Major Study Finds Pregnancy Issue Actually Linked to Autism, And It’s Not Vaccines

It’s a common but erroneous belief among anti-vaxxers that if a pregnant woman gets jabbed, she puts her unborn child at risk of autism.

This couldn’t be further from the truth. Instead, a growing body of research suggests that when a mother goes unvaccinated, that is when she truly leaves her child vulnerable.

A new study of nearly 1.8 million children in Sweden has found that the risks for autism and depression are significantly higher if your mother was hospitalised with an infection during pregnancy.

The results build on a nascent but burgeoning idea that specific infections, when contracted during pregnancy, can harm a developing brain, boosting the risk of psychiatric disorders coming on later in life, including conditions such as bipolar disorder, schizophreniadepression, and autism.

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This new study, however, paints a much broader stroke. Instead of revealing one or two bad infections, the authors found that the results remained the same whether or not the hospitalisation was due to severe infections – like influenza, meningitis and pneumonia – or much more mild UTIs.

In other words, it isn’t necessarily a specific virus, but infection in general that appears to be causing these problems, and it seems to be the case even when the affliction can’t reach the fetal brain.

“The results indicate that safeguarding against and preventing infection during pregnancy as far as possible by, for instance, following flu vaccination recommendations, may be called for,” says Verena Sengpiel, an expert in obstetrics and gynaecology at the University of Gothenburg.

Drawing on data from the Medical Birth Register for almost 1.8 million children, born in Sweden between 1973 and 2014, the authors tallied how many of their mothers had been hospitalised with an infection during their respective pregnancies.

The researchers then tracked these children and their mental health through the inpatient register until 2014, when the oldest ones were turning 41.

Statistical analysis of the data revealed a worrying link between a child’s mental health and their mother’s immune system.

While the study did not find an increased risk of schizophrenia or bipolar disorder, the authors did find that when a pregnant woman goes to the hospital for an infection, her child is more likely to seek hospital treatment for depression and autism later on in life.

In fact, among these children, the increased risk was 79 percent for autism and 24 percent for depression.

“Overall, we found evidence that exposure to maternal infection during fetal life increased the risk of autism and possibly of depression in the child,” the authors write.

“Although the individual risk appears to be small, the population effects are potentially large.”

As fascinating as it is, the study is only observational, so it can’t tell us exactly how a maternal infection would impact a child’s developing brain.

Nevertheless, recent studies on animal models have suggested that these infections might be causing an inflammatory reaction in the nervous system, altering gene expression in the brain and changing its architecture.

The thing is, many of these studies also note there are a multitude of genetic factors at play, so the answer to this puzzle could be highly complex.

“Our results cannot exclude the possibility of increased risk for psychopathologic conditions as a result of a dual “hit”: an inflammatory fetal brain injury on a background of genetic susceptibility,” the authors of the new study write.

More research will be needed before we can say for sure what is going on. In the meantime, however, the best thing a pregnant mother can do is stay healthy and adhere to the best medical advice out there. Getting all your vaccinations is a good start.

Source: JAMA Psychiatry.

Ondansetron in Early Pregnancy Seen Not to Promote Cardiac Birth Defects Overall

A new report provides some reassurance regarding the safety of the antiemetic ondansetron when taken for nausea and vomiting in early pregnancy, researchers say.

In the large retrospective cohort study, use of ondansetron in the first trimester of pregnancy was not associated with an increased risk for cardiac malformations overall.

In a secondary finding, use of the drug was associated with increased risk for oral clefts, although the absolute risk was low.

“These results suggest that ondansetron does not meaningfully increase the risk of congenital malformations, although a small increase in the risk of oral clefts cannot be excluded,” Krista F. Huybrechts, Brigham and Women’s Hospital and Harvard Medical School, Boston, told | Medscape Cardiology.

“These results will hopefully provide reassurance to women who experience nausea and vomiting in pregnancy and need to make a risk–benefit trade off regarding treatment,” said Huybrechts, lead author on the study published December 18 in JAMA.

