Associations Between Prenatal Cannabis Exposure and Childhood Outcomes: Results From the ABCD Study

Abstract

Importance: In light of increasing cannabis use among pregnant women, the US Surgeon General recently issued an advisory against the use of marijuana during pregnancy.

Objective: To evaluate whether cannabis use during pregnancy is associated with adverse outcomes among offspring.

Design, setting, and participants: 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.

Exposure: Prenatal cannabis exposure prior to and after maternal knowledge of pregnancy.

Main outcomes and measures: 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.

Results: 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).

Conclusions and relevance: 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.

Figure.. Association of Prenatal Cannabis Exposure After Maternal Knowledge of Pregnancy With Risk of Adverse Childhood Outcomes

A, Psychotic-like experiences. B, Internalizing problems. C, Externalizing problems. D, Attention problems. E, Thought problems. F, Social problems. G, Cognition. H, Birth weight. Raw data values are plotted. As scales differ, y axes are not directly comparable across panels. Vertical lines indicate SEs. Statistics are presented in Table 2 and Table 3 and eTables 1 and 2 in the Supplement. Log-transforming data reduce differences in variability across groups and results in similar conclusions (eTable 4 in the Supplement). CBCL indicates Child Behavior Checklist. ^aP < .05 only before false discovery rate correction. ^bFalse discovery rate–corrected P < .05.