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Wymore EM, Wagner K, Gold C, Halmo LS. High Stakes: Exploring the Impact of Cannabis Use in Pregnancy and Lactation. Neoreviews 2025; 26:e247-e263. [PMID: 40164212 DOI: 10.1542/neo.26-4-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 12/10/2024] [Indexed: 04/02/2025]
Abstract
Cannabis is the most commonly used federally illicit substance during pregnancy in the United States, with an estimated prevalence of 3% to 30%. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics discourage cannabis use during pregnancy and breastfeeding due to safety concerns for the fetus and infant. Despite these recommendations, nearly half of active cannabis users continue use in pregnancy. In this review, we summarize cannabis pharmacology and metabolism with a focus on delta-9-tetrahydrocannabinol, the psychoactive component of the cannabis plant, highlighting its significance in quantifying exposure and the impact on outcomes studies. We also provide a concise review of current evidence on the effects of perinatal cannabis use and pregnancy, infant, and childhood outcomes, acknowledging the limitations of this evidence. Additionally, we provide targeted counseling recommendations for harm reduction strategies and lactation considerations for birthing parents who use cannabis.
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Affiliation(s)
- Erica M Wymore
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Katharine Wagner
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Christine Gold
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Laurie Seidel Halmo
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
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Avalos LA, Oberman N, Alexeeff SE, Croen LA, Davignon MN, Adams SR, Ansley D, Chambers CD, Steuerle K, Young-Wolff KC. Early Maternal Prenatal Cannabis Use and Child Developmental Delays. JAMA Netw Open 2024; 7:e2440295. [PMID: 39422907 PMCID: PMC11581621 DOI: 10.1001/jamanetworkopen.2024.40295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/23/2024] [Indexed: 10/19/2024] Open
Abstract
Importance Maternal prenatal cannabis use is associated with adverse neonatal health effects, yet little is known about its association with child developmental outcomes. Objective To evaluate associations between maternal prenatal cannabis use in early pregnancy and child early developmental delays. Design, Setting, and Participants This cohort study included 119 976 children born to 106 240 unique individuals between January 2015 and December 2019 and followed up to aged 5.5 years or younger (through December 31, 2021) at Kaiser Permanente Northern California. Individuals were screened for prenatal cannabis use via self-report and urine toxicology at entrance into prenatal care (approximately 8- to 10-weeks' gestation). Data were analyzed from February 2023 to March 2024. Exposure Maternal prenatal cannabis use defined as any use (self-reported or by urine toxicology testing) and use frequency. Main Outcomes Early developmental delays (speech and language disorders, motor delays, global delays) in children up to age 5.5 years defined by International Statistical Classification of Diseases and Related Health Problems, Ninth Revision and Tenth Revision diagnoses codes ascertained from electronic health records. Results In this cohort of 119 976 pregnancies among 106 240 unique pregnant individuals, there were 29 543 Hispanic pregnancies (24.6%), 6567 non-Hispanic Black pregnancies (5.5%), 46 823 non-Hispanic White pregnancies (39.0%), 12 837 pregnancies (10.7%) to individuals aged 24 years or younger, and 10 365 pregnancies (8.6%) to individuals insured by Medicaid. Maternal prenatal cannabis use was documented for 6778 pregnancies (5.6%). Daily maternal prenatal cannabis use was reported for 618 pregnancies (0.5%), weekly for 722 pregnancies (0.6%), and monthly or less for 1617 pregnancies (1.3%). No association was observed between maternal prenatal cannabis use and child speech and language disorders (HR, 0.93; 95% CI, 0.84-1.03), global developmental delays (HR, 1.04; 95% CI, 0.68-1.59), or motor delays (HR, 0.86; 95% CI, 0.69-1.06). No association was detected between the frequency of maternal prenatal cannabis use and child early developmental delays. Conclusions and Relevance In this cohort study, maternal prenatal cannabis use was not associated with an increased risk of child early developmental delays. Future research is needed to assess different patterns of cannabis use throughout pregnancy. Given the association between maternal prenatal cannabis use and other adverse outcomes, pregnant individuals should be educated on those risks.
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Affiliation(s)
- Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Pleasanton
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California
| | - Nina Oberman
- Division of Research, Kaiser Permanente Northern California, Pleasanton
| | | | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Pleasanton
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California
| | - Meghan N. Davignon
- Pediatric Developmental Disabilities, Pediatric Subspecialties, Kaiser Permanente Roseville Medical Center, Roseville, California
| | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Pleasanton
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Christina D. Chambers
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla
| | - Kristin Steuerle
- Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, California
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Pleasanton
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
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Willford JA, Kaufman JM. Through a teratological lens: A narrative review of exposure to stress and drugs of abuse during pregnancy on neurodevelopment. Neurotoxicol Teratol 2024; 105:107384. [PMID: 39187031 DOI: 10.1016/j.ntt.2024.107384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
Teratological research shows that both prenatal stress and prenatal substance exposure have a significant impact on neurodevelopmental outcomes in children. Using human research, the purpose of this narrative review is to explore the degree to which these exposures may represent complex prenatal and postnatal risks for the development of cognition and behavior in children. An understanding of the HPA axis and its function during pregnancy as well as the types and operationalization of prenatal stress provide a context for understanding the direct and indirect mechanisms by which prenatal stress affects brain and behavior development. In turn, prenatal substance exposure studies are evaluated for their importance in understanding variables that indicate a potential interaction with prenatal stress including reactivity to novelty, arousal, and stress reactivity during early childhood. The similarities and differences between prenatal stress exposure and prenatal substance exposure on neurodevelopmental outcomes including arousal and emotion regulation, cognition, behavior, stress reactivity, and risk for psychopathology are summarized. Further considerations for teratological studies of prenatal stress and/or substance exposure include identifying and addressing methodological challenges, embracing the complexity of pre-and postnatal environments in the research, and the importance of incorporating parenting and resilience into future studies.
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Affiliation(s)
- Jennifer A Willford
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057, United States of America.
| | - Jesse M Kaufman
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057, United States of America
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Talavera-Barber MM, Morehead E, Ziegler K, Hockett C, Elliott AJ. Prenatal cannabinoid exposure and early language development. Front Pediatr 2023; 11:1290707. [PMID: 38078314 PMCID: PMC10702953 DOI: 10.3389/fped.2023.1290707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/31/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction The effect of prenatal cannabis exposure (PCE) on childhood neurodevelopment remains poorly understood. There is a paucity of studies describing the neurodevelopment impact of PCE in infancy. The Mullen Scale of Early Learning (MSEL) is a cognitive screening tool that can be used from birth to 68 months and includes language and motor domains. Here we aim to explore the association between PCE during pregnancy and neurodevelopmental outcomes at 12 months of age. Methods Participants were pregnant persons/infant pairs enrolled in The Safe Passage Study, a large prospective cohort study. Inclusion criteria included data available on PCE with associated MSEL scores at 12 months of age. Exposed participants were defined as early exposure (1st trimester only) or late exposure (2nd or 3rd trimester) and were randomly matched with unexposed participants. Multiple linear regression models were performed to test associations between prenatal cannabis exposure and the five Mullen subscales: gross motor, fine motor, expressive language, receptive language, and visual reception. Results Sixty-nine exposed and 138 randomly matched unexposed infants were included in the analyses. Mothers of children with PCE were younger with the mean age 23.7 years for early exposure (n = 51) and 22.8 years for late exposure (n = 18). Maternal characteristics with prenatal cannabis use include a high-school education, American Indian or Alaska Native descent, lower socioeconomic status and co-use of tobacco. There were no gestational age or sex difference among the groups. Expressive (95% CI: 2.54-12.76; p = 0.0036,) and receptive language scores (95% CI: 0.39-8.72; p = 0.0322) were significantly increased between late-exposed infants compared to unexposed infants following adjustment for covariates. Gross motor scores (95% CI: 1.75-13; p = 0.0105) were also significantly increased for early-exposed infants with no difference in visual reception scores. Conclusion Preclinical studies have shown abnormal brain connectivity in offspring exposed to cannabis affecting emotional regulation, hyperactivity, and language development. Results from this study link PCE to altered early language development within the first year of life. Exposed infants demonstrated increased expressive and receptive language scores at 12 months of age, which can translate to better performance in school. However, further research is needed to determine the implications of these results later in childhood.
