get from other vaccines: mild fever, headache, fatigue, joint pain, pain or swelling at the site of the vaccine. There is nothing unusual about any of those," said Brownstein. "There may be slight differences between vaccine types, but they are generally pretty consistent."

These mild symptoms may develop over the first couple days and should be temporary.

Some people may also notice an itchy rash on their arm where they were vaccinated, which has been coined "COVID arm." The Centers for Disease Control and Prevention still recommend that people who have "COVID arm" get their second vaccine on schedule.

It is important to remember that long-term health problems from the COVID vaccine are extremely unlikely. Most people who have side effects will have them within six weeks of their vaccine, according to the CDC.

When should I be concerned?

"It is those one in a million, incredibly rare, serious side effects that you should speak to a provider about, such as persistent headache, a full-body rash, swelling, abdominal pain, leg pain, shortness of breath," cautioned Brownstein.

These are the symptoms for which you should contact your doctor.

"We watch everyone for 15 minutes after their vaccine, to monitor for anaphylaxis, but this risk is extremely low," Dr. Richard Shellenberger, the associate program director of internal medicine at St. Joseph Mercy Hospital, Ann Arbor, said.

Anaphylaxis is a type of severe allergic reaction characterized by breathing problems, hives, weakness, paleness, fast heart rate and dizziness. We encourage you to take full advantage of the 15-minute observation period, particularly if you have a history of reactions to vaccines.

"We certainly see side effects, but nothing has been serious. Out of more than 10,000 doses that we have likely given, we have not seen any serious reactions or anaphylaxis," Shellenberger added.

The CDC and Food and Drug Administration encourage you to report side effects in the Vaccine Adverse Event Reporting System (VAERS). The information in the VAERS system is user submitted, so the cases need to be investigated before a clear association with vaccination can be established.

If scientists find a connection between a safety issue and a vaccine, the FDA and the vaccine manufacturer will work toward an appropriate solution to address the specific safety concern.

Make sure to bring home your vaccine card and take a photo of it and store it in a safe place. It will help be evidence of vaccination and be a good reminder of which vaccine you received, the dates of your dose and any follow-up appointments required.

It's up to you if you want to share you vaccine selfie with those you care about, but with a little planning for the day you are bound to have a better experience yourself.

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(NEW YORK) -- With oceans rising, forests burning and growing pollution, climate change can be a depressing topic.

No wonder so many avoid talking about it with our friends, family and especially our children.

However, talking about the crisis is one of the most important things we can do, according to experts.

ABC News spoke with Harriet Shugarman, executive director of Climate Mama and author of How to Talk to Your Kids about Climate Change, as well as youth climate justice activist Mitzi Joelle Tan. They shared some essential tips for talking to young people about the complex topic:

1. Instill a love for nature in young kids

Very young children can start to form a connection with nature, from going to the local park to gardening at home to learning the names of animals and local species.

"You don't want to tell kids all about carbon dioxide emissions at the age of 5, but just instilling a love for the environment, being connected to nature, I think that is so important at any age," Tan said.

"There are ways to engage our youngest children in nature that instill that sense of wonder and beauty," Shugarman told ABC's Good Morning America.

"Whether you live in the middle of a city, or out in the country, enjoying nature and sharing that people are working to protect it is really important," she added.

2. Tell kids the truth in ways they can understand

"Very young kids can understand pollution," Shugarman said. "We can say that cars and factories pollute, and we're working towards making that clean."

"We may think our young kids are too little to hear some of the impacts of climate change, but children can often see straight through to the truth. Depending on the child's age, telling the truth will simply involve going into different levels of detail," Shugarman added.

Tan shared some of her own experiences learning about climate change at a young age from an Indigenous leader in her community.

"When I was told about Climate Change, [the Indigenous leader] wasn't trying to convince us that we have to fight back or that we had to be activists," Tan said. "The simple fact was what made me realize that he's right, it's simple. It makes sense, this is something that we'll keep experiencing and it will only get worse if we don't do anything, so we have the fact that we have no choice."

3. Remember to focus on the positives, too

"You can't just go, 'Oh, you're doomed.' It always has to be an empowering message that yes, this is horrible, but there is something that you can do," Tan said.

"Know it's OK for kids to feel sad or to feel angry, and that those are normal reactions, but then, coming out the other side, right after we felt sad or grief, that it's an amazing opportunity to say, because we're alive right now, when really important decisions that matter are happening, we can be part of that together," Shugarman suggested.

And children can learn about the power of civic action, too, by taking simple steps to engage with their communities.

"Even as early as in elementary school, kids can learn about our democracy, about fighting for our climate, especially if you share examples of other young people and what they're doing to help the climate," Shugarman added.

4. Show them you care about the planet and are working to make it better

"As parents, as caregivers, we have to show them that we get it, too, and it's important to us," said Shugarman. "Also, making clear how it presents so many opportunities, because we can all be part of the solutions." Taking responsibility for your role in this ongoing challenge can go a long way, too.

