Since Marijuana has been legalized in many states, there is a general perception that it is a natural and safe drug unlike other drugs.  This perception is reflected in the number of pregnant women who use marijuana while pregnant.  In 2017, a study showed that 1 in 20 women used marijuana while pregnant.  In 2002, the number of women who used marijuana was 1 in 10.    

Now before we talk about marijuana use in pregnancy and autism, let’s review some stuff we already know about MJ use in pregnancy.  First it does cross the placenta.   THC crosses the placenta and can be found in fetal circulation at 10% of the maternal level.  Second, we also know that marijuana can bind to fetal cannabinoid receptors as early as 14 weeks of pregnancy.  Third, studies have shown that exposure to marijuana in pregnancy can disrupt normal brain development.  Children born to women who used marijuana while pregnant are more likely to have low birth weight at birth, hyperactivity, and attention, cognitive and behavioral issues.

So, a couple weeks ago a study out of Canada published in Nature showed that women who used marijuana while pregnant were 1.5 times more likely to have a child with autism. The researchers reviewed 500,000 births between 2007 and 2012 in Ontario, Canada.  They found an association between maternal cannabis use in pregnancy and the incidence of autism spectrum disorder in these children.  The incidence of autism spectrum disorder diagnosis was 4 per 1000 children who were exposed to marijuana and 2.4 among children who were not exposed to MJ in utero. 

So, while this study does not definitively prove that marijuana use during pregnancy causes autism, there does seem to be a strong association.  Based on these findings, as well as ACOG (American College of Obstetricians and Gynecologists) recommendation, we encourage our patients to avoid using marijuana during pregnancy and breastfeeding.  

​Dr. Pam

Just like hormonal changes that can occur during pregnancy, there are also big changes that go on in a woman after delivery.  These changes generally last at least a few months, and hormone levels can be affected in some women for as long as they choose to breastfeed.  These fluctuations can influence everything from hair loss to libido to irregular bleeding, and for some women, the effects can be quite dramatic.  Here’s a quick overview of what goes up and what comes down:

1. Prolactin – prolactin is the hormone responsible for milk production, so for moms who elect to breastfeed, this hormone remains persistently elevated.  Prolactin generally leads to feelings of relaxation and calm, but it directly counteracts dopamine, which plays a big role in sexual arousal and gratification.  Thus, you can feel pretty serene while you’re breastfeeding, but you might be so content that you don’t care about having sex.
2. Oxytocin – during breastfeeding, this hormone increases and causes milk letdown and release.  It’s also associated with bonding both with breastfeeding and sex.  During intercourse, it’s released during orgasm, so it’s not uncommon for milk leakage to happen during sex.  Depending on the amount of leakage that happens, some women can become a bit self-conscious, and in turn, this can decrease desire for intercourse.
3. Estrogen – estrogen will be low for at least the first several months after delivery, and it may continue to be low throughout breastfeeding.  Low estrogen can cause menopausal-type changes within the vagina, leading to decreased lubrication and elasticity with increased tightness, which, in turn, can cause painful intercourse.  That drop in estrogen after delivery also plays a big role in postpartum hair loss.  While this should resolve in few months to year and typically only involves catching up with the normal loss that doesn’t happen during pregnancy, for some women the sudden large amounts of hair loss can be pretty traumatic.  Be sure to continue prenatal vitamins, use gentle brushing and hair car techniques, and remember that this change should be temporary.
4. Testosterone – this hormone plays a role in libido/desire, and it is suppressed in the postpartum period and with breastfeeding.
5. FSH – this hormone is responsible for menstrual cycle regulation, and while levels don’t change much during the postpartum period and breastfeeding, it’s level of activity can.  Change in FSH activity may contribute to anovulation (not releasing an egg).  While change in FSH activity can be helpful in preventing pregnancy for some women (some women can still get pregnant while breastfeeding), it can also be a culprit for some pretty erratic bleeding.  Both menstrual and nonmenstrual bleeding can be very unpredictable for women while breastfeeding, with cycles ranging from completely absent to dysfunctional bleeding nearly every day.  The same irregularity can be present with fertility while breastfeeding as well, with some women who don’t ovulate and can’t get pregnant to those with resumption of normal cycles and fertility to those who become pregnant even before they have their first menstrual cycle after their baby is born.