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Affiliation(s)
- Maria M. Talavera-Barber
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Evlyn Morehead
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Katherine Ziegler
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Christine Hockett
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
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McPherson C. Up in Smoke: The Impacts of Marijuana During Pregnancy. Neonatal Netw 2023; 42:222-232. [PMID: 37491043 DOI: 10.1891/nn-2022-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 07/27/2023]
Abstract
Numerous drugs ingested during pregnancy can impact the developing fetus. Although some effects are apparent at birth as overt teratogenicity or profound neonatal withdrawal, others become apparent only after a careful long-term follow-up into childhood. Shifting legal and cultural attitudes toward marijuana have led to increased use during pregnancy. This shift should prompt health care providers to carefully consider the drug's mechanism of action, its interaction with the placenta, and the potential consequences of fetal exposure. The primary psychoactive compound in marijuana is Δ9-tetrahydrocannabinol (THC), which agonizes endogenous cannabinoid receptors. Cannabinoid receptors are present in the fetal brain early in gestation and appear to have an important role in the developing central nervous system. THC crosses the placenta in sufficient quantities to raise concerns about exogenous exposure during fetal development. Robust follow-up studies suggest that marijuana use during pregnancy contributes to suboptimal fetal growth. At school age, heavy prenatal marijuana exposure predicts challenges in executive function (specifically, memory and reasoning) and externalizing behavior (e.g., hyperactivity and inattention). Memory and behavioral problems persist into early adulthood. These challenges coincide with a higher risk of heavy marijuana use in offspring. In concert with a suboptimal environment, young adults may experience a higher risk of global cognitive impairment and/or delinquency. Importantly, these adverse outcomes appear to be mitigated by postnatal factors including home environment. Ongoing studies in the modern era will be vital to enhance our understanding of the mechanisms by which THC impacts the fetus and confirm or refute knowledge regarding long-term impact. This knowledge will inform both health care providers and parents in collaborative decision-making to optimize the outcome of children.
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Moore BF, Salmons KA, Hoyt AT, Swenson KS, Bates EA, Sauder KA, Shapiro ALB, Wilkening G, Kinney GL, Neophytou AM, Sempio C, Klawitter J, Christians U, Dabelea D. Associations between Prenatal and Postnatal Exposure to Cannabis with Cognition and Behavior at Age 5 Years: The Healthy Start Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4880. [PMID: 36981794 PMCID: PMC10049128 DOI: 10.3390/ijerph20064880] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Prenatal exposure to cannabis may influence childhood cognition and behavior, but the epidemiologic evidence is mixed. Even less is known about the potential impact of secondhand exposure to cannabis during early childhood. OBJECTIVE This study sought to assess whether prenatal and/or postnatal exposure to cannabis was associated with childhood cognition and behavior. STUDY DESIGN This sub-study included a convenience sample of 81 mother-child pairs from a Colorado-based cohort. Seven common cannabinoids (including delta 9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD)) and their metabolites were measured in maternal urine collected mid-gestation and child urine collected at age 5 years. Prenatal and postnatal exposure to cannabis was dichotomized as exposed (detection of any cannabinoid) and not exposed. Generalized linear models examined the associations between prenatal or postnatal exposure to cannabis with the NIH Toolbox and Child Behavior Checklist T-scores at age 5 years. RESULTS In this study, 7% (n = 6) of the children had prenatal exposure to cannabis and 12% (n = 10) had postnatal exposure to cannabis, with two children experiencing this exposure at both time points. The most common cannabinoid detected in pregnancy was Δ9-THC, whereas the most common cannabinoid detected in childhood was CBD. Postnatal exposure to cannabis was associated with more aggressive behavior (β: 3.2; 95% CI: 0.5, 5.9), attention deficit/hyperactivity problems (β: 8.0; 95% CI: 2.2, 13.7), and oppositional/defiant behaviors (β: 3.2; 95% CI: 0.2, 6.3), as well as less cognitive flexibility (β: -15.6; 95% CI: -30.0, -1.2) and weaker receptive language (β: -9.7; 95% CI: -19.2, -0.3). By contrast, prenatal exposure to cannabis was associated with fewer internalizing behaviors (mean difference: -10.2; 95% CI: -20.3, -0.2) and fewer somatic complaints (mean difference: -5.2, 95% CI: -9.8, -0.6). CONCLUSIONS Our study suggests that postnatal exposure to cannabis is associated with more behavioral and cognitive problems among 5-year-old children, independent of prenatal and postnatal exposure to tobacco. The potential risks of cannabis use (including smoking and vaping) during pregnancy and around young children should be more widely communicated to parents.
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Affiliation(s)
- Brianna F. Moore
- Department of Epidemiology, Human Genetics and Environmental Sciences, Health Science Center, The University of Texas, Austin, TX 78712, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Kaytlyn A. Salmons
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Adrienne T. Hoyt
- Department of Health Promotion and Behavioral Science, Health Science Center, The University of Texas, Austin, TX 78712, USA
| | - Karli S. Swenson
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Emily A. Bates
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Allison L. B. Shapiro
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Greta Wilkening
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Andreas M. Neophytou
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Cristina Sempio
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Jost Klawitter
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Uwe Christians
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
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Mulligan MK, Hamre KM. Influence of prenatal cannabinoid exposure on early development and beyond. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:10981. [PMID: 38389825 PMCID: PMC10880766 DOI: 10.3389/adar.2023.10981] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2024]
Abstract
Public perception surrounding whether cannabis use is harmful during pregnancy often diverges greatly from the recommendations of doctors and healthcare providers. In contrast to the medical guidance of abstinence before, during, and after pregnancy, many women of reproductive age believe cannabis use during pregnancy is associated with little potential harm. Legalization and social cues support public perceptions that cannabis use during pregnancy is safe. Moreover, pregnant women may consider cannabis to be a safe alternative for treating pregnancy related ailments, including morning sickness. Compounding the problem is a lack of medical and federal guidance on safe, low, or high-risk levels of cannabis use. These issues mirror the continuing debate surrounding alcohol use and health, in particular, whether there are safe or lower risk levels of alcohol consumption during pregnancy. Clinical studies to date suffer from several limitations. First, most human studies are correlative in nature, meaning that causal associations cannot be made between in utero cannabis exposure and health and behavioral outcomes later in life. Due to obvious ethical constraints, it is not possible to randomly assign pregnant mothers to cannabis or other drug exposure conditions-a requirement needed to establish causality. In addition, clinical studies often lack quantitative information on maternal exposure (i.e., dose, frequency, and duration), include a small number of individuals, lack replication of outcome measures across cohorts, rely on self-report to establish maternal drug use, and suffer from unmeasured or residual confounding factors. Causal associations between maternal cannabis exposure and offspring outcomes are possible in preclinical cohorts but there is a large amount of heterogeneity across study designs and developmental differences between rodents and humans may limit translatability. In this review, we summarize research from human and preclinical models to provide insight into potential risks associated with prenatal cannabinoid exposure (PCE). Finally, we highlight gaps in knowledge likely to contribute to the growing divide between medical guidance and public attitudes regarding cannabis use during pregnancy.