Evidence for the fetal safety of ondansetron, which is often prescribed for nausea and vomiting during pregnancy, is “limited and conflicting,” the researchers note in their article.

They looked at data from the Medicaid Analytic eXtrract (MAX) database of more than 1.8 million pregnancies, including 88,467 (4.9%) with exposure to ondansetron during the first trimester. They focused on cardiac malformations and oral clefts, the main congenital anomalies identified with any consistency in previous studies.

There were 14,577 cardiac abnormalities in 1,727,947 unexposed infants and 835 in 88,467 exposed infants. The adjusted risk difference was −0.8 (95% confidence interval [CI], −7.3 to 5.7 per 10,000 births) and the adjusted relative risk was 0.99 (95% CI, 0.93 to 1.06).

There was a small but statistically significant increased risk for oral clefts with first-trimester exposure to ondansetron (1912 cases in unexposed infants and 124 in exposed infants). The adjusted risk difference was 2.7 (95% CI, 0.2 – 5.2 per 10,000 births) and the adjusted relative risk was 1.24 (95% CI, 1.03 – 1.48).

After multiple adjustments, there was no difference in the risk for cardiac or overall congenital anomalies in infants born to women exposed to ondansetron. The adjusted risk difference was 5.4 (95% CI, −7.3 to 18.2 per 10,000 births) and the adjusted relative risk was 1.01 (95% CI, 0.98 to 1.05).

“The findings were consistent across a broad range of sensitivity analyses,” the authors report.

Although not formally approved for the treatment nausea and vomiting during pregnancy, the drug’s use for this purpose increased from 0.01% in 2000 to 12% in 2013, they point out.

In an accompanying editorial, David M. Haas, MD, Indiana University School of Medicine, Indianapolis, says early and effective safe treatment of nausea and vomiting in pregnancy is “crucial.”

This study provides “important and helpful” information for physicians to use when counseling women about the safety of treatment options, Haas writes.

The study shows clearly that although the adjusted relative risk for oral clefts was “elevated, the absolute risk increase is very low. The multiple adjustments and comparison groups presented, including accounting for the potential baseline risk of nausea and vomiting, demonstrate the robustness of the authors’ conclusions,” he adds.

Helping Pregnant Women and Clinicians Understand the Risk of Ondansetron for Nausea and Vomiting During Pregnancy

Nausea and vomiting during pregnancy (sometimes termed morning sickness) are among the most common medical issue to arise during pregnancy. Most pregnant women experience some form of nausea and vomiting, and prevalence rates are as high as 50% to 80%.1 Conservative measures, such as dietary modifications and avoidance of triggers, often do not control symptoms, so medications and other nondrug therapies are tried.2 Nausea and vomiting is one of the most common indications for prescriptions during pregnancy.3 Because this is a condition mainly of the first trimester, pregnant women and clinicians have concerns about the potential effects these therapies might have on the developing fetus.

In this issue of JAMA, Huybrechts and colleagues4 attempt to clarify associations of a commonly used antiemetic, ondansetron, with fetal congenital malformations. Because these malformations are typically rare, establishing cause and effect of a single drug and an anomaly is extremely difficult. Association studies using robust data sets often provide the best available evidence for establishing risk or safety of a drug. The authors describe some of the limitations of prior association studies and detail how the Medicaid Analytic eXtract (MAX) database is ideally suited to overcome some of these prior limitations. Because the authors have used these data for other pregnancy exposure studies, they are well-suited for the current analysis.

In this study, the authors used data from more than 1.8 million pregnancies, allowing for a large number of analyses and adjustments. Focusing on cardiac malformations and oral clefts (the main congenital anomalies identified with any consistency in prior studies), the authors found no significant association between ondansetron and cardiac abnormalities (14 577 abnormalities among 1 727 947 unexposed infants and 835 abnormalities among 88 467 exposed infants; adjusted risk difference, −0.8; 95% CI, −7.3 to 5.7 per 10 000 births; adjusted relative risk, 0.99, 95% CI; 0.93 to 1.06). They also detected a small but statistically significant increased risk of oral clefts with first-trimester exposure to ondansetron (1912 abnormalities among unexposed infants and 124 abnormalities among exposed infants; adjusted risk difference, 2.7; 95% CI, 0.2 to 5.2 per 10 000 births; adjusted RR, 1.24; 95% CI, 1.03 to 1.48). After multiple adjustments, the authors also found no difference in the risk of cardiac or overall congenital anomalies for infants of women exposed to ondansetron.

