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Poor executive function and aggressive behavior at age 5 years was observed among children exposed to cannabis during pregnancy, a cohort study suggested.

Among 250 children, age-corrected standard scores for attention and inhibitory control on the were about 0.4 standard deviations lower for those exposed to cannabis compared with those who were unexposed (β = -6.1 points, 95% CI -10.8 to -1.4) after propensity score weighting and adjustment for confounders, reported Sarah Keim, PhD, of the Abigail Wexner Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and co-authors.

Exposed children were also more likely to show aggressive behavior, such as hitting in the face using a fist (β=0.17, 95% CI 0.02-0.31), they noted in .

"We embarked on this line of research because we noticed several years ago that there had been an uptick in the prevalence of cannabis use during pregnancy in the U.S.," Keim told MedPage Today. "We were familiar with research that had been done a couple of decades ago showing some of the harms of [cannabis exposure] to child development and behavior, but that research hadn't been updated with a more contemporary sample of children."

Keim added that cannabis use during pregnancy had more than doubled from 2003 to 2017, and the potency of cannabis has also increased dramatically -- show up to 13 times more potency -- in the past couple of decades.

Pointing to the association between cannabis exposure and worse attention and inhibitory control, she noted "that jumped out at us, in particular, because, one, it was among the strongest associations we observed in the study, but also was so strikingly consistent with a couple of classic longitudinal studies that were done back in the 80s and 90s."

"These findings reinforce the existing clinical recommendations that are out there [from] the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists," Keim said. "Hopefully this evidence gives some renewed, fresh data for clinicians to use when they approach their patients."

In , Ran Barzilay, MD, PhD, and Lauren White, PhD, both of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, noted that these findings "should be interpreted in the context of wider intergenerational influences on neurodevelopment."

"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," they wrote.

Until more research is available, Barzilay and White advised clinicians to consider cannabis exposure during pregnancy to be a broader risk factor for maternal health, as well as a child's neurodevelopment.

"It might suggest that women who use cannabis during pregnancy represent a high-risk group who may benefit from counseling and intervention beyond a recommendation for cannabis abstinence during pregnancy," they added.

For this cohort study, the authors collected data on 250 mother-child dyads who were patients at Ohio State University Wexner Medical Center from 2016 through 2020. All children were born between May 25, 2010 and February 7, 2016, and all assessments were conducted when the children were 5 years old.

Of the 250 children, 80 were exposed to cannabis (32%), 62% were Black or African American, 20% were white, and 4% were Hispanic. The authors noted that use of tobacco, other drugs, and alcohol during pregnancy were also common, and most families were living in poverty.

Cannabis exposure was measured prospectively by urine toxicology, maternal self-report, and obstetric record abstraction.

The study was limited by several factors, including the potential for the misclassification of cannabis exposure. The authors also did not have data on the dose or timing of cannabis exposure. Residual confounding factors were also possible.

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