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Affiliation(s)
- Megan K Mulligan
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center (UTHSC), Memphis, TN, United States
| | - Kristin M Hamre
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center (UTHSC), Memphis, TN, United States
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8
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Thompson M, Vila M, Wang L, Thabane L, Shea AK. Prenatal cannabis use and its impact on offspring neuro-behavioural outcomes: A systematic review. Paediatr Child Health 2023; 28:8-16. [PMID: 36865761 PMCID: PMC9971580 DOI: 10.1093/pch/pxac079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/09/2022] [Indexed: 03/04/2023] Open
Abstract
Introduction Cannabis is a widely used substance in pregnancy, yet there is a paucity of literature addressing the neuro-behavioural consequences for prenatally exposed children. Our systematic review synthesizes currently available data for the impact of prenatal cannabis use on offspring intelligence and cognitive functioning. Methods MEDLINE, EMBASE, PsychINFO, CINAHL, and Clinicaltrials.gov were searched. Observational studies comparing prenatal cannabis use to controls were included. Offspring neuro-behavioural outcomes were grouped in prespecified domains of (1) intelligence and (2) cognitive functioning. Random-effect models were performed for meta-analyses when at least three studies reported the same outcome. All others were summarized qualitatively. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework was used to assess evidence certainty. Results Of the 1982 reviewed studies (n = 523,107 patients), 28 were included. Significant heterogeneity and cohort redundancy limited meta-analysis. Very low-quality evidence from pooled analyses showed no significant associations between prenatal cannabis exposure and attention [standardized mean difference = -0.27 (95% CI = -0.60 to 0.07)], global intelligence quotient [-0.16 (-0.42 to 0.10)], reading [-0.05 (-0.29 to 0.20)], written comprehension [-0.09 (-0.40 to 0.22)], spelling [-0.04 (-0.26 to 0.17)], and mathematics [-0.01 (-0.15 to 0.13)]. No significant associations were found between prenatal cannabis exposure for all other outcomes. Individual studies reported significant differences between the heavy use groups and non-exposed, although this did not prove to be significant when outcomes were pooled. Conclusions The current review did not find a clear association between prenatal cannabis use and offspring neuro-behavioural outcomes. However, evidence was low quality and heterogenous. Further prospective investigation is needed to elucidate any potential association between prenatal cannabis use and long-term neuro-developmental outcomes.
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Affiliation(s)
- Mary Thompson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Merima Vila
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alison K Shea
- The Research Institute, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Sujan AC, Young-Wolff KC, Avalos LA. In-utero cannabis exposure and long-term psychiatric and neurodevelopmental outcomes: The limitations of existing literature and recommendations for future research. Birth Defects Res 2022; 114:689-713. [PMID: 35708102 PMCID: PMC9357094 DOI: 10.1002/bdr2.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/25/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022]
Abstract
Given increases in cannabis use in pregnancy and animal model research showing effects of in-utero cannabis exposure, high-quality information on long-term consequences of in-utero cannabis exposure in humans is needed. While reviews have summarized findings from observational studies with humans, reviews have not focused on limitations of these studies and recommendations for future research. Therefore, we critically reviewed observational research on in-utero cannabis exposure and psychiatric and neurodevelopmental outcomes measured at or after age 3 and provided recommendations for future research. We used Web of Science, Google Scholar, and work cited from relevant identified publications to identify 46 papers to include in our review. Our review includes two main sections. The first section highlights the extensive limitations of the existing research, which include small and nongeneralizable samples, reliance on self-reported data, lack of detail on timing and amount of exposure, inclusion of older exposure data only, not accounting for important confounders, inclusion of potential mediators as covariates, not including outcome severity measures, and not assessing for offspring sex differences. The second section provides recommendations for future research regarding exposure and outcome measures, sample selection, confounder adjustment, and other methodological considerations. For example, with regard to exposure definition, we recommend that studies quantify the amount of cannabis exposure, evaluate the influence of timing of exposure, and incorporate biological measures (e.g., urine toxicology measures). Given that high-quality information on long-term consequences of in-utero cannabis exposure in humans does not yet exit, it is crucial for future research to address the limitations we have identified.
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Affiliation(s)
- Ayesha C Sujan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Hussain S, Breit KR, Thomas JD. The effects of prenatal nicotine and THC E-cigarette exposure on motor development in rats. Psychopharmacology (Berl) 2022; 239:1579-1591. [PMID: 35338387 DOI: 10.1007/s00213-022-06095-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Abstract
RATIONALE In the USA, nicotine and cannabis are the most common licit and illicit drugs used among pregnant women. Importantly, nicotine and cannabis are now being combined for consumption via e-cigarettes, an increasingly popular delivery device. Both nicotine and tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, cross the placenta barrier. However, the consequences of prenatal cannabis use are not well understood, and less is known about potential combination effects when consumed with nicotine, especially via e-cigarettes. OBJECTIVE The present study used a rodent model to examine how prenatal e-cigarette exposure to nicotine, THC, and the combination impacts motor development among offspring. METHODS Pregnant Sprague-Dawley rats were exposed to nicotine (36 mg/mL), THC (100 mg/mL), the combination, or vehicle via e-cigarette inhalation from gestational days (GD) 5-20. One sex pair per litter was tested on an early sensorimotor development task (postnatal days [PD] 12-20) and a parallel bar motor coordination task (PD 30-32). RESULTS Combined prenatal exposure to nicotine and THC delayed sensorimotor development, even though neither drug produced impairments on their own. In contrast, prenatal exposure to either nicotine or THC impaired motor coordination, whereas combined exposure exacerbated these effects, particularly among females. CONCLUSIONS These data illustrate that prenatal exposure to either nicotine or THC may alter motor development, and that the combination may produce more severe effects. These findings have important implications for pregnant women as we better understand the teratogenic effects of these drugs consumed via e-cigarettes.
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Affiliation(s)
- S Hussain
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, CA, San Diego, USA
| | - K R Breit
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, CA, San Diego, USA.,Department of Psychology, West Chester University of Pennsylvania, West Chester, PA, USA
| | - J D Thomas
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, CA, San Diego, USA.