According to the American College of Obstetricians and Gynecologists (ACOG)–endorsed treatment algorithm, ondansetron, a serotonin receptor antagonist, is not the first-line drug for treatment of nausea and vomiting.1 However, it is one of the most commonly used agents in practice.3,5 This may be because of its different formulations, including an oral dissolving tablet, and its perceived effectiveness. Thus, it is important that clinicians and pregnant women have accurate safety information about its use during pregnancy.

Treatment of nausea and vomiting can be difficult and must be tailored to the individual patient. Often, a single treatment or combination of treatments that work for one woman will be ineffective for another. In the population studied by Huybrecht et al, 139 932 pregnant women (7.7%) also filled a prescription for promethazine, 52 818 (2.9%) filled a prescription for metoclopramide, and 9036 filled a prescription for pyridoxine (vitamin B6, 0.5%)—3 commonly used agents for nausea and vomiting. According to the treatment algorithm proposed by the ACOG Practice Bulletin, pyridoxine, alone or in combination with doxylamine, is listed as the first-line agent. Ondansetron appears as a third-line option in the algorithm.1

Ondansetron is metabolized by cytochrome P450 (CYP) enzymes that are polymorphic, such as CYP 2D6. Understanding how genetic differences among individuals cause varied responses to the same drug may have implications for prescribing.6 Because there are often genetic-based differences in activity of common drug-metabolizing enzymes, transporters, and receptors among individuals, pharmacogenomics can help guide therapeutic choices in several disease states.7 Further research is needed for ondansetron and other drugs for nausea and vomiting to determine if pharmacogenomic or specific phenotype characteristics can help personalize treatment for improved outcomes.8,9

In the evolving era of personalized medicine, rapidly determining the most effective therapy can have tangible benefits. Women with severe nausea and vomiting have decreased work productivity, more time away from personally fulfilling activities, and may have higher rates of adverse pregnancy outcomes.10,11 Additionally, severe nausea and vomiting was cited as a reason for higher rates of pregnancy termination from the Motherisk project in Canada.12 Thus, early and effective safe treatment of nausea and vomiting is crucial.

The article by Huybrechts and colleagues provides important and helpful information for physicians and other clinicians to use when counseling women about the safety of treatment options. The safety of some other options, such as pyridoxine, has been established.13 The current article documents clearly that while the adjusted relative risk of oral clefts was elevated, the absolute risk increase is very low. The multiple adjustments and comparison groups presented, including accounting for the potential baseline risk of nausea and vomiting, demonstrate the robustness of the authors’ conclusions.

In addition, the authors acknowledge the typical limitations of these types of analyses. Because of the low frequency of congenital anomaly outcomes, randomized trials would need to have enormous sample sizes to detect differences between drug exposures. Thus, observational data are best suited for these studies. One additional relevant limitation of the data set is that prescriptions for the current recommended first-line treatment, pryidoxine (with or without doxylamine), may not have been completely captured. The prescription combination of doxylamine and pyridoxine was approved by the US Food and Drug Administration in 2013, the final year the MAX data were queried. Many women may have obtained these components over-the-counter, and thus the true polypharmacy rates for nausea and vomiting treatment are not accounted for in the data set.

Utilizing a large data set, the study by Huybrechts et al provides some reassurance for obstetricians and other clinicians, as well as for pregnant women regarding the safety of a commonly used medication for nausea and vomiting. The potential risk and safety findings must be weighed with the effectiveness of ondansetron in treating nausea and vomiting and avoiding hyperemesis gravidarum. The analysis also provides additional reassurance of no increased risk of cardiac or total congenital malformations. As clinicians and pregnant women engage in informed, shared decision-making surrounding treatment for nausea and vomiting, the current information is important for contextualizing risks in light of the potential benefits.