"Many youth really get it; that's why we have this big youth climate movement. I think they are feeling a really heavy weight," said Shugarman. "I think that adults have said, 'Well the youth have risen ... so they're gonna fix it,' and that's unfair and wrong, and from my perspective, it must be intergenerational."

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Angela Hertenstein

(NEW YORK) -- Celebrities such as Kim Kardashian and Gabrielle Union have put surrogacy in the spotlight in recent years by sharing that they welcomed children via surrogates.

In the United States, the use of surrogacy has been on the rise, with more than 18,000 babies born via gestational carrier cycles between 1999 and 2013, the most recent data available, according to the U.S. Centers for Disease Control and Prevention (CDC).

Gestational surrogacy occurs when a woman carries a pregnancy that was made with another woman's egg and another man's sperm, so the surrogate has no genetic relation to the baby. In traditional surrogacy, the surrogate's eggs are used, so she is the biological mother of the child she carries.

Surrogacy is legal in the U.S. but is not federally regulated, so laws vary from state to state. The cost of surrogacy can go into the hundreds of thousands of dollars.

Angela Hertenstein, 43, a registered nurse in Indianapolis, has been a surrogate for four different families over the past decade. She is currently pregnant with her fifth surrogacy after working with Gift of Life Surrogacy Agency, near Toledo, Ohio, to find a match.

Below, Hertenstein describes what it is like to be a surrogate and what she wants other people to know about the process:

I have been a surrogate for four different families, given birth to three sets of twins, two singletons, and I am currently pregnant with my fifth family.

From previous relationships, I’ve had two children of my own, and my husband has three. We contemplated having children together for about 30 seconds, but decided having a blended family of five, all within six years apart, was enough.

But when the opportunity to have a baby for someone else, who couldn’t have their own, presented itself, I jumped at the chance. Beyond enjoying being pregnant, I really loved the thought of helping another couple. So, being a surrogate was a perfect fit for me.

I was working in a doctor’s office in 2012 when I met the person who would change my life, another nurse who had just been hired.

She was talking to a group of us one day and had mentioned in passing that she had been a surrogate before.

I told her that I had always wanted to be a surrogate and had actually looked into it at one point. She informed me that the fertility doctor she worked with was looking for trustworthy individuals to be surrogates for his clinic. I gave her my information, she gave the clinic my information, and within the next couple of hours they called and set me up with an appointment for the following month for testing.

I told my husband when I got home, and he immediately took off work that day to take me to the appointment, about a 3.5-hour drive from Indianapolis.

We got to the clinic not knowing what to expect. The appointment involved an ultrasound, blood work and forms to fill out. The purpose of the ultrasound was to make sure that everything I possessed for the job was in good shape and I was healthy enough to become pregnant.

It was only a short six months later that I was pregnant with my first family.

After finding out that I was pregnant, I had to travel to the clinic every other week for check-up appointments until I was 12 weeks along. I consider myself a superstitious person, so the first time I drove to the clinic alone, it was cold, and I wore a pair of black yoga pants, knee-high rainbow socks and black boots.

I made it there and back safely and on time, so every time after that, I wore those socks and boots with every visit. Nine years later I still wear these socks to every appointment. Every time I walk into the office for labs, an ultrasound or the anticipated day of transfer, I always hear, "The rainbow sock lady is here!"

My husband and I got to meet the IPs (intended parents) at the signing of the paperwork for my first journey. We went out to eat with them after that and spent the afternoon getting to know each other. They were from overseas, and the most interesting people we have ever met. Not only were they interesting, but they were so passionate about having a family that it melted our hearts.

The first ultrasound revealed that I was having twins, and the parents were just over the moon with happiness and excitement.

Through this journey, I got to know the parents very well. I looked forward to talking with them every day. I loved sharing how the babies were doing, what it felt like to have two little humans wiggling around inside me, and how both babies already seemed to have their own personalities.

The biggest difference in a surrogate pregnancy and my own, is the happiness factor is tripled. For every milestone, ultrasound and defining moment, there is not only my excitement, but the parents’ as well.

The three most common questions I get when asked about being a surrogate are: Did you know the parents before this or are they family? How do you feel about giving up the baby/babies? And of course, how much do you get paid?

To the first question my answer is always: I didn’t know them prior, but I know them now, and I feel like we are family.

To the second question my answer is always: These people have tried so hard for so long to become parents and have been through so much that seeing the look on their faces when they hold their child or children for the first time is priceless.

My answer to the third question circles back to my answer to the second question: The look is priceless.

After giving birth to the first set of twins, I stayed with the family for a week. I pumped breast milk for the babies, helped take care of them while the parents arranged for their birth certificates and passports and helped teach the dad how to properly hold and dress his sons. This is just another example of the unparalleled joy that comes with being a surrogate.

I love sharing my story as a surrogate, because it gives me the opportunity to educate people on what it actually means to be a surrogate and how infertility affects everyone.

There is so much more to having babies for other people than is portrayed in the media. Not only do you forever change the lives of the expecting parents, but you are now eternally apart of something greater than yourself.

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