Category: Obstetrics & Gynaecology

B Cells Are Elevated in PCOS – But Are not The Cause

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While previous research have shown that while more B cells are present in women in polycystic ovary syndrome (PCOS), a new study by researchers at Karolinska Institutet has ruled out B cells as the cause of this common syndrome. The study is published in eLife.

Affecting 10–15% of women of fertile age, PCOS is linked to irregular ovulation and menstruation, pregnancy complications, and insulin resistance, all of which are worsened by being overweight. PCOS increases with rising body mass index, and in women with severe obesity, it is around 25%. While the root cause of the condition is unknown, a driver is a surplus of androgens.  

A recent study has shown that women with PCOS have a higher number of B cells in their blood and proposed that these contribute to the development of PCOS through the production of autoimmune antibodies.

“We’ve now examined how B cells affect the development of PCOS with the goal to find new ways of treating the conditions,” says the study’s last author Elisabet Stener-Victorin, research group leader for reproductive endocrinology and metabolism at the Department of Physiology and Pharmacology at Karolinska Institutet.

First, blood from women with PCOS was examined and showed abnormal variations in the frequency of different populations of B cells compared to healthy women. Among these were the so called double negative B cells, a heterogeneous cluster, where some have been described as poised to develop autoimmune functions.

To study whether B cells may cause PCOS, the researchers transferred antibodies from women with PCOS to mice to see if they developed the syndrome. While this proved not to be the case, they did put on weight.

Mice unaffected by B cells

The next step was to transfer B cells from PCOS-like mice (induced by continuous exposure to androgens) to mice lacking B cells to test the hypothesis that B cells drive the development of the disease. However, the recipient mice were unaffected by this transfer.

To see if B cells play an essential role in the development of PCOS, mice lacking B cells were exposed to androgens. These mice were not protected as expected, but developed the same characteristics as normal mice acquire when exposed to androgens.

Finally, androgen exposed PCOS-like mice displayed altered B cell frequencies, as women with PCOS, and simultaneous treatment with a drug that blocks androgen receptors, prevents these alterations of B cells in both blood and tissues, such as ovaries and endometrium.

The researchers conclude that androgens are necessary for the condition to form, but not B cells, the role of which remains unclear.

“B cells are clearly affected in the syndrome, which could contribute to a higher susceptibility to some comorbidities, but they don’t cause PCOS,” says Sara Torstensson, PhD student at Institutet and shared first author.

“We are now studying how other immune cells are affected and how this influences reproductive and metabolic function in PCOS,” says Angelo Ascani, guest PhD student at Graz University, Austria and also first author.

Source: Karolinska Institutet

Foetal Exposure to THC could Lead to Long-lasting Health Impacts

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Consuming THC (Delta-9-tetrahydrocannabinol) while pregnant could potentially affect development of the foetus and lead to life-long health impacts for offspring, according to a new study published in the journal Clinical Epigenetics.

THC is the main psychoactive ingredient in cannabis, which is growing in popularity and availability. The prevalence of cannabis use in pregnancy is also rapidly increasing, especially during the first trimester, when the foetus is most vulnerable to environmental exposures, to mitigate common symptoms like morning sickness. However, the potential effects of prenatal cannabis use on foetal development remain inconclusive, in part due to a lack of safety data. This study aimed to identify the potential long-term health impacts of THC use during pregnancy.

In a non-human primate model, Oregon Health & Science University researchers found that exposing a pregnant subject to THC altered placental and foetal epigenetics. Researchers also found that that these changes to gene regulation and expression are consistent with those seen with many common neurobehavioural conditions, including autism spectrum disorder.

“Cannabis is one of the most commonly used drugs and is widely available across the country, so there is a common perception that its completely safe to use,” said the study’s lead author Lyndsey Shorey-Kendrick, PhD, a computational biologist in the Division of Neurosciences at OHSU’s Oregon National Primate Research Center, or ONPRC. “The reality is that cannabis still carries many health risks for certain populations, including those who are pregnant. If we’re able to better understand the impacts, we can more effectively communicate the risks to patients and support safer habits during the vulnerable prenatal period.”

In a model using nonhuman primates, researchers administered THC in a daily edible and compared its effects to a group receiving a placebo. Specifically, researchers evaluated the epigenetic changes in several key areas that indicate healthy prenatal development: the placenta and foetal lung, brain and heart.