PRAC issues warning for Valproate use during pregnancy

This Pregnant Personal Trainer Is Owning Her Runs

A lesson in adapting your fitness routine to your circumstances.



Working out when you’re pregnant can be a challenge, especially when you get close to your due date. And, for a lot of people, going for a vigorous run is out of the question.

That’s why one (very) pregnant personal trainer’s dedication to her running habit is so impressive. She’s making a point to squeeze in regular runs as she documents the whole thing on Instagram. Megan Mayer’s Instagram is filled with inspiring posts that feature her running—outside in a sports bra with her bump on full display, cranking it out on her treadmill, and cruising down the road while bundled up on a cold day.

In the process, Mayer has developed a serious following. And fans regularly comment on her posts to encourage her to keep going.

Mayer, who is now eight and a half months pregnant with her first child, tells SELF that running now is a lot tougher than it used to be.

“I went from taking no walk breaks to having to walk during almost every run,” she says. Mayer says she’s also slowed down a lot and always has to be near a bathroom, which is why she tends to opt for a treadmill.

She currently aims to run about four times a week and usually walks for a minute before running a mile and walking again. “I always set out for at least a three-mile run,” she says. “Three miles is a good enough workout that I feel like I accomplished something.” And, on days when she’s just not feeling great, she’ll simply walk three miles. That’s a big departure from her nonpregnancy routine. Mayer says she ran an average of 50 miles a week before her pregnancy and did up to 12 marathons, half marathons, and triathlons a year.

Still, Mayer says she’s “so thankful” that she’s been able to run throughout her pregnancy. “Not only do I feel great after my runs, but I also get my endorphin rush from running,” she says. “Even though I had to significantly decrease my runs and workouts when I got pregnant, I am still able to be active, and I am proud of that.”

Running seems like an intense form of exercise when you’re heavily pregnant, but it’s perfectly fine to keep it up if you were a runner before you got pregnant.

If you’re having a healthy pregnancy, it’s recommended that you try to get at least 150 minutes of moderate-intensity aerobic exercise (think: brisk walking) a week, per the American Congress of Obstetricians and Gynecologists. ACOG also says that if you regularly ran before your pregnancy, you’re fine to keep doing so as long as you’re healthy and your doctor is OK with it.

This is because women with a history of running have the conditioning and balance necessary to keep it up. They also know when they’re pushing too much, the way running typically affects their bodies, and when something feels off, James Pivarnik, Ph.D., a professor of kinesiology at Michigan State University who studies the effect of exercise on pregnant women, tells SELF. Keeping up your running while pregnant can help you maintain your fitness, balance, and sanity, Pivarnik says.

But, if you weren’t a runner before you became pregnant, it’s not a good idea to suddenly start, Pivarnik says—it could be too taxing on your body at a time when it’s already dealing with a lot.

You’re probably fine to keep your running distance and pace consistent in the beginning of your pregnancy (if you feel up for it). But it’s pretty likely you’re going to want to scale back at some point.

For starters, you’ve got a decent amount of bulk in front by the third trimester, and it’s kind of tiring to carry all that around, especially when you’re moving at a fast pace. Also, you have to pee a lot toward the end of your pregnancy, which means you’re probably going to need to take frequent bathroom breaks while you exercise. Plus, pregnancy is tiring and as you approach your due date, it’s completely understandable that you might not feel like going on a five-mile run.

But again, any exercise you can do during your pregnancy is great if you’re healthy, and it’s completely normal for you to need to scale back a little, especially as your pregnancy progresses. If you know you want to keep running but aren’t sure how far you should go anymore, Pivarnik recommends just listening to your body and how hard it feels like you’re working on a run. “If you stick with a certain perception of effort, you will naturally slow down as your pregnancy progresses,” he says.