In short, hormones in the postpartum period and while breastfeeding can vary dramatically from woman to woman and have a variety of effects on their health.  Lack of sleep, a fussy newborn, stress of being a new (or repeat) parent and adjustment to the amount of time needed by your new baby can wreak havoc on everything from mood to uterine bleeding to libido, and the hormonal changes during the postpartum period can add a bit of fuel to this fire.  Sometimes the fix can be as simple as starting a birth control pill to regulate your cycle; other times medical intervention or counseling may be needed for postpartum depression.  While it may feel like your newborn is sucking the life right out of you, these symptoms are common, so be sure to discuss your concerns with your provider, and remember that all of these changes should be temporary, so there is a light at the end of the tunnel 😊

​Dr. Nick

The most common complaint I’ve been getting lately is this- “I’ve gained a ton of weight since this pandemic started.”  Many of us went from working full time to working in our PJ’s at home.  Everything has been closed including the gym.  Fourth of July celebrations and the Rodeo were cancelled. Weddings, graduations, kids’ sports activities and summer vacations were are cancelled.  After being told not to mingle with family or friends and just stay home to be safe, it’s easy to find yourself 19 pounds heavier.  Here are some simple tips on what you can do to lose some of those pandemic pounds while regaining your mental and physical health. 
​

1. Rule #1: No Snacking at all.  Snacking throughout the day causes continuous insulin release.  This tells your muscle and fat cells to store all the fat and sugar you eat.  This is how you gain weight.  Also, more frequent insulin release leads to insulin resistance because your cells stop responding to the insulin produced.  I always tell patients to stick to only 2 to 3 meals a day and no more than that while drinking only water in between.  This is the reason that fasting diets are so successful- they take advantage of decreased insulin release throughout the day, and this is how they contribute to weight loss.
2. Rule #2: Stay Away from Processed Foods.  Anything that can survive in your refrigerator for more than 2 weeks is likely processed.  Again, the emphasis is on refrigerator.  Most things in your pantry other than dried spices are processed.  Most processed foods are high in sugar, salt, and artificial everything.  These foods were made in a laboratory somewhere and have an excessive amount of sugar, salt and flavor enhancers to encourage constant cravings.  They are very calorie dense and nutrient poor.  Start looking at nutrition labels on food and if you see things like MSG, natural flavoring, disodium guanylate, yeast extract, hydrolyzed protein, autolyzed yeast, aspartame, and other long chemical names that you can’t pronounce-don’t buy it or consume it.  This is not real food.  These are mostly chemicals manufactured in a laboratory that are high in calories and artificial flavors and packaged and then sold in a grocery store near you.
3. Rule #3: Try to Cook Your Own Meals.  This will help you stay away from processed foods and allow you to have control over how much sugar and salt you consume.  I know this is time consuming, but this is the only way to have control over your overall nutritional health, and while there are limited social options, now is a good time to learn a new skill that may even become a hobby.  It will also save you lots of money. 
4. Rule #4: Be wary of excessively fatty foods and diet fads.  Diets like the Atkins diet are popular because they allow you to eat fatty foods like bacon and butter.  The idea is that you can eat really yummy fatty foods and as long as you restrict carbs you will trick your body into seeking energy in stored fat.  This sounds awesome in theory- you can eat fatty foods and lose weight.  While patients do lose weight initially, most are unable to maintain such a low carb diet for long.  In addition, eating a lot of fat puts a lot of oxidative stress on your body and is what contributes to metabolic syndrome and other chronic diseases of obesity.  Believe it or not, Dr. Atkins died obese and likely of heart disease.
5. Rule #5: Get outside and get active.  Go for a walk, run, hike, bike ride whatever, but you need to get out of the house.  Studies are beginning to suggest that most contracted the coronavirus at home.  Enjoy the fresh air and get some Vitamin D.  While exercise and activity does not contribute to weight loss as much as dietary changes, it helps maintain weight loss and is overall good for your physical as well as mental health.  Also, especially important right now, is the fact that exercise helps boost your immune system.

Hopefully this helps!  Don’t let the 'Rona get you down.  Eat health and enjoy the outdoors!
 
Dr. Pam