When looking at these areas, analyses showed that THC exposure altered the epigenome, meaning a process in which the information encoded in a gene is turned into a function or observable trait. Genes are all specifically coded to contribute to different functions of the body and brain, so any impact on epigenetic processes due to drug exposure is concerning, especially during a critical developmental window such as pregnancy.

Researchers found that significant changes involved genes associated with common neurobehavioral disorders, including autism spectrum disorder and attention deficit hyperactivity disorder. These conditions are linked to adverse health outcomes in childhood and adolescence, including poorer memory and verbal reasoning skills, and increased hyperactivity, impulsivity and inattention.

The research team hopes findings from this study will add to the limited existing literature on THC use during pregnancy, and help guide patient counselling and public health polices focused on cannabis in the future.

“It’s not common practice for providers to discuss cannabis use with patients who are pregnant or trying to conceive,” said the study’s corresponding author, Jamie Lo, MD, MCR, associate professor of obstetrics and gynaecology (maternal-foetal medicine) at OHSU. “I hope our work can help open up a broader dialogue about the risks of cannabis use in the preconception and prenatal period, so we can improve children’s health in the long run.”

Source: Oregon Health & Science University

One in Five Women Conceive Naturally after IVF Treatment

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Around 20% of women who needed fertility treatment, such as IVF, to conceive their first child are likely to get pregnant naturally in the future, finds a new study published in Human Reproduction. University College London researchers analysed data from 11 studies of over 5000 women around the world between 1980 and 2021, to evaluate how common it is to get pregnant naturally after delivering a baby conceived by fertility treatment.

They found that at least one in five women conceived naturally after having had a baby using fertility treatment such as IVF mostly within three years. This figure remained unchanged, even when taking into account the different types and outcome of fertility treatment – alongside length of follow up.

Infertility is defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse, and it is estimated to affect one in seven heterosexual couples.

However, not all women seeking and undergoing fertility treatment are absolutely or permanently infertile. And half of couples who struggle to conceive naturally in the first year of trying will go on to do so in the second year.

Not so rare an occurrence

Although it is typically considered ‘rare’ for a woman to get pregnant naturally, if she has previously had fertility treatment, the researchers want to highlight how it is not in fact an unusual event.

The team consider the findings to be particularly important, as many women may not realise that they could conceive naturally following fertility treatment. This could lead to them becoming pregnant again quickly or when they aren’t ready – which could be problematic for both the health of the mother and child.

Lead author, Dr Annette Thwaites (UCL EGA Institute for Women’s Health) said: “Our findings suggest that natural pregnancy after having a baby by IVF is far from rare. This is in contrast with widely held views – by women and health professionals – and those commonly expressed in the media, that it is a highly unlikely event.”

Much has changed since the early days of IVF and it is now used for a wide range of causes of infertility, including cases where no cause is ever found.

In addition, some women may not have experienced infertility at all but used treatment for other reasons. This could include single women using donor sperm, women in same sex relationships, surrogates or those seeking to screen for serious genetic conditions.

So, it is important for those who have had successful IVF to know how likely they are to conceive naturally afterwards.

IVF was first used in 1978 and now, more than 10 million babies worldwide have been born using the treatment – equating to between 1% and 6% of all babies born per year in the developed world by 2020.

In order to track the data more accurately and analyse which factors make natural pregnancy after having a baby by fertility treatment more likely, the researchers are calling for linked national data sets.

They hope that this information could then be used to counsel people considering their options after successful fertility treatment.

Dr Thwaites said: “Knowing what is possible would empower women to plan their families and make informed choices regarding further fertility treatment and/or contraception.”

Study limitations

Some limitations were the included studies being mostly of moderate quality with wide variation in geography, cause of subfertility, type and outcome of fertility treatment and length of follow up making direct comparisons difficult.

Source: University College London

Targeting A Particular Bacteria Reduced Endometriosis Lesions

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A research group from Nagoya University in Japan has discovered that using an antibiotic to target Fusobacterium reduced the formation of lesions associated with endometriosis, a gynaecological disorder characterised by endometrial tissue growing outside of the uterus. Their findings, published in Science Translational Medicine, suggest an alternative treatment for this disorder based on antibiotics.