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Directive clinique n o 425b : Le cannabis aux différentes périodes de la vie des femmes - Partie 2 : Grossesse, période postnatale et allaitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:445-454.e1. [PMID: 35400522 DOI: 10.1016/j.jogc.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIF Fournir aux fournisseurs de soins les meilleures données probantes sur l'utilisation de cannabis et la santé des femmes. Les domaines d'intérêt sont le dépistage, la dépendance et le sevrage; la communication et la tenue de dossier; la grossesse (y compris les issues fœtales et maternelles); la gestion de la douleur maternelle; les soins postnataux (y compris la fumée secondaire et la parentalité); et l'allaitement. POPULATION CIBLE Femmes enceintes, allaitantes ou qui planifient une grossesse. BéNéFICES, RISQUES ET COûTS: Discuter de l'utilisation de cannabis avec les femmes enceintes, allaitantes ou qui planifient une grossesse les aide à faire des choix éclairés. D'après des données probantes limitées, il faut éviter l'utilisation de cannabis pendant la grossesse ou l'allaitement, ou réduire la consommation au maximum si l'abstention n'est pas un objectif atteignable, étant donné l'absence de données sur l'innocuité et le suivi à long terme des grossesses et nourrissons exposés au cannabis. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed et Cochrane Library pour extraire des articles sur l'utilisation de cannabis pendant la grossesse et l'allaitement publiés entre le 1er janvier 2018 et le 5 février 2021. Les termes de recherche ont été déterminés à partir de termes de recherche MeSH, de mots clés et de leurs variantes : cannabis, cannabinoids, cannabidiol, CBD, THC, marijuana, edible, pregnancy, pregnant, prenatal, perinatal, postnatal, breastfeed, breastfed, lactation, nursing, fetus, fetal, neonatal, newborn et child. Les auteurs ont inclus toutes les publications des types suivants : essais cliniques, études observationnelles, revues (y compris les revues systématiques et les méta-analyses), directives cliniques et déclarations de conférences de consensus. Les principaux critères d'inclusion étaient les femmes enceintes et allaitantes, comme population cible, et l'exposition au cannabis, comme intervention d'intérêt. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins de santé qui prodiguent des soins aux femmes en âge de procréer. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Graves LE, Robert M, Allen VM, Dama S, Gabrys RL, Tanguay RL, Turner SD, Green CR, Cook JL. Guideline No. 425b: Cannabis Use Throughout Women's Lifespans - Part 2: Pregnancy, the Postnatal Period, and Breastfeeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:436-444.e1. [PMID: 35400521 DOI: 10.1016/j.jogc.2022.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To provide health care providers with the best evidence on cannabis use and women's health. Areas of focus include screening, dependence, and withdrawal; communication and documentation; pregnancy (including maternal and fetal outcomes); maternal pain control; postpartum care (including second-hand smoking and parenting); and breastfeeding. TARGET POPULATION The target population includes women who are planning a pregnancy, pregnant, or breastfeeding. BENEFITS, HARMS, AND COSTS Discussing cannabis use with women who are planning a pregnancy, pregnant, or breastfeeding allows them to make informed choices about their cannabis use. Based on the limited evidence, cannabis use in pregnancy or while breastfeeding should be avoided, or reduced as much as possible if abstaining is not feasible, given the absence of safety and long-term follow up data on cannabis-exposed pregnancies and infants. EVIDENCE PubMed and Cochrane Library databases were searched for articles relevant to cannabis use during pregnancy and breastfeeding published between January 1, 2018, and February 5, 2021. The search terms were developed using the MeSH terms and keywords and their variants, including cannabis, cannabinoids, cannabidiol, CBD, THC, marijuana, edible, pregnancy, pregnant, prenatal, perinatal, postnatal, breastfeed, breastfed, lactation, nursing, fetus, fetal, neonatal, newborn, and child. In terms of publication type, all clinical trials, observational studies, reviews (including systematic reviews and meta-analyses), guidelines, and conference consensus statements were included. The main inclusion criteria were pregnant and breastfeeding women as the target population, and exposure to cannabis as the intervention of interest. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care providers who care for women of reproductive age. SUMMARY STATEMENTS RECOMMENDATIONS.
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Wang GS, Buttorff C, Wilks A, Schwam D, Metz TD, Tung G, Pacula RL. Cannabis legalization and cannabis-involved pregnancy hospitalizations in Colorado. Prev Med 2022; 156:106993. [PMID: 35150750 PMCID: PMC8956031 DOI: 10.1016/j.ypmed.2022.106993] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/09/2021] [Accepted: 02/06/2022] [Indexed: 11/16/2022]
Abstract
The primary objective of this study was to evaluate the association between presence of recreational cannabis dispensaries and prevalence of cannabis-involved pregnancy hospitalizations in Colorado. This was a retrospective cohort study of pregnancy-related hospitalizations co-coded with cannabis diagnosis codes in the Colorado Hospital Association from January 1, 2011, through December 31, 2018 (recreational cannabis began January 1, 2014). Our primary outcome was cannabis-involved pregnancy hospitalizations per 10 k live births per county. The primary exposure measure was county variation in the number of recreational dispensaries. We controlled for counties' baseline exposure to medical cannabis dispensaries and used Poisson regression to evaluate the association between exposure to recreational cannabis and hospitalizations. During the study period, cannabis-involved pregnancy hospitalizations increased from 429 to 1210. Mean hospitalizations per county (1.7 to 4.7) and per 10 k live births (13.2 to 55.7) increased. Overall, increasing recreational dispensaries were associated with increases in hospitalizations (1.02, CI: 1.00,1.04). When comparing counties with different densities of baseline medical cannabis market, low and high exposure counties had fewer hospitalizations than those counties with no exposure (low: IRR 0.97, CI: 0.96-0.99; high: 0.98, CI: 0.96-0.99). In Colorado, there was more than a two-fold increase in cannabis-involved pregnancy hospitalizations between 2011 and 2018. Counties with no baseline exposure to medical cannabis had a greater increase than other counties, suggesting the recreational market may influence cannabis use among pregnant individuals.
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Affiliation(s)
- George Sam Wang
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America.
| | - Christine Buttorff
- RAND Corporation, 1200 S. Hayes St, Arlington, VA 22202, United States of America.
| | - Asa Wilks
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Daniel Schwam
- RAND Corporation, 1200 S. Hayes St, Arlington, VA 22202, United States of America.
| | - Torri D Metz
- University of Utah Health, 50 Medical Dr N, Salt Lake City, UT 84132, United States of America.
| | - Gregory Tung
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Health Systems, Management & Policy, Program for Injury Prevention, Education and Research (PIPER), Colorado School of Public Health, 13001 E. 17th Place, MS B119, United States of America.
| | - Rosalie Liccardo Pacula
- University of Southern California, Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, 635 Downey Way, VPD 514J, Los Angeles, CA 90089-3333, United States of America.
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De Genna NM, Willford JA, Richardson GA. Long-term effects of prenatal cannabis exposure: Pathways to adolescent and adult outcomes. Pharmacol Biochem Behav 2022; 214:173358. [PMID: 35216971 PMCID: PMC8911923 DOI: 10.1016/j.pbb.2022.173358] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 12/09/2022]
Abstract
With the increased prevalence, potency, and acceptability of cannabis use during pregnancy, it is important to understand the developmental effects of prenatal cannabis exposure (PCE). This review discusses methodological considerations for studies of PCE, including the assessment of exposures, covariates, and outcomes, and reviews findings from prospective, longitudinal studies of PCE. There is some evidence for associations between PCE and restricted growth at birth, but not for long-term effects on growth. PCE appears to have subtle yet enduring effects on memory and achievement in children and adolescents. Despite differences in sample demographics and measurement, there are remarkably consistent effects of PCE on externalizing behaviors, such as delinquency and substance use, which persist into adulthood. Longitudinal analyses demonstrate the importance of early cannabis initiation for pathways between PCE and adult functioning, including substance use and abuse, memory deficits, and psychotic symptoms. Animal studies demonstrate direct effects on the development of the brain via activation of endogenous endocannabinoid systems. Cannabis-induced activation of the endocannabinoid system causes alterations in the release of neurotransmitters and the modulation of brain plasticity in neural pathways that underlie cognition, motivation, and behavior regulation. Future research should consider cannabis use before pregnancy, the timing and route of exposure, polysubstance exposures, and inter-generational effects.
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Affiliation(s)
- Natacha M. De Genna
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O’Hara Street, Pittsburgh, PA 15213,Corresponding author:
| | - Jennifer A. Willford
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057
| | - Gale A. Richardson
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O’Hara Street, Pittsburgh, PA 15213
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15
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Warton FL, Taylor PA, Warton CMR, Molteno CD, Wintermark P, Zöllei L, van der Kouwe AJ, Jacobson JL, Jacobson SW, Meintjes EM. Reduced fractional anisotropy in projection, association, and commissural fiber networks in neonates with prenatal methamphetamine exposure. Dev Neurobiol 2020; 80:381-398. [PMID: 33010114 PMCID: PMC7855045 DOI: 10.1002/dneu.22784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/31/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022]
Abstract
Prenatal exposure to methamphetamine is associated with neurostructural changes, including alterations in white matter microstructure. This study investigated the effects of methamphetamine exposure on microstructure of global white matter networks in neonates. Pregnant women were interviewed beginning in mid-pregnancy regarding their methamphetamine use. Diffusion weighted imaging sets were acquired for 23 non-sedated neonates. White matter bundles associated with pairs of target regions within five networks (commissural fibers, left and right projection fibers, and left and right association fibers) were estimated using probabilistic tractography, and fractional anisotropy (FA) and diffusion measures determined within each connection. Multiple regression analyses showed that increasing methamphetamine exposure was significantly associated with reduced FA in all five networks, after control for potential confounders. Increased exposure was associated with lower axial diffusivity in the right association fiber network and with increased radial diffusivity in the right projection and left and right association fiber networks. Within the projection and association networks a subset of individual connections showed a negative correlation between FA and methamphetamine exposure. These findings are consistent with previous reports in older children and demonstrate that microstructural changes associated with methamphetamine exposure are already detectable in neonates.
