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Women who smoke marijuana during pregnancy may impair their baby’s growth and development in the womb, a new study suggests.

Poor fetal growth and reduced head circumference at birth are linked to an increased risk of problems with thinking, memory and behavior in childhood. Cigarette smoking during pregnancy is known to impair fetal growth, but studies on the potential effects of marijuana have been inconclusive.

For the new study, researchers in the Netherlands followed more than 7,000 pregnant women, 3 percent of whom acknowledged smoking marijuana at least during early pregnancy. They found that babies born to marijuana users tended to weigh less and have smaller heads than other infants.

What’s more, the study found, the longer a woman had used marijuana during pregnancy, the stronger the impact on birth size — suggesting that the drug itself was to blame.

And while most marijuana users in the study also smoked cigarettes, the drug appeared to have effects over and above those of tobacco. In fact, marijuana showed stronger effects on birth size than tobacco, the investigators report in the Journal of the American Academy of Child and Adolescent Psychiatry.

The findings suggest that marijuana use, even restricted to early pregnancy, may have irreversible effects on fetal growth, write the researchers, led by Hannan El Marroun of Erasmus University Medical Center in Rotterdam.

To prevent this, they add, women who smoke marijuana should quit before becoming pregnant.

The study included almost 7,500 pregnant women who were surveyed on their use of alcohol, tobacco and drugs, and had ultrasounds to chart fetal growth during the first, second and third trimesters.

Overall, 214 women said they had used marijuana before and during early pregnancy; 81 percent quit after learning they were pregnant, but 41 women continued to smoke marijuana throughout pregnancy.

The researchers found that, on average, marijuana users gave birth to smaller babies, particularly those who had used throughout pregnancy.

Women who had smoked only during early pregnancy had babies who were

156 grams — about 5.5 ounces — lighter than infants born to women who had not used the drug. Women who had continued to smoke past early pregnancy had babies who were 277 grams, or nearly 10 ounces, smaller.

Based on ultrasound, marijuana use only in early pregnancy impaired fetal growth by about 11 grams per week, while use throughout pregnancy slowed fetal growth by roughly 14 grams per week. That compared with a deficit of 4 grams per week with tobacco use, the researchers found.

Similar patterns were seen when the researchers looked at fetal head circumference.

According to El Marroun’s team, mothers’ marijuana use could stunt fetal growth for several reasons. Like tobacco smoking, it may deprive the fetus of oxygen. It is also possible that the byproducts of marijuana directly affect the developing nervous and hormonal systems of the fetus.

Finally, the researchers note, pregnant women who use marijuana may have other factors in their lives – such as a less-than-healthy diet or chronic stress — that could contribute to poor fetal growth.

SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry

If you’re ready to ditch your toddler’s diapers for good, the best time to start potty training may be between the second and third birthdays.

A new study suggests 27 to 32 months is the ideal window for moving your child out of diapers. Children who were toilet trained after 32 months were more likely to have urge incontinence — daytime wetting and bed-wetting — between ages 4 and 12.

And potty training children sooner than 27 months generally doesn’t work either, according to background information in the study. Prior research has shown potty training too soon just prolongs the process.

“There are two schools of thought on potty training. One is to try to train the kids very, very early, and another says you should wait until kids are older and demonstrating signs of being ready. But there has never been a study scientifically showing when is the best time,” said lead study author Dr. Joseph Barone, chief of urology at Bristol-Myers Squibb Children’s Hospital in New Brunswick, N.J. “This study gives parents an idea of when it’s a good time to train,” he said.

Although there are always parents on the playground who brag they trained their child in a day, the study — published in the December 2009 issue of the Journal of Pediatric Urology — found timing was more important than technique.

Researchers asked the parents of 157 children ages 4 to 12 who were seen by a doctor for urge incontinence about when they started potty training and which method they used. Their answers were compared to those from the parents of 58 children matched for age, gender, race and other factors who did not have urge incontinence.

The mean age for toilet training of children with urge incontinence was 31.7 months, compared to 28.7 months for children who did not have problems with daytime wetting.

As for technique, parents were given three choices: a child-oriented approach, described as waiting for the child to show signs of readiness before initiating training and then letting the child direct the toilet training process; a parent-oriented approach, described as starting training when the parent was ready and then bringing the child to the toilet at regular, defined intervals, or a combination of the two.

Researchers found no difference in the method of toilet training and the likelihood of having problems with wetting at ages 4 to 12.

Age shouldn’t be the deciding factor in beginning potty training, said Peter Stavinoha, author of the book “Stress-Free Potty Training” and a clinical neuropsychologist at Children’s Medical Center of Dallas.

The key is making sure your child is physically and developmentally ready, Stavinoha said. Although many children will show potty training readiness at about 2 1/2, it can vary, Stavinoha said.