Endometriosis affects one in ten women between the ages of 15 and 49. The disorder can cause lifelong health problems, including pelvic pain and infertility. Although it can be treated using hormone therapy and surgical resection, these procedures sometimes lead to side effects, recurrence, and a significant impact on pregnancy.

The group led by Professor Yutaka Kondo (he, him) and Assistant Professor Ayako Muraoka (she, her) from the Nagoya University Graduate School of Medicine, in collaboration with the National Cancer Center, found that the uterus of mice infected with Fusobacterium had more and heavier lesions. However, mice that had been given an antibiotic to eradicate Fusobacterium saw improved lesion formation.

The team’s findings strongly suggest that targeting Fusobacterium is an effective non-hormonal antibiotic treatment for endometriosis. Dr Kondo praised the potential for easier diagnosis and treatment. “Eradication of this bacterium by antibiotic treatment could be an approach to treat endometriosis for women who are positive for fusobacteria infection, and such women could be easily identified by vaginal swab or uterus swab,” he said.

This study also shows the benefit of looking at upstream events to determine causative agents. The initial finding was that a protein called transgelin (TAGLN) was often upregulated in patients with endometriosis. This was unsurprising because the protein is associated with processes that are important in the development of endometriosis. However, this finding led them to determine that transforming growth factor beta (TGF-β) seemed to cause the upregulation of TAGLN. Since TGF-β is released by macrophages, the natural anti-inflammatory response and immune regulation cells of the body, this led them to conclude that these macrophages were being activated in response to Fusobacterium.

“In this study, we demonstrated that the Fusobacterium-TAGLN-endometriosis axis is frequently dysregulated in endometriosis,” said Dr Kondo. “Our data provide a strong and novel rationale for targeting Fusobacterium as a non-hormonal antibiotic-based treatment for endometriosis.”

Clinical trials of antibiotic treatment for human patients are ongoing at the Department of Obstetrics and Gynecology at Nagoya University Hospital.

Source: Nagoya University

Rethink Needed for the Genetic Cause of Very Early Menopause

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A new study showed that it may be necessary to rethink the genetic cause previously held to be behind very early menopause. Until now, variants in any one of more than 100 genes were thought to cause premature ovarian insufficiency (POI), which results in menopause before age 40. This affects around 1% of women, making it a leading cause of infertility. Under current guidance, a variation in one of these genes is cause for clinicians to consider a genetic diagnosis of POI.

Now, in the largest study to date, published in Nature Medicine, researchers analysed genetic data from more than 104 733 women in UK Biobank, of whom 2231 reported experiencing menopause before the age of 40.

The study found evidence that 98% of women carrying variations in the genes that were previously considered to be causes of premature menopause in fact had menopause over 40, therefore ruling out a diagnosis of POI in these women.

Anna Murray, Professor of Human Genetics at the University of Exeter Medical School is a senior author on the study. She said: “Our research means rethinking what causes very early menopause. The presence of specific genetic variants in multiple women who experience premature menopause has led to the assumption that they are causing the condition – but we have shown that these gene variations are also found in women with a normal age of menopause and therefore in many cases the link could just be coincidence. It now seems likely that premature menopause is caused by a combination of variants in many genes, as well as non-genetic factors. As genomic medicine evolves, we need to apply this standard of evidence to other conditions, so we can tailor diagnosis, treatment and support.”

Dr Julia Prague, Consultant Endocrinologist and Clinical Academic at the University of Exeter, and an author on the paper, said: “Having a very early menopause is often extremely distressing because it means losing fertility and treatment with hormone replacement is required to prevent negative health consequences. Clinicians need to understand the reasons why premature menopause occurs so that they do not miss the true underlying cause and can counsel patients appropriately. Misinterpreting genetic tests could have negative implications for women, such as suggesting that their relatives may also be at risk of very early menopause due to their genes, when in fact they may not be.”

Stasa Stankovic, of the University of Cambridge’s MRC Epidemiology Unit, and co-lead analyst of the study, said: “Each woman’s unique genetic combination shifts menopause timing, either earlier or later. Although genetic variation in the studied genes were not sufficient to cause very early menopause, we did identify genetic drivers that had a much more subtle impact on reproductive longevity. For example, women carrying genetic variation in TWNK and SOHLH2 genes experienced menopause up to three years earlier than the general population. Our future studies will continue using the power of human genomics to better understand the underlying biology of reproductive ageing in women and key genetic drivers of its extreme forms, including very early menopause. With this knowledge, we are also paving the path towards development of next-generation treatments for reproductive disorders.”