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Affiliation(s)
- Fleur L Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Paul A Taylor
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- African Institute for Mathematical Sciences, Muizenberg, South Africa
- Scientific and Statistical Computing Core, National Institutes of Health, Bethesda, MA, USA
| | - Christopher M R Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pia Wintermark
- Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Lilla Zöllei
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Andre J van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Joseph L Jacobson
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sandra W Jacobson
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ernesta M Meintjes
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Marijuana and Opioid Use during Pregnancy: Using Zebrafish to Gain Understanding of Congenital Anomalies Caused by Drug Exposure during Development. Biomedicines 2020; 8:biomedicines8080279. [PMID: 32784457 PMCID: PMC7460517 DOI: 10.3390/biomedicines8080279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/09/2023] Open
Abstract
Marijuana and opioid addictions have increased alarmingly in recent decades, especially in the United States, posing threats to society. When the drug user is a pregnant mother, there is a serious risk to the developing baby. Congenital anomalies are associated with prenatal exposure to marijuana and opioids. Here, we summarize the current data on the prevalence of marijuana and opioid use among the people of the United States, particularly pregnant mothers. We also summarize the current zebrafish studies used to model and understand the effects of these drug exposures during development and to understand the behavioral changes after exposure. Zebrafish experiments recapitulate the drug effects seen in human addicts and the birth defects seen in human babies prenatally exposed to marijuana and opioids. Zebrafish show great potential as an easy and inexpensive model for screening compounds for their ability to mitigate the drug effects, which could lead to new therapeutics.
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Barnes JL, Mohr C, Ritchey CR, Erikson CM, Shiina H, Rossi DJ. Developmentally Transient CB1Rs on Cerebellar Afferents Suppress Afferent Input, Downstream Synaptic Excitation, and Signaling to Migrating Neurons. J Neurosci 2020; 40:6133-6145. [PMID: 32631938 PMCID: PMC7406284 DOI: 10.1523/jneurosci.1931-19.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 01/13/2023] Open
Abstract
The endocannabinoid system plays important roles in brain development, but mechanistic studies have focused on neuronal differentiation, migration, and synaptogenesis, with less attention to transcellular interactions that coordinate neurodevelopmental processes across developing neural networks. We determined that, in the developing rodent cerebellar cortex (of both sexes), there is a transient window when the dominant brain cannabinoid receptor, CB1R, is expressed on afferent terminals instead of output neuron Purkinje cell synapses that dominate the adult cerebellum. Activation of these afferent CB1Rs suppresses synaptic transmission onto developing granule cells, and consequently also suppresses excitation of downstream neurons in the developing cortical network, including nonsynaptic, migrating neurons. Application of a CB1R antagonist during afferent stimulation trains and depolarizing voltage steps caused a significant, sustained potentiation of synaptic amplitude. Our data demonstrate that transiently expressed afferent CB1Rs regulate afferent synaptic strength during synaptogenesis, which enables coordinated dampening of transcortical developmental signals.SIGNIFICANCE STATEMENT The endogenous cannabinoid system plays diverse roles in brain development, which, combined with the rapidly changing legal and medical status of cannabis-related compounds, makes understanding how exogenous cannabinoids affect brain development an important biomedical objective. The cerebellum is a key brain region in a variety of neurodevelopmental disorders, and the adult cerebellum has one of the highest expression levels of CB1R, but little is known about CB1R in the developing cerebellum. Here we report a developmentally distinct expression and function of CB1R in the cerebellum, in which endogenous or exogenous activation of CB1Rs modifies afferent synaptic strength and coordinated downstream network signaling. These findings have implications for recreational and medical use of exogenous cannabinoids by pregnant and breastfeeding women.
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MESH Headings
- Action Potentials
- Animals
- Cannabinoid Receptor Antagonists/pharmacology
- Cell Movement
- Excitatory Postsynaptic Potentials
- Female
- Male
- Mice
- Mice, Inbred C57BL
- Neurogenesis
- Neurons, Afferent/drug effects
- Neurons, Afferent/metabolism
- Neurons, Afferent/physiology
- Purkinje Cells/drug effects
- Purkinje Cells/metabolism
- Purkinje Cells/physiology
- Receptor, Cannabinoid, CB1/antagonists & inhibitors
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB1/metabolism
- Synapses/metabolism
- Synapses/physiology
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Affiliation(s)
- Jesse L Barnes
- Washington State University, Integrative Physiology and Neuroscience, Pullman, Washington 99164
| | - Claudia Mohr
- Washington State University, Integrative Physiology and Neuroscience, Pullman, Washington 99164
| | - Caitlin R Ritchey
- Washington State University, Integrative Physiology and Neuroscience, Pullman, Washington 99164
| | - Chloe M Erikson
- Washington State University, Integrative Physiology and Neuroscience, Pullman, Washington 99164
| | - Hiroko Shiina
- Washington State University, Integrative Physiology and Neuroscience, Pullman, Washington 99164
| | - David J Rossi
- Washington State University, Integrative Physiology and Neuroscience, Pullman, Washington 99164
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Torres CA, Medina-Kirchner C, O'Malley KY, Hart CL. Totality of the Evidence Suggests Prenatal Cannabis Exposure Does Not Lead to Cognitive Impairments: A Systematic and Critical Review. Front Psychol 2020; 11:816. [PMID: 32457680 PMCID: PMC7225289 DOI: 10.3389/fpsyg.2020.00816] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/02/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Despite limited data demonstrating pronounced negative effects of prenatal cannabis exposure, popular opinion and public policies still reflect the belief that cannabis is fetotoxic. Methods: This article provides a critical review of results from longitudinal studies examining the impact of prenatal cannabis exposure on multiple domains of cognitive functioning in individuals aged 0 to 22 years. A literature search was conducted through PsycINFO, PubMed, and Google Scholar. Articles were included if they examined the cognitive performance of offspring exposed to cannabis in utero. Results: An examination of the total number of statistical comparisons (n = 1,001) between groups of participants that were exposed to cannabis prenatally and non-exposed controls revealed that those exposed performed differently on a minority of cognitive outcomes (worse on <3.5 percent and better in <1 percent). The clinical significance of these findings appears to be limited because cognitive performance scores of cannabis-exposed groups overwhelmingly fell within the normal range when compared against normative data adjusted for age and education. Conclusions: The current evidence does not suggest that prenatal cannabis exposure alone is associated with clinically significant cognitive functioning impairments.
