Prenatal cannabis exposure linked to worse executive function, more aggressive behavior
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Key takeaways:
- One-third of children in the cohort were exposed to cannabis prenatally.
- Children who were exposed performed worse at planning, inhibitory control and attention.
Young children who were exposed to cannabis before birth performed worse at executive functioning tasks and were more prone to aggressive behavior, according to findings from a small study published in JAMA Pediatrics.
“The findings were not particularly surprising because they actually align well with the results of some important studies on this topic that were done in the 1980s and 1990s,” Sarah A. Keim, PhD, MA, MS, principal investigator in the Center for Biobehavioral Health at Nationwide Children’s Hospital’s Research Institute, told Healio. “The main difference is that we were able to see these associations earlier in childhood and in more specific aspects of development and behavior than before.”
As Healio previously reported, prenatal cannabis use nearly doubled in California from 2012 to 2022, and prenatal exposure is associated with preterm birth and low birth weight. However, researchers found it was not associated with developmental delays in children.
For their study, Keim and colleagues recruited 355 pregnant women who were planning to deliver at the Ohio State University Wexner Medical Center between May 25, 2010, and Feb. 7, 2016. They followed up 5 years later to evaluate each child’s executive function and aggressive behavior.
Out of 250 children (53% girls) who participated, most were non-Hispanic Black or African American (62%), 50 were non-Hispanic white (20%), 20 identified as more than one race (14%) and 11 identified as Hispanic (4%). According to the researchers, most families earned less than the national poverty level.
Nearly 40% of mothers reported using tobacco during pregnancy (39%), 22% reported using alcohol and 26% reported using other drugs while pregnant, according to the study.
Overall, 80 children (32%) had been exposed to cannabis before birth. Keim and colleagues found that the children who were exposed to cannabis performed 0.4 standard deviations worse in inhibitory control and attention and 0.3 standard deviations worse at planning, compared with unexposed children.
The researchers also observed the participants for aggressive behavior. When children hit a Bobo Doll during the observation, the researchers considered fisted hits as more aggressive than open-hand hits. They found that children who were exposed to cannabis prenatally were more aggressive than unexposed children, as “17 percentage points more hits to the face were fisted,” they wrote.
In a related editorial, Ran Barzilay, MD, PhD, and Lauren K. White, PhD, from the department of psychiatry at University of Pennsylvania’s Perelman School of Medicine, wrote that Keim’s study stands out from previous research because it accounted for confounders like poverty, substance use during pregnancy and maternal mental health and stress.
However, because of the small sample size, single site and large proportion of Black women and women from low socioeconomic households, they said the study may not be generalizable. They also noted that the demographic factors among exposed children were significantly different from the unexposed children, and “while the authors statistically adjusted for these potential confounders, many of the group differences could not be mitigated to allow a pure comparison.”
“There is a critical need for more large-scale research that incorporates multiple environmental confounders and applies methods tailored to address causal effects of exposures in observational data,” Barzilay and White wrote. “Until such compelling causal evidence is available, it may be prudent to consider prenatal cannabis exposure a broader exposomic risk factor for offspring neurodevelopment, rather than a causal factor.”
Keim said pediatricians should refer to AAP guidelines, which advise avoiding cannabis during pregnancy.
“Some women may turn to cannabis to help deal with some common issues of pregnancy including nausea, sleep problems and stress,” Keim said. “Although cannabis is a natural product, there are still many risks to using it during pregnancy.”
References:
- Barzilay R, et al. JAMA Pediatr. 2024;doi:10.1001/jamapediatrics.2024.4358.
- Keim SA, et al. JAMA Pediatr. 2024;doi:10.1001/jamapediatrics.2024.4352.
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