Source: University of Exeter

Newly Discovered Embryonic Cell Self-destructs to Prevent Defects

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Scientists studying gene activity data of the early human embryo have discovered an overlooked type of cell which self-destructs within days of forming, as part of a quality control process to protect the developing foetus. The findings, published in PLoS Biology, give insights on what happens at the very first stages of life after fertilisation which could in the future help improve IVF or regenerative medicine treatments.

Self-destructing embryonic cell

As a zygote develops, cells start to specialise, and like trains sent to different end stations, some will be shunted off to become the placenta while others will become the embryo.

The team of scientists analysed previously published data on gene activity of each individual cell from 5-day old embryos and discovered around a quarter of the cells didn’t fit the profile of any of the known cell types (pre-embryo, pre-placenta etc).

Investigating further, they discovered that these cells contained so-called “Young transposable elements” or “jumping genes.” These are rogue elements of DNA that can copy themselves and insert themselves back into our DNA, often causing damage in the process.

Staining of embryos by project collaborators in Spain confirmed the existence of the cells with proteins derived from the jumping genes.

Looking a little further forward in time, the team found their descendants both have DNA damage and undergo a process of programmed cell death.

Quality control mechanism

This process, the researchers suggest, looks like a form of quality control: selection between cells in favour of the good ones.

Dr Zsuzsanna Izsva?k, co-senior author from the Max Delbrück Center and an expert on mobile DNA, said: “Humans, like all organisms, fight a never-ending game of cat and mouse with these harmful jumping genes.

“While we try and suppress these jumping genes by any means possible, very early in development they are active in some cells, probably because we cannot get our genetic defences in place fast enough.”

Co-lead author Professor Laurence Hurst, from the Milner Centre for Evolution at the University of Bath, said: “If a cell is damaged by the jumping genes – or any other sort of error such as having too few or too many chromosomes – then the embryo is better off removing these cells and not allowing them to become part of the developing baby.

“We are used to the idea of natural selection favouring one organism over another. What we are seeing within embryos also looks like survival of the fittest but this time between almost identical cells. It looks like we’ve uncovered a novel part of our arsenal against these harmful genetic components.”

Using old genetic enemies to fight new ones

Conversely, the single-cell data showed that the key cells that will become the embryo (the inner cell mass or ICM) don’t contain jumping genes but instead express a virus-like gene called human endogenous virus H. This helps suppress the young jumping genes in the inner cell mass, fitting with an emerging pattern that we use our old genetic enemies to fight our new ones.

The authors suggest that if the quality control process is too sensitive, the embryo as a whole may die. This might explain why some mutations in our system to detect damage in early embryos are also associated with infertility.

Source: University of Bath

New Study Finds Depression Risk with Hormonal Contraceptive Use

The possibility that contraceptive pills might have negative effects on mental health and even lead to depression has long been debated. Now, evidence published in Epidemiology and Psychiatric Sciences shows that contraceptive pills are in fact linked to depression, with teenage girls at particularly increased risk.

This study is one of the largest and widest-ranging to date, following more than a quarter of a million women from UK Biobank from birth to menopause.

The researchers collected data about women’s use of contraceptive pills, the time at which they were first diagnosed with depression and when they first experienced symptoms of depression without receiving a diagnosis. The method of contraception studied was combined contraceptive pills, which contain progestogen and oestrogen. Progestogen prevents ovulation and thickens the cervical mucus to prevent sperms from entering the uterus, while oestrogen thins the uterine lining to hinder the implantation of a fertilised egg.

“Although contraception has many advantages for women, both medical practitioners and patients should be informed about the side-effects identified in this and previous research,” says Therese Johansson at Uppsala University, one of the researchers leading the study.

According to the study, women who began to use contraceptive pills as teenagers had a 130% higher incidence of symptoms of depression, while the corresponding increase among adult users was 92%.

“The powerful influence of contraceptive pills on teenagers can be ascribed to the hormonal changes caused by puberty. As women in that age group have already experienced substantial hormonal changes, they can be more receptive not only to hormonal changes but also to other life experiences,” Johansson says.

The researchers were also able to see that the increased incidence of depression declined when the women continued to use contraceptive pills after the first two years. However, teenage users of contraceptive pills still had an increased incidence of depression even after stopping using the pill, which was not observed in adult users of contraceptive pills.