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Affiliation(s)
- Ciara A Torres
- School of Social Work, Columbia University, New York, NY, United States.,Department of Psychology, Columbia University, New York, NY, United States
| | | | - Kate Y O'Malley
- Division on Substance Use, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychological Sciences, Swinburne University, Hawthorn, VIC, Australia
| | - Carl L Hart
- Department of Psychology, Columbia University, New York, NY, United States.,Division on Substance Use, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
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19
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El Marroun H, Bolhuis K, Franken IHA, Jaddoe VWV, Hillegers MH, Lahey BB, Tiemeier H. Preconception and prenatal cannabis use and the risk of behavioural and emotional problems in the offspring; a multi-informant prospective longitudinal study. Int J Epidemiol 2020; 48:287-296. [PMID: 30239742 DOI: 10.1093/ije/dyy186] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies of the long-term consequences of maternal cannabis use on child development beyond the neonatal period are sparse. In the current study, we use a multi-information approach to assess the association of prenatal cannabis exposure and child behavioural and emotional functioning. To explore the possible causal nature of the association, we investigated whether maternal tobacco and paternal cannabis use during pregnancy were also associated with child problems. METHODS The study population included children of a population-based birth cohort in The Netherlands (n = 5903). Information on parental cannabis use was collected using questionnaires; urine of mothers was analysed for the presence of cannabis metabolites. Child behavioural and emotional problems at approximately 7-10 years were measured using validated teacher-, child- and mother-reports. RESULTS Our findings show associations of maternal cannabis use during pregnancy with offspring externalising problems (B = 0.53; 95% CI: 0.29-0.77), but not with internalising problems (B = -0.10; 95% CI: -0.31-0.11). However, maternal cannabis use before pregnancy was also associated with offspring externalising problems (B = 0.27; 95% CI: 0.02-0.52). Further, cannabis use by the father was associated with child externalising problems (B = 0.36; 95% CI: 0.22-0.49) but not internalising problems. CONCLUSIONS Prenatal exposure to maternal cannabis use is specifically associated with offspring behavioural problems, but not emotional problems. This association is probably not due to an effect of intrauterine cannabis exposure on fetal development, because both maternal and paternal cannabis exposure during pregnancy were related to offspring externalising problems. Our findings suggest that the association can be explained through residual confounding, most likely through shared genetic vulnerabilities for parental cannabis use and offspring behavioural problems.
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Affiliation(s)
- Hanan El Marroun
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, CA, The Netherlands.,Department of Psychology, Education and Child Studies - Erasmus University Rotterdam, 3000 DR, The Netherlands.,The Department of Pediatrics, Erasmus MC, Rotterdam, CA, The Netherlands
| | - Koen Bolhuis
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, CA, The Netherlands
| | - Ingmar H A Franken
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,Department of Psychology, Education and Child Studies - Erasmus University Rotterdam, 3000 DR, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, CA, The Netherlands.,The Department of Pediatrics, Erasmus MC, Rotterdam, CA, The Netherlands.,The Department of Epidemiology Erasmus MC, Rotterdam, CA, The Netherlands
| | - Manon H Hillegers
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands
| | - Benjamin B Lahey
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Henning Tiemeier
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,The Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
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Ondersma SJ, Beatty JR, Puder KS, Janisse J, Svikis DS. Feasibility and Acceptability of e-Screening and Brief Intervention and Tailored Text Messaging for Marijuana Use in Pregnancy. J Womens Health (Larchmt) 2019; 28:1295-1301. [PMID: 30657434 PMCID: PMC6743084 DOI: 10.1089/jwh.2018.7169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: There are at present no evidence-based interventions for marijuana use during pregnancy, despite it being by far the most commonly used illicit drug during pregnancy. Lack of treatment-seeking, combined with implementation challenges, has limited the extent to which at-risk women receive interventions of any kind. This study sought to evaluate the feasibility and acceptability of two high-reach technology-based interventions: electronic screening and brief intervention (e-SBI) and tailored text messaging, delivered either alone or in combination. Materials and Methods: In this exploratory feasibility trial, pregnant women seeking prenatal care services and scoring positive for marijuana use risk (n = 45) were randomly assigned to e-SBI, text messaging, or e-SBI plus text messaging. We examined completion rates and acceptability ratings as a function of intervention condition and participant characteristics. Results: All participants assigned to receive the e-SBI (n = 30) were able to complete it during the in-clinic baseline session. Participants assigned to text messaging (n = 30) received a median of 24 text messages before giving birth; 6 of 30 (20%) chose to end text messages before giving birth. Acceptability ratings for the e-SBI were high, with most being above 4.4 on a 5-point scale (e.g., for ease of use, respectfulness, and helpfulness). Acceptability ratings for some aspects of the texting intervention were also high (e.g., for ease of understanding and respectfulness). Participants in the combined e-SBI plus texting condition chose to stop messages at a rate of 13.3% (2 of 15), versus 26.7% (4 of 15) in the texting-only condition (p = 0.37). Conclusions: These two high-reach intervention elements showed strong feasibility and modest to high acceptability. Future efforts evaluating efficacy are warranted, and should specifically examine the possibility that combining text messaging with a brief intervention may promote retention.
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Affiliation(s)
- Steven J. Ondersma
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Jessica R. Beatty
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan
| | - Karoline S. Puder
- Department of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan
| | - James Janisse
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Dace S. Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, Virginia
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Ediger K, Hasan SU, Synnes A, Shah J, Creighton D, Isayama T, Shah PS, Lodha A. Maternal smoking and neurodevelopmental outcomes in infants <29 weeks gestation: a multicenter cohort study. J Perinatol 2019; 39:791-799. [PMID: 30996278 DOI: 10.1038/s41372-019-0356-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes of preterm infants at 18-21 months corrected age (CA) whose mothers smoked during pregnancy to those whose mothers did not smoke. STUDY DESIGN Preterm infants born at <29 weeks of gestation and evaluated at 18-21 months CA were included. Primary outcome was a composite outcome of death or neurodevelopmental impairment (NDI). RESULTS Of a total of 2760 infants, 699 met exclusion criteria. Of the remaining 2061 infants, 280 (13.6%) were exposed to maternal smoking and 1781 (86.4%) were not. The odds of the composite outcome of death or NDI (aOR 1.40; 95% CI: 1.03-1.91), NDI alone (aOR 1.43; 95% CI: 1.01-2.03), and Bayley-III motor score <85 (aOR 1.91; 95% CI: 1.31-2.81) were higher in exposed infants. CONCLUSIONS Exposure to maternal smoking was associated with adverse composite outcome of death or NDI, NDI alone and lower motor scores at 18-21 months CA.
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Affiliation(s)
- Krystyna Ediger
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shabih U Hasan
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jyotsna Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Dianne Creighton
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Tetsuya Isayama
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Abhay Lodha
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada.
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Ashford K, Fallin-Bennett A, McCubbin A, Wiggins A, Barnhart S, Lile J. Associations of first trimester co-use of tobacco and Cannabis with prenatal immune response and psychosocial well-being. Neurotoxicol Teratol 2019; 73:42-48. [PMID: 30936023 DOI: 10.1016/j.ntt.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only. METHODS A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women. RESULTS Participant average age was 29.1 years, approximately half had a high school education or less, and half were unemployed. Compared to tobacco only users, co-users were more likely to be non-White, younger and more economically disadvantaged. In the adjusted linear regression models, TNF-α levels were significantly lower among co-users relative to tobacco only users, after adjusting for age, race/ethnicity, body mass index and tobacco use group (tobacco cigarettes, electronic nicotine delivery devices [ENDS] or both). TNF-α was the only immune marker found to be significant in this analysis. Measured stress levels (M = 5.9, SD = 3.3; potential range 0-16) and depression scores (M = 7.8, SD = 5.8; potential range 0-30) were low across all participants and did not differ as a function of co-use. CONCLUSION Preliminary results suggest women co-using during the first trimester exhibit decreased pro-inflammatory immune responsivity on one out of eight markers. Further research is needed to determine the impact of this immune modulation on fetal health outcomes and the unique contribution of cannabis.