Mayer says she knows she turns heads when she’s out running in a sports bra with her bump on display, but she doesn’t care—and she says other pregnant women shouldn’t either. “Don’t be scared of what others will think of you if you decide to be active during your pregnancy,” she says. “You will probably hear some negative comments along the way, but just do your best to ignore them. As long as you have your doctor’s permission to be active, don’t let other people stop you.”

And, she adds, don’t be afraid to slow down or walk on your runs—all that matters is that you’re being active and healthy, for you and your baby.

What to Expect After IUD Removal: Ob/Gyn Experts Explain

Breathe a sigh of relief: Getting it taken out is nothing like getting it inserted.

Whether you have an IUD removal on the books or you’re just wondering what the procedure is like, you’ve come to the right place. IUDs, also known as intrauterine devices, are little T-shaped instruments that reside snugly inside the uterus and ward off pregnancy with a variety of mechanisms. The hormonal kinds release levonorgestrel, a synthetic form of the hormone progestin, to prevent ovulation, thicken cervical mucous, and thin the lining of the uterus, according to the U.S. National Library of Medicine. The non-hormonal IUD releases copper ions, which are toxic to sperm.

IUDs sound like some impressive sci-fi invention, but they’re real, and they’re giving women excellent control over their reproductive futures. But after a certain point, the IUD has got to go, whether you’re ready to start trying for a baby or it’s just reached its time limit.

If you’ve been through the insertion process, which usually ranges from uncomfortable to downright painful, you might think about your future removal date with at least a little trepidation. Good news: Chances are you’ve got nothing to fear. Here, ob/gyns explain exactly what to expect during the removal of your Mirena, ParaGard, or other kind of IUD—both in the moment and afterward.

When do I need to get my IUD removed?

The official recommendations are to remove Mirena, a common hormonal option, five years after insertion. The same goes for Kyleena, another hormonal option from the maker of Mirena. You’ll need to replace hormonal IUDs Liletta and Skylaa bit earlier (four and three years, respectively). As for the copper ParaGard, which doesn’t use hormones? You can keep that superstar in for up to 10 years.

But, of course, you can always get your IUD removed earlier than any of these benchmarks if you want to get pregnant or if you’ve decided another birth control option makes more sense for you.

What actually happens during the IUD removal?

You know those strings hanging out of the bottom of your IUD? This is their time to shine. “The vast majority of the time, [IUD removal] simply involves doing a simple exam much like a Pap smear,” board-certified ob/gyn Antonio Pizarro, M.D., tells SELF. “If the strings are visible, the doctor grasps them using an instrument called ring forceps and gently pulls the IUD out.”

“Usually patients get really worked up, then when it’s done, they say, ‘Oh, that’s it?'” Jacques Moritz, M.D., an ob/gyn at Weill Cornell Medicine and NewYork-Presbyterian Hospital, tells SELF. The ease of removal comes down to a few major things, he explains: The doctor isn’t using an instrument to push past your cervix (the way they do during insertion), the IUD’s wings don’t have to open up in your uterus (ditto), plus the IUD’s arms just fold in on themselves when it’s being removed, so it’s as small as possible.

Is it painful to have an IUD removed?

“Anyone who has an IUD basically paid the price when getting it—the pain happens during insertion,” Dr. Moritz says. Keep in mind that even when rating the experience as terrible, many women say the pain of getting an IUD was well worth it since they provide such stellar protection against pregnancy.

“Everybody gets nervous about [removal], but it should almost not be felt. Just one deep breath, and it’s done,” Dr. Moritz says. Can’t you practically feel your uterus relaxing at this very welcome news? Even better, depending on your insurance, the entire cost of the removal may be covered.

Are there any IUD removal complications?

Most often, the process only takes a few minutes, then you’re good to go. But in the rare case that the doctor can’t find the strings, removal becomes a bit more involved. The IUD strings can shift a bit, sometimes curling up around the cervix so they’re harder to access, or maybe they were cut too short in the first place. In those instances, doctors can try to “tease” them out using some instruments, and it won’t exactly feel pleasant, Dr. Moritz says. “It’s not super painful, but definitely uncomfortable,” he explains. He gives himself a cutoff of 10-15 minutes to try teasing the IUD out. If that doesn’t work, other measures will.