“It is important to emphasise that most women tolerate external hormones well, without experiencing negative effects on their mood, so combined contraceptive pills are an excellent option for many women. Contraceptive pills enable women to avoid unplanned pregnancies and they can also prevent illnesses that affect women, including ovarian cancer and uterine cancer. However, certain women may have an increased risk of depression after starting to use contraceptive pills.”

The findings of the study point to a need for healthcare professionals to be more aware of possible links between different systems in the body, such as depression and the use of contraceptive pills. The researchers conclude that it is important for care providers to inform women who are considering using contraceptive pills of the potential risk of depression as a side-effect of the medicine.

“Since we only investigated combined contraceptive pills in this study, we cannot draw conclusions about other contraceptive options, such as mini pills, contraceptive patches, hormonal spirals, vaginal rings or contraceptive rods. In a future study, we plan to examine different formulations and methods of administration. Our ambition in comparing different contraceptive methods is to give women even more information to help them take well-informed decisions about their contraceptive options,” Johansson says.

Source: Uppsala University

Researchers Advise Stopping Heparin Use for Pregnant Women with Thrombophilia and Miscarriage Risk

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Heparin, commonly prescribed to pregnant women with an inheritable blood clotting condition and a history of recurrent miscarriage does not help to reduce their miscarriage risk, new research has found. The UK-led international study was published in The Lancet.

Researchers are now advising doctors to stop offering the anticoagulant heparin to women and birthing people with inherited thrombophilia, an inherited condition which increase clotting risk.

Despite the lack of evidence and guidance, doctors often prescribe heparin to women with recurrent miscarriage and inherited thrombophilia. It’s costly for health services, and inconvenient for women who must inject the drug daily and are more likely to experience bruising as a result.

The results show that a daily injection of heparin does not improve the chance of a live birth for women who have previously had two or more miscarriages and confirmed inherited thrombophilia, when compared to standard care.

Led by Professor Siobhan Quenby at the University of Warwick, the ALIFE2 trial recruited women from 40 hospitals in Europe and the US.

326 women with inherited thrombophilia and recurrent miscarriage were split into 2 groups; 164 received heparin across the course of their pregnancy, starting from as soon as possible after a positive pregnancy test and ending at the start of labour. 162 were not offered the medication.

All women received standard obstetrician-led care and all women were encouraged to take folic acid.

The rate of live births for each group was roughly the same: 116 women (71.6%) treated with heparin had a baby born alive after 24 weeks’ pregnancy. 112 women (70.9%) in the standard care group had a baby born alive after 24 weeks’ pregnancy.

The risk of other pregnancy complications, including miscarriage, babies with low birth weight, placental abruption, premature birth or pre-eclampsia, was about the same for both groups.

As expected, bruising easily was reported by 73 (45%) of women in the group taking heparin (mostly around injection-sites) and only 16 (10%) in the standard care group.

Professor Siobhan Quenby says, “Based on these findings, we don’t recommend the use of Low Molecular Weight Heparin for women with recurrent pregnancy loss and confirmed inherited thrombophilia.”

“We also suggest that screening for inherited thrombophilia in women with recurrent pregnancy loss is not needed. Patients and doctors will always value knowing about any factor which could be associated with recurrent miscarriage, but the association between inherited thrombophilia and recurrent miscarriage isn’t proven: a recent review of research showed that thrombophilia is as common in the general population as it is in women with recurrent miscarriage.”

“Many women with recurrent miscarriage around the world are tested for inherited thrombophilia and are treated with heparin daily. Research now shows that this screening is not needed, the treatment isn’t effective, and it is giving false hope to many by continuing to offer it as a potential preventive treatment.”

Twenty-eight percent of women who participated in the trial lost their badly wanted pregnancies, and these unexplained losses will be the focus of further study, as our researchers continue to search for answers and treatment to prevent early pregnancy loss.

Source: Medical Xpress

Low Maternal Vitamin D Levels may Increase Schizophrenia Risk of Offspring

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Neuroscientists published in the Journal of Neurochemistry, shows that maternal levels of vitamin D are key in the development of dopaminergic neurons, which are thought to be involved in schizophrenia.