“Many parents approach potty training as something over which they have total control,” Stavinoha said. “Parents are a big contributor to their child’s development, but they don’t really control it. Parents are there to facilitate, to guide, to reinforce and to praise, but parents shouldn’t put pressure on themselves that if they do a series of steps, the children will achieve a certain outcome.”

If you feel like you’ve been changing diapers forever, you’re not alone. Over the last few decades, the mean age of potting training has crept up in the United States and other countries, including Brazil, Switzerland and China, the article said. In 1980, the mean age U.S. children were toilet-trained was 26 months. In 2003, it was 36.8 months.

One possible explanation for later potty training is the widespread availability and convenience of disposable diapers, the study authors propose.

Tips to Trouble-Free Toilet Training

When you think it’s time, Barone and Stavinoha offer these tips for getting kids trained:
Look for signs of readiness. These include showing interest in the potty or toilet; staying dry during naps or for several hours during the day; being able to follow simple directions; being able to pull down their own pants; using words, posture or facial expressions that indicate they have to go.
Make a small potty available in the bathroom. Try doing practice runs when you think your toddler might need to go by having him sit or stand in front of the potty for a few minutes several times a day. Most likely, your toddler won’t actually go, Stavinoha said. But it can help them recognize the urge to go and associate the potty with it.
If your child resists, don’t sweat it. Setting up a battle of wills will only make the process unnecessarily difficult on mom and dad. Back off for a few weeks, then try again.
While potty training, avoid asking: “Do you have to go to the potty?” “You’re almost guaranteed your child will tell you ‘no’,” Stavinoha said.

If a child is 4 or 5 and still not staying dry during the day, or if you suspect the reason may have a physical cause, discuss it with the pediatrician, Stavinoha said.

SOURCES: Joseph Barone, M.D., chief, urology, Bristol-Myers Squibb Children’s Hospital, Robert Wood Johnson University Hospital, New Brunswick, N.J., and associate professor of surgery at UMDNJ-Robert Wood Johnson Medical School; Peter Stavinoha, Ph.D., clinical neuropsychologist, Children’s Medical Center of Dallas;

Quitting smoking after a diagnosis of early stage lung cancer doubles the odds that a patient will live another five years, a new study finds.

“The results are quite dramatic. I don’t think anybody would have expected such a dramatic difference. It’s incredible,” said Dr. Norman Edelman, chief medical officer for the American Lung Association. “The important caveat is that this is early lung cancer.”

Early stage lung malignancies can have cure rates of 50 percent to 60 percent, Edelman noted. The tragedy is that very few lung cancers (perhaps 20 percent, the authors stated) are diagnosed at this early stage.

The new findings are published in the Jan. 21 online edition of BMJ.

According to an accompanying journal editorial, fewer than one-third of all patients with lung cancer are still alive just one year after diagnosis.

Of course, the best way to prevent lung cancer is to never smoke, or to quit if you do smoke. People who quit smoking have a dramatically lower incidence of being diagnosed with lung cancer over the life span, experts note.

But it’s been less clear how quitting smoking might affect patient prognosis after a diagnosis has already been handed down, the study authors said.

To find out, the British researchers pored over data from 10 prior observational studies looking at the impact of quitting smoking post-diagnosis.

“We used meta-analysis to summarize their findings,” said study lead author, Amanda Parsons, a Ph.D. candidate at the U.K. Centre for Tobacco Control Studies at the University of Birmingham College of Medicine and Dentistry. “Quitting smoking was associated with around double the chance of surviving at any time point compared to people who continued to smoke.”

Only 29 to 33 percent of early stage lung cancer patients who kept smoking survived for five years, while 63 to 70 percent of patients who quit survived that long, Parsons stated.

The survival seemed to come from a lower likelihood of tumor recurrence, not from heart/lung improvements, the researchers said.

All the patients were early stage and had been treated with either surgery, chemotherapy or radiation so, Parsons added, “the results can only be applied to this group of lung cancer patients. This work does not tell us anything about the benefits of quitting smoking if you have advanced disease.”

And because all of the studies included in this analysis were observational in nature, it’s not certain yet whether quitting smoking actually caused the decline in deaths.

Still, the findings beg the question of whether smoking cessation counseling should be routinely offered to people diagnosed with lung cancer.

According to Parsons, “smoking cessation support is not routinely offered to patients with lung cancer although some hospitals may offer this support.” That’s in Britain, Edelman noted, and the odds of there being any consistency in this area is even less likely in the U.S., which has no overarching health care system.

“Certainly the American Lung Association pushes smoking cessation for everybody. We say over and over again — it’s never too late to quit. There’s good evidence that you can get benefits if you’re 70 years old,” he said.

SOURCES: Amanda Parsons, Ph.D. candidate and research fellow, U.K. Centre for Tobacco Control Studies, University of Birmingham College of Medicine and Dentistry, Birmingham, U.K.; Norman Edelman, M.D., chief medical officer, American Lung Association