DEAR DR. ROACH: I've read that there's a big increase in whooping cough. I am pregnant and want to know the best way to protect my baby. Is it exclusive breastfeeding? Getting the vaccine? Making sure that visitors are vaccinated or wear masks?

-D.G.

Answer: Whooping cough is caused by a species of bacteria called Bordetella pertussis. This causes a respiratory infection that can be very serious in infants, with over 80% of the youngest babies needing hospitalization. You are right that there have been massive increases in the risk of this infection during the past two years. An infant normally receives a pertussis vaccine at 2 months, although it can be given as early as 6 weeks in an outbreak setting.

The most important way for a pregnant woman to protect her baby from pertussis before the baby can be vaccinated is to get vaccinated herself during the second trimester of pregnancy. This vaccine is recommended for all pregnant women for every pregnancy, even if they're already vaccinated.

This is more to protect her baby than to protect her, since the antibodies she makes after the vaccine will be transmitted across the placenta. This gives her baby 80% to 96% protection against whooping cough during the critical period before the baby can be vaccinated. Although breastfeeding has many benefits, the evidence that it protects the baby against whooping cough is weak, with a large study showing minimal benefit.

DEAR DR ROACH: I'd love to get your opinion on prescribing one of the new weight-loss drugs for a patient (me) who has a strong history of pancreatic cancer. Both of my parents died of the disease. I'm a 67-year-old woman in good health who needs to lose weight.

My primary care physician is reluctant to prescribe them based on their interactions with the pancreas. I know that the black-box warning for pancreatitis was changed from "contraindicated" to "warning," but I'm still trying to determine how statistically significant the effects of the drug are on my chances of getting cancer.

-L.D.M.

Answer: There's a strong recommendation against the use of GLP-1 agonists like semaglutide (Ozempic) or tirzepatide (Zepbound) in people with a personal or family history of medullary thyroid cancer (10% or less of thyroid cancers are medullary). This also includes people with a syndrome called multiple endocrine neoplasia type 2 (1 in 35,000 people).

There's a suspicion that inflammation of the pancreas (pancreatitis) might be more likely in people who use GLP-1 drugs, but there's no clear risk (although people who were at a high risk for pancreatitis were often excluded from studies). I can understand why a history of pancreatitis might make your doctor cautious. However, there have been extensive studies of the risk of pancreatic cancer with GLP-1 agonists, and a review of 60 published studies didn't find a risk. Instead, they did find a possible protection from pancreatic cancer.

Since there's not a good alternative for weight loss that provides the same degree of effectiveness and safety as GLP-1 drugs, and because the data are reassuring about pancreatic cancer, I don't think your family history should affect your decision of taking a GLP-1 drug for weight loss. You might consider genetic counseling to help identify any personal risk for pancreatic cancer that you might've inherited from your parents.

Contact Dr. Roach at: ToYourGoodHealth@med.cornell.edu.