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Affiliation(s)
- Kristin Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA.
| | - Amanda Fallin-Bennett
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Amanda Wiggins
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Sheila Barnhart
- University of Kentucky College of Social Work, 653 Patterson Office Tower, Lexington, KY 40506, USA
| | - Josh Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA; Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
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Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, Rehm J, Room R. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health 2017; 107:e1-e12. [PMID: 28644037 PMCID: PMC5508136 DOI: 10.2105/ajph.2017.303818] [Citation(s) in RCA: 275] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. OBJECTIVES To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. SEARCH METHODS We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. SELECTION CRITERIA We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. DATA COLLECTION AND ANALYSIS We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. MAIN RESULTS For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). AUTHORS' CONCLUSIONS Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
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Affiliation(s)
- Benedikt Fischer
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cayley Russell
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Pamela Sabioni
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wim van den Brink
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Bernard Le Foll
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Jürgen Rehm
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Wang GS. Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization. J Med Toxicol 2017; 13:99-105. [PMID: 27139708 PMCID: PMC5330955 DOI: 10.1007/s13181-016-0552-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/04/2016] [Accepted: 04/13/2016] [Indexed: 01/11/2023] Open
Abstract
An "unintended consequence" of marijuana legalization is the impact on the pediatric population. From prenatal exposure to unintentional childhood exposures, through concerns of adolescence abuse and marijuana use for medicinal indications in children, marijuana exposure can affect pediatric patients at every stage in childhood. Regardless of the stage or reason of exposure, concerns exist about short-term and long-term consequences in a child's physical and mental health. The use of cannabidiol (CBD) may have some benefit for the treatment of epilepsy, but emphasis needs to be on rigorous clinical trials to evaluate efficacy and safety. As more states allow both medical and recreational marijuana, availability and prevalence of use will likely increase and more surveillance and research is needed to evaluate the consequences on the pediatric population.
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Affiliation(s)
- George Sam Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave B251, Aurora, CO, 80045, USA.
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26
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Doney R, Lucas BR, Watkins RE, Tsang TW, Sauer K, Howat P, Latimer J, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Visual-motor integration, visual perception, and fine motor coordination in a population of children with high levels of Fetal Alcohol Spectrum Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:346-57. [PMID: 27228005 DOI: 10.1016/j.ridd.2016.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Visual-motor integration (VMI) skills are essential for successful academic performance, but to date no studies have assessed these skills in a population-based cohort of Australian Aboriginal children who, like many children in other remote, disadvantaged communities, consistently underperform academically. Furthermore, many children in remote areas of Australia have prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD), which are often associated with VMI deficits. METHODS VMI, visual perception, and fine motor coordination were assessed using The Beery-Buktenica Developmental Test of Visual-Motor Integration, including its associated subtests of Visual Perception and Fine Motor Coordination, in a cohort of predominantly Australian Aboriginal children (7.5-9.6 years, n=108) in remote Western Australia to explore whether PAE adversely affected test performance. Cohort results were reported, and comparisons made between children i) without PAE; ii) with PAE (no FASD); and iii) FASD. The prevalence of moderate (≤16th percentile) and severe (≤2nd percentile) impairment was established. RESULTS Mean VMI scores were 'below average' (M=87.8±9.6), and visual perception scores were 'average' (M=97.6±12.5), with no differences between groups. Few children had severe VMI impairment (1.9%), but moderate impairment rates were high (47.2%). Children with FASD had significantly lower fine motor coordination scores and higher moderate impairment rates (M=87.9±12.5; 66.7%) than children without PAE (M=95.1±10.7; 23.3%) and PAE (no FASD) (M=96.1±10.9; 15.4%). CONCLUSIONS Aboriginal children living in remote Western Australia have poor VMI skills regardless of PAE or FASD. Children with FASD additionally had fine motor coordination problems. VMI and fine motor coordination should be assessed in children with PAE, and included in FASD diagnostic assessments.
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Affiliation(s)
- Robyn Doney
- School of Public Health, Curtin University, Perth, Australia.
| | - Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; Poche Center for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - Rochelle E Watkins
- Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia.
| | - Kay Sauer
- School of Public Health, Curtin University, Perth, Australia; Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia.
| | - Peter Howat
- School of Public Health, Curtin University, Perth, Australia; Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia.
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia.
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia; University of Notre Dame, Broome, Australia.
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia.
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; The Sydney Children's Hospitals Network (Westmead), Sydney, Australia.
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Gao W, Lin W, Grewen K, Gilmore JH. Functional Connectivity of the Infant Human Brain: Plastic and Modifiable. Neuroscientist 2016; 23:169-184. [PMID: 26929236 PMCID: PMC5145769 DOI: 10.1177/1073858416635986] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Infancy is a critical and immensely important period in human brain development. Subtle changes during this stage may be greatly amplified with the unfolding of different developmental processes, exerting far-reaching consequences. Studies of the structure and behavioral manifestations of the infant brain are fruitful. However, the specific functional brain mechanisms that enable the execution of different behaviors remained elusive until the advent of functional connectivity fMRI (fcMRI), which provides an unprecedented opportunity to probe the infant functional brain development in vivo. Since its inception, a burgeoning field of infant brain functional connectivity study has emerged and thrived during the past decade. In this review, we describe (1) findings of normal development of functional connectivity networks and their relationships to behaviors and (2) disruptions of the normative functional connectivity development due to identifiable genetic and/or environmental risk factors during the first 2 years of human life. Technical considerations of infant fcMRI are also provided. It is our hope to consolidate previous findings so that the field can move forward with a clearer picture toward the ultimate goal of fcMRI-based objective methods for early diagnosis/identification of risks and evaluation of early interventions to optimize developing functional connectivity networks in this critical developmental window.
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Affiliation(s)
- Wei Gao
- 1 Biomedical Imaging Research Institute (BIRI), Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Weili Lin
- 2 Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, NC, USA
| | - Karen Grewen
- 3 Departments of Psychiatry, Neurobiology, and Psychology, University of North Carolina at Chapel Hill, NC, USA
| | - John H Gilmore
- 4 Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
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El Marroun H, Tiemeier H, Franken IHA, Jaddoe VWV, van der Lugt A, Verhulst FC, Lahey BB, White T. Prenatal Cannabis and Tobacco Exposure in Relation to Brain Morphology: A Prospective Neuroimaging Study in Young Children. Biol Psychiatry 2016; 79:971-9. [PMID: 26422004 DOI: 10.1016/j.biopsych.2015.08.024] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/25/2015] [Accepted: 08/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cannabis use during pregnancy has been associated with negative behavioral outcomes and psychopathology in offspring. However, there has been little research evaluating alterations in brain structure as a result of maternal cannabis use. In this prospective study, we investigated the association between prenatal cannabis exposure and brain morphology in young children. METHODS We matched 96 children prenatally exposed to tobacco only (without cannabis) with 113 unexposed control subjects on the basis of age and gender and subsequently selected 54 children exposed to prenatal cannabis (mostly combined with tobacco exposure). These children (aged 6 to 8 years) were part of a population-based study in the Netherlands, the Generation R Study, and were followed from pregnancy onward. We assessed brain volumetric measures and cortical thickness in magnetic resonance imaging scans using FreeSurfer. We performed vertexwise analyses in FreeSurfer and linear regression analyses adjusting for relevant covariates using Statistical Package for the Social Sciences. RESULTS Prenatal cannabis exposure was not associated with global brain volumes, such as total brain volume, gray matter volume, or white matter volume. However, prenatal cannabis exposure was associated with differences in cortical thickness: compared with nonexposed control subjects, cannabis-exposed children had thicker frontal cortices. Prenatal tobacco exposure compared with nonexposed control subjects was associated with cortical thinning, primarily in the superior frontal and superior parietal cortices. CONCLUSIONS Our findings suggest an association between prenatal cannabis exposure and cortical thickness in children. Further research is needed to explore the causal nature of this association.
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Affiliation(s)
- Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Generation R Study Group, Rotterdam, The Netherlands.