Professor Darryl Eyles has built on past research out of his laboratory at the Queensland Brain Institute linking maternal vitamin D deficiency and brain development disorders, such as schizophrenia, to understand the functional changes taking place in the brain.

Schizophrenia is associated with many developmental risk factors, both genetic and environmental. While the precise neurological causes of the disorder are unknown, what is known is that schizophrenia is associated with a pronounced change in the way the brain uses dopamine, the neurotransmitter often referred to as the brain’s ‘reward molecule’.

Professor Eyles has followed the mechanisms that might relate to abnormal dopamine release and discovered that maternal vitamin D deficiency affects the early development and later differentiation of dopaminergic neurons.

The team at the Queensland Brain Institute developed dopamine-like cells to replicate the process of differentiation into early dopaminergic neurons that usually takes place during embryonic development.

They cultured the neurons both in the presence and absence of the active vitamin D hormone. In three different model systems they showed dopamine neurite outgrowth was markedly increased. They then showed alterations in the distribution of presynaptic proteins responsible for dopamine release within these neurites.

“What we found was the altered differentiation process in the presence of vitamin D not only makes the cells grow differently, but recruits machinery to release dopamine differently,” Professor Eyles said.

Using a new visualisation tool known as false fluorescent neurotransmitters, the team could then analyse the functional changes in presynaptic dopamine uptake and release in the presence and absence of vitamin D.

They showed that dopamine release was enhanced in cells grown in the presence of the hormone compared to a control.

“This is conclusive evidence that vitamin D affects the structural differentiation of dopaminergic neurons.”

Leveraging advances in targeting and visualising single molecules within presynaptic nerve terminals has enabled Professor Eyles and his team to further explore their long-standing belief that maternal vitamin D deficiency changes how early dopaminergic circuits are formed.

The team is now exploring whether other environmental risk factors for schizophrenia such as maternal hypoxia or infection similarly alter the trajectory of dopamine neuron differentiation.

Eyles and his team believe such early alterations to dopamine neuron differentiation and function may be the neurodevelopmental origin of dopamine dysfunction later in adults who develop schizophrenia.

Source: University of Queensland

Cannabis Use in Pregnancy Reduces Birth Weights

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With growing legalisation and recreational use of cannabis comes a change in attitudes. Research has shown that dispensaries often recommend cannabis for the easing of pregnancy symptoms, especially morning sickness.

Growing evidence links cannabinoid consumption during pregnancy with poor child outcomes, though the exact effects on the developing foetus remain unclear. In a study published in Frontiers in Pediatrics, researchers in the US have now examined how timing of cannabis exposure during pregnancy impacts foetal development.

“We show that even when marijuana use occurred only in the first trimester of pregnancy, birth weight was significant reduced, by more than 150g on average,” said senior author Dr Beth Bailey, professor and director of population health research at Central Michigan University“If that use continued into the second trimester, newborn head circumference was significantly decreased as well.”

Continued exposure results in largest deficiencies

“These findings are important as newborn size is one of the strongest predictors of later child health and development,” added study first author Dr Phoebe Dodge.

Recent work, including the research by Dodge et al., has shown significant effects of cannabis use on newborn size. “Size deficits were largest among newborns exposed to marijuana throughout gestation,” Bailey explained. The babies born after continued in-utero exposure were nearly 200g lighter, and their head circumference was nearly 1cm less than that of babies who had not been exposed. Pregnancy cannabis use did not significantly predict newborn length in this study.

The effects the scientists observed have also shed light on patterns of use. Their study showed that occasional use, such as for first trimester morning sickness, may reduce fetal growth in the same way as continued use throughout pregnancy. The same is true for other use in early stages, including cases when someone uses cannabis not knowing they are pregnant.

Quitting before pregnancy is best recommendation

The authors pointed out that in their study they did not have information about how much or how often participants used cannabis. Their results were based on whether people did or did not use it at certain times in pregnancy. Therefore, the study could not establish if there was a connection between heavy use and more pronounced outcomes in newborn growth.

More studies are needed to determine whether timing or amount of use is most important when it comes to effects on newborn size, they wrote.

 “The best recommendation is that women should be advised to quit marijuana use prior to becoming pregnant,” Dodge said. However, quitting as soon as possible after getting pregnant is the second-best option to avoid long term adverse health and developmental outcomes. “There are some benefits of quitting among those who begin pregnancy using marijuana,” she continued.

Source: EurekAlert!