“Rarely do IUDs become dislodged or the strings get lost,” Dr. Pizarro says. But on the off chance that something like that happens, doctors may use an ultrasound or hysteroscope (a thin lit tube that allows a doctor to see inside the uterus) to locate the IUD so they can remove it, potentially with anesthesia depending on the situation. “Even then, it’s limited invasiveness,” Dr. Pizarro says.

What kind of IUD removal side effects should I be prepared for?

You might feel a cramp as it the doctor pulls it out (again, it shouldn’t feel anything like the one some women experience during insertion) or you might not even realize it’s happened, Dr. Pizarro says. You may also experience some residual cramping or a little bleeding after an IUD removal, but as long as it isn’t severe and goes away in a few hours or, at worst, a couple of days, you don’t have anything to worry about.

One thing to really think about is that your period may change. The specific way it might change after IUD removal depends on what kind of IUD you had and how the device changed your cycle over time. Hormonal and non-hormonal IUDs change periods in different ways. You might enjoy lighter, less painful periods on a hormonal IUD like Mirena—or they may stop completely. So, when you get a hormonal IUD removed, your period will probably revert to what it was like without hormones, Dr. Moritz says.

As for the copper IUD, it’s all about how your body adjusted to it over time. Copper IUDs can make periods heavier and crampier at first, but for some women, that abates, while others deal with more intense periods the entire time. After getting a copper IUD removed, your period might become lighter and less annoying or not change much at all, the experts explain.

How long does it take to get pregnant after an IUD?

“Fertility is possible immediately,” Dr. Pizarro says. If you’re not ready to have kids yet or ever and your removal was normal, it might make sense for you to get another IUD in the same visit (this is often easier both time-wise and mindset-wise).

If you decide not to get a new IUD for whatever reason and you’re not interested in making babies, be sure to find another solid form of contraception you can rely on to keep you childfree.

Acetaminophen Use During Pregnancy Associated with Language Delay in Girls

Is It Really Normal to Have Nipple Hair?

Read this before feeling weird about your nipples.
Nipple hair

If you’ve ever noticed a rogue nipple hair, it probably prompted an array of emotions including confusion (um, hi, what are you doing here?) and annoyance (what does one even do about unwanted nipple hair?). But, in most cases, having hair around your nipples is actually perfectly ordinary. Think of it this way: You have hair all over you body, so your breasts shouldn’t be any exception.

Pretty much everyone has some level of hair on their breasts.

What people typically call “nipple hair” usually isn’t on the actual nipple at all. Instead, this hair often pops up on the areolae, aka the pigmented circles surrounding your nipples, and other non-nipple breast skin. “It is extremely common for women to have hair around the nipples,” Joshua Zeichner, M.D., a New York City-based board-certified dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center, tells SELF.

The exact percentage of how many women have breast hair isn’t known, since this isn’t something that has been studied at large or that women usually report to their doctors. Still, women’s health expert Jennifer Wider, M.D., agrees, telling SELF that breast hair is “very common.”

But…why does it exist? Biologically speaking, humans likely developed body hair for many reasons, some of which scientists haven’t yet fully pinpointed. Hair around your nipples may be a holdover from when body hair was an important part of regulating your temperature, Dr. Zeichner says. Since things like air conditioning, heaters, and fuzzy sweaters can do that now, the hair around your nipples doesn’t seem to serve any present-day purpose. Consider it boob decoration.

There are a few factors that can determine how much (or how little) hair you have on your boobs.

Like any other kind of body hair, breast hair can vary in amount, thickness, and color from person to person. Similarly to your pubic hair, it can also look different from the hair on the rest of your body, Dr. Zeichner says.

You may notice more hair growing around your nipples if your hormones are fluctuating more than usual, like during pregnancySherry A. Ross, M.D., a women’s health expert and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells SELF. The pregnancy-induced surge of estrogen can prolong your hair’s growth phase, so just like the hair on your head can seem especially long and lush when you’re expecting, so can the hair on your breasts, Dr. Wider explains. It’s all normal.