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Department of Psychiatry, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ingmar H A Franken
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Pediatrics, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands
| | - Benjamin B Lahey
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Tonya White
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Departments of Pediatrics, Rotterdam, The Netherlands
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Smith AM, Mioduszewski O, Hatchard T, Byron-Alhassan A, Fall C, Fried PA. Prenatal marijuana exposure impacts executive functioning into young adulthood: An fMRI study. Neurotoxicol Teratol 2016; 58:53-59. [PMID: 27263090 DOI: 10.1016/j.ntt.2016.05.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 05/04/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Understanding the potentially harmful long term consequences of prenatal marijuana exposure is important given the increase in number of pregnant women smoking marijuana to relieve morning sickness. Altered executive functioning is one area of research that has suggested negative consequences of prenatal marijuana exposure into adolescence. Investigating if these findings continue into young adulthood and exploring the neural basis of these effects was the purpose of this research. Thirty one young adults (ages 18-22years) from the longitudinal Ottawa Prenatal Prospective Study (OPPS) underwent functional magnetic resonance imaging (fMRI) during four tasks; 1) Visuospatial 2-Back, 2) Go/NoGo, 3) Letter 2-Back and 4) Counting Stroop task. Sixteen participants were prenatally exposed to marijuana while 15 had no prenatal marijuana exposure. Task performance was similar for both groups but blood flow was significantly different between the groups. This paper presents the results for all 4 tasks, highlighting the consistently increased left posterior brain activity in the prenatally exposed group compared with the control group. These alterations in neurophysiological functioning of young adults prenatally exposed to marijuana emphasizes the importance of education for women in child bearing years, as well as for policy makers and physicians interested in the welfare of both the pregnant women and their offspring's future success.
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Affiliation(s)
- Andra M Smith
- University of Ottawa, School of Psychology, Ottawa, ON K1N 6N5, Canada.
| | - Ola Mioduszewski
- University of Ottawa, School of Psychology, Ottawa, ON K1N 6N5, Canada
| | - Taylor Hatchard
- University of Ottawa, School of Psychology, Ottawa, ON K1N 6N5, Canada
| | | | - Carley Fall
- University of Ottawa, School of Psychology, Ottawa, ON K1N 6N5, Canada
| | - Peter A Fried
- Carleton University, Department of Psychology, Ottawa, ON, Canada
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Fan J, Jacobson SW, Taylor PA, Molteno CD, Dodge NC, Stanton ME, Jacobson JL, Meintjes EM. White matter deficits mediate effects of prenatal alcohol exposure on cognitive development in childhood. Hum Brain Mapp 2016; 37:2943-58. [PMID: 27219850 DOI: 10.1002/hbm.23218] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022] Open
Abstract
Fetal alcohol spectrum disorders comprise the spectrum of cognitive, behavioral, and neurological impairments caused by prenatal alcohol exposure (PAE). Diffusion tensor imaging (DTI) was performed on 54 children (age 10.1 ± 1.0 years) from the Cape Town Longitudinal Cohort, for whom detailed drinking histories obtained during pregnancy are available: 26 with full fetal alcohol syndrome (FAS) or partial FAS (PFAS), 15 nonsyndromal heavily exposed (HE), and 13 controls. Using voxelwise analyses, children with FAS/PFAS showed significantly lower fractional anisotropy (FA) in four white matter (WM) regions and higher mean diffusivity (MD) in seven; three regions of FA and MD differences (left inferior longitudinal fasciculus (ILF), splenium, and isthmus) overlapped, and the fourth FA cluster was located in the same WM bundle (right ILF) as an MD cluster. HE children showed lower FA and higher MD in a subset of these regions. Significant correlations were observed between three continuous alcohol measures and DTI values at cluster peaks, indicating that WM damage in several regions is dose dependent. Lower FA in the regions of interest was attributable primarily to increased radial diffusivity rather than decreased axonal diffusivity, suggesting poorer axon packing density and/or myelination. Multiple regression models indicated that this cortical WM impairment partially mediated adverse effects of PAE on information processing speed and eyeblink conditioning. Hum Brain Mapp 37:2943-2958, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jia Fan
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Sandra W Jacobson
- Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Paul A Taylor
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,African Institute for Mathematical Sciences, Muizenberg, Western Cape, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Neil C Dodge
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Mark E Stanton
- Department of Psychology, University of Delaware, Newark, Delaware
| | - Joseph L Jacobson
- Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Ernesta M Meintjes
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
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Grace T, Bulsara M, Robinson M, Hands B. Early life events and motor development in childhood and adolescence: a longitudinal study. Acta Paediatr 2016; 105:e219-27. [PMID: 26684020 DOI: 10.1111/apa.13302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 12/25/2022]
Abstract
AIM Few studies have reported on early life risk factors for motor development outcomes past childhood. Antenatal, perinatal and neonatal factors affecting motor development from late childhood to adolescence were explored. As sex differences in motor development have been previously reported, males and females were examined separately. METHODS Participants (n = 2868) were from the Western Australian Pregnancy Cohort Study. Obstetric and neonatal data were examined to determine factors related to motor development at 10 (n = 1622), 14 (n = 1584) and 17 (n = 1221) years. The Neuromuscular Development Index (NDI) of the McCarron Assessment of Motor Development determined offspring motor proficiency. Linear mixed models were developed to allow for changes in motor development over time. RESULTS Maternal pre-eclampsia, Caesarean section and low income were negatively related to male and female motor outcomes. Lower percentage of optimal birthweight was related to a lower male NDI. Younger maternal age, smoking during early pregnancy and stress during later pregnancy were related to lower female NDIs. CONCLUSION Events experienced during pregnancy were related to motor development into late adolescence. Males and females were influenced differently by antenatal and perinatal risk factors; this may be due to sex-specific developmental pathways.
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Affiliation(s)
- Tegan Grace
- School of Health Sciences; University of Notre Dame Australia; Fremantle Western Australian Australia
| | - Max Bulsara
- Institute for Health Research; University of Notre Dame Australia; Fremantle Western Australian Australia
| | - Monique Robinson
- The Telethon Kids Institute; Subiaco Western Australian Australia
| | - Beth Hands
- Institute for Health Research; University of Notre Dame Australia; Fremantle Western Australian Australia
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Clark CAC, Espy KA, Wakschlag L. Developmental pathways from prenatal tobacco and stress exposure to behavioral disinhibition. Neurotoxicol Teratol 2015; 53:64-74. [PMID: 26628107 DOI: 10.1016/j.ntt.2015.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
Prenatal tobacco exposure (PTE) and prenatal stress exposure (PSE) both have been linked to externalizing behavior, although their effects generally have been considered in isolation. Here, we aimed to characterize the joint or interactive roles of PTE and PSE in early developmental pathways to behavioral disinhibition, a profile of cognitive and behavioral under-control that presages severe externalizing behavior. As part of a prospective, longitudinal study, 296 children were assessed at a mean age of 5 years. Exposures were assessed via repeated interviews across the prenatal period and bioassays of cotinine were obtained. Behavioral disinhibition was assessed using temperament measures in infancy, performance-based executive control tasks and measures of disruptive and inattentive behavior. PSE was associated with a higher probability of difficult temperament in infancy. Each exposure independently predicted poorer executive control at age 5 years. Difficult temperament and executive control difficulties in turn predicted elevated levels of disruptive behavior, although links from PTE and PSE to parent-reported attention problems were less robust. Children who experienced these prenatal exposures in conjunction with higher postnatal stress exposure showed the lowest executive control and highest levels of disruptive behavior. Findings highlight the compounding adverse impact of PTE and PSE on children's behavioral trajectories. Given their high concordance, prenatal health campaigns should target these exposures in tandem.
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Affiliation(s)
- C A C Clark
- Department of Psychology, University of Arizona, United States
| | - K A Espy
- Department of Psychology, University of Arizona, United States; Developmental Cognitive Neuroscience Laboratory, University of Nebraska-Lincoln, United States
| | - L Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Policy Research, Northwestern University, United States
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Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci 2015; 9:601. [PMID: 26582983 PMCID: PMC4631947 DOI: 10.3389/fnhum.2015.00601] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/18/2015] [Indexed: 01/17/2023] Open
Abstract
Prenatal marijuana exposure (PME) is linked to neurobehavioral and cognitive impairments; however, findings in childhood and adolescence are inconsistent. Type-1 cannabinoid receptors (CB1R) modulate fetal neