Prenatal cannabis exposure after knowledge of the pregnancy is associated with increased childhood psychopathology after covariate adjustment; exposure before knowledge shows no independent effects after adjustment.
Summary
ABCD study (n=11.489 children 9–11 years, 22 US sites); prenatal cannabis exposure after knowledge of pregnancy associated with significantly increased childhood psychopathology (PLEs, externalizing/internalizing/attention/social behavior), sleep problems, increased BMI, lower cognition and reduced brain volume (all FDR-corrected p<0,04; all |β|>0,02). Exposure exclusively before knowledge of pregnancy after covariate control: no significant effect (FDR-corrected p>0,70).
P
PopulationChildren aged 9–11 years from the ABCD study (USA, 22 sites), n=11.489, of whom 655 (5,7%) with prenatal cannabis exposure
I
InterventionPrenatal cannabis exposure (before and after maternal knowledge of pregnancy)
C
ControlNo prenatal cannabis exposure
O
OutcomeAfter covariate adjustment: exposure after knowledge of pregnancy associated with increased psychotic-like experiences as well as externalizing, attention, thought and social problems (all β > 0,02; FDR-corrected p < 0,02); exposure only before knowledge no longer significantly different from no exposure (all |β| < 0,02; FDR-corrected p > 0,70)
Confidence in the evidence
Very lowLowModerateHigh
Low
The second of four GRADE levels, the effect estimate is of limited reliability.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeMixed
Citations / year★★★★★
Authors
Paul SE, Hatoum AS, Fine JD, Johnson EC, Hansen I, Karcher NR, Moreau AL, Bondy E, Qu Y, Carter EB, Rogers CE, Agrawal A, Barch DM, Bogdan R.
<h4>Importance</h4>In light of increasing cannabis use among pregnant women, the US Surgeon General recently issued an advisory against the use of Cannabis during pregnancy.<h4>Objective</h4>To evaluate whether cannabis use during pregnancy is associated with adverse outcomes among offspring.<h4>Design, setting, and participants</h4>In this cross-sectional study, data were obtained from the baseline session of the ongoing longitudinal Adolescent Brain and Cognitive Development Study, which recruited 11 875 children aged 9 to 11 years, as well as a parent or caregiver, from 22 sites across the United States between June 1, 2016, and October 15, 2018.<h4>Exposure</h4>Prenatal cannabis exposure prior to and after maternal knowledge of pregnancy.<h4>Main outcomes and measures</h4>Symptoms of psychopathology in children (ie, psychotic-like experiences [PLEs] and internalizing, externalizing, attention, thought, and social problems), cognition, sleep, birth weight, gestational age at birth, body mass index, and brain structure (ie, total intracranial volume, white matter volume, and gray matter volume). Covariates included familial (eg, income and familial psychopathology), pregnancy (eg, prenatal exposure to alcohol and tobacco), and child (eg, substance use) variables.<h4>Results</h4>Among 11 489 children (5997 boys [52.2%]; mean [SD] age, 9.9 [0.6] years) with nonmissing prenatal cannabis exposure data, 655 (5.7%) were exposed to cannabis prenatally. Relative to no exposure, cannabis exposure only before (413 [3.6%]) and after (242 [2.1%]) maternal knowledge of pregnancy were associated with greater offspring psychopathology characteristics (ie, PLEs and internalizing, externalizing, attention, thought and, social problems), sleep problems, and body mass index, as well as lower cognition and gray matter volume (all |β| > 0.02; all false discovery rate [FDR]-corrected P < .03). Only exposure after knowledge of pregnancy was associated with lower birth weight as well as total intracranial volume and white matter volumes relative to no exposure and exposure only before knowledge (all |β| > 0.02; all FDR-corrected P < .04). When including potentially confounding covariates, exposure after maternal knowledge of pregnancy remained associated with greater PLEs and externalizing, attention, thought, and social problems (all β > 0.02; FDR-corrected P < .02). Exposure only prior to maternal knowledge of pregnancy did not differ from no exposure on any outcomes when considering potentially confounding variables (all |β| < 0.02; FDR-corrected P > .70).<h4>Conclusions and relevance</h4>This study suggests that prenatal cannabis exposure and its correlated factors are associated with greater risk for psychopathology during middle childhood. Cannabis use during pregnancy should be discouraged.