If you notice that you’re producing a lot more hair here than you used to, it could be a sign of a condition like polycystic ovary syndrome (PCOS), which can cause excessive hair growth on your face and body. This type of hair growth is known as hirsutism and can happen because of elevated male hormones, like testosterone, which are a common characteristic of PCOS, Dr. Ross says.

Keep in mind that having hair around your nipples without any other symptoms isn’t a sign of PCOS, Dr. Wider says. But if you’re noticing a lot more than usual and you’re also getting hair on your face, coupled with symptoms like bad acneand irregular periods, it’s worth flagging for your doctor. They can evaluate you and, if necessary, recommend treatment like birth control or other medications to prevent excessive hair growth.

Bottom line: Hair surrounding your nipples is usually just a part of having breasts.

There’s no reason to feel weird about it, or like your breasts need to be as smooth and hairless as a baby dolphin. But if you really can’t stand having breast hair, you can pluck it just like you would pluck your eyebrows (and it might hurt, just like it can with your eyebrows). The skin around your nipples is delicate and can be easily irritated, Dr. Zeichner says, so razors and wax are dicier options than simply tweezing.

If you have more hair around your nipples than you care to pluck, a dermatologist can talk to you about electrolysis (a procedure that involves inserting a tiny needle into the hair follicle and sending in an electric current to destroy the root) or laser hair removal, Dr. Zeichner says. (Just keep in mind that laser hair removal runs the risk of creating skin discoloration or other side effects, so you want to make sure you see someone who knows what they’re doing.)

Again, having hair around your nipples is super normal and not something you need to stress about or consider removing if it’s not bothering you. But, if it does bother you or it seems like a sign something’s up with your health, talk to your doctor to discuss ways you can nip any bothersome breast hair in the bud.

6 Things That Can Actually Impact Your Breast Size

It’s more than just your genes.
Various breast sizes

Most body parts, like your arms, legs, feet, and ears, grow to a certain size and then stop. Your boobs, on the other hand, are a completely different story. Your breast size and shape can go change throughout your life.

Of course, your boobs tend to have a standard size that you consider your “normal.” And, while they may deviate here and there, you probably eventually come back to this size. While it’s easy to think that your cup size was predestined, there are actually a lot of things that affect boob size. Here are the biggest factors that influence the overall size of your breasts.

1. Your family history.

Your genes dictate your hair and skin color, how tall you are, and a bunch of other things including, yup, your breast size. But your genes are more likely to predict your breast baseline—not your actual size. “Women often are born with their breast size, but it can change in their lifetime,” Nazanin Khakpour, M.D., F.A.C.S., a surgical oncologist specializing in breast cancer at Moffitt Cancer Center, tells SELF. That doesn’t mean you’re guaranteed to be a C-cup if your mom and sister are, but it’s definitely more likely for you than someone who comes from a family with a history of A-cups.

2. Your weight.

Breasts are made up of supportive tissue, milk glands and ducts, and fat, and how much you have of each is unique to you. Some women have more supportive tissue than fat and vice-versa. If your breasts contain a decent amount of fat, you could see a difference in your boob size when you gain or lose weight, Sherry Ross, M.D., a women’s health expert at Providence Saint John’s Health Center in Santa Monica, CA and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells SELF. That said, you probably won’t see a huge change if you gain or lose a few pounds. “It usually has to be a significant weight gain or loss to change your breast size,” Dr. Ross says.

3. Pushups, bench presses, and other pectoral exercises.

If you started lifting recently and noticed your boobs seem a little perkier lately, that may be related. Doing pectoral exercises can strengthen your pecs, which sit behind your breast tissue, and can cause your boobs to push out a tiny bit more than usual, Albert Matheny, M.S., R.D., C.S.C.S., of SoHo Strength Lab and Promix Nutrition, tells SELF. Keep in mind that these exercises won’t actually increase your breast size—but they might grow the muscle behind the breast, which could make them appear a little bigger.

4. Your birth control.

Your birth control can do more than prevent an unintended pregnancy and help regulate your period: Hormonal birth control methods like the pill, the shot, and the hormonal IUD can actually impact your breast size, women’s health expert Jennifer Wider, M.D., tells SELF. This is largely due to water retention, she says—and it’s unlikely to last. “It’s usually most noticeable when someone starts birth control,” Dr. Wider adds.

5. Pregnancy and breastfeeding.

Pregnancy boobs are a legit phenomena—a woman’s breasts can grow several cup sizes during pregnancy thanks to hormonal changes like increases in progesterone, Dr. Khakpour says. Your breasts may swell up even more when you’re breastfeeding thanks to your milk coming in, but they typically go back to normal about three to six months after you stop nursing, Dr. Khakpour says.

And if you have a few kids, the effects may be more pronounced. “Some women may experience changes in breast size and shape after multiple births and breastfeeding,” Dr. Khakpour says.

6. Your age.

Your boobs probably aren’t the same now as they were when you were 15, and it’s likely they’ll look different down the road. Most women’s breasts will become less perky with time, and that’s totally normal, Dr. Ross says. “It’s largely due to a change in skin elasticity and stretched ligaments,” she says.

While it’s normal for your boobs to change, there’s often a reason behind it that you can pinpoint. But, if you find that you’re experiencing sudden breast changes and you don’t know why, it’s important to talk to your doctor. While it’s likely due to something you haven’t thought of, it could be a sign of a tumor or growth in your breast. Again, don’t panic if you notice changes, but it’s best to get it checked out, just in case, Dr. Wider says.

Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations

Importance  The frequency of antipsychotic (AP) use during pregnancy has approximately doubled during the last decade. However, little is known about their safety for the developing fetus, and concerns have been raised about a potential association with congenital malformations.

Objective  To examine the risk for congenital malformations overall and cardiac malformations associated with first-trimester exposure to APs.

Design, Setting, and Participants  This nationwide sample of 1 360 101 pregnant women enrolled in Medicaid with a live-born infant constituted the pregnancy cohort nested in the Medicaid Analytic Extract database, which included data from January 1, 2000, to December 31, 2010. Participants were enrolled in Medicaid from 3 months before their last menstrual period through at least 1 month after delivery. Relative risks (RRs) were estimated using generalized linear models with fine stratification on the propensity score to control for the underlying psychiatric disorders and other potential confounders. Data were analyzed during 2015.

Exposures  Use of APs during the first trimester, the etiologically relevant period for organogenesis.

Main Outcomes and Measures  Major congenital malformations overall and cardiac malformations identified during the first 90 days after delivery.

Results  Of the 1 341 715 pregnancies that met inclusion criteria (mean [SD] age of women, 24.02 [5.77] years), 9258 (0.69%) filled at least 1 prescription for an atypical AP and 733 (0.05%) filled at least 1 prescription for a typical AP during the first trimester. Overall, 32.7 (95% CI, 32.4-33.0) per 1000 births not exposed to APs were diagnosed with congenital malformations compared with 44.5 (95% CI, 40.5-48.9) per 1000 births exposed to atypical and 38.2 (95% CI, 26.6-54.7) per 1000 births exposed to typical APs. Unadjusted analyses suggested an increased risk for malformations overall for atypical APs (RR, 1.36; 95% CI, 1.24-1.50) but not for typical APs (RR, 1.17; 95% CI, 0.81-1.68). After confounding adjustment, the RR was reduced to 1.05 (95% CI, 0.96-1.16) for atypical APs and 0.90 (95% CI, 0.62-1.31) for typical APs. The findings for cardiac malformations were similar. For the individual agents examined, a small increased risk in overall malformations (RR, 1.26; 95% CI, 1.02-1.56) and cardiac malformations (RR, 1.26; 95% CI, 0.88-1.81) was found for risperidone that was independent of measured confounders.

Conclusions and Relevance  Evidence from this large study suggests that use of APs early in pregnancy generally does not meaningfully increase the risk for congenital malformations overall or cardiac malformations in particular. The small increase in the risk for malformations observed with risperidone requires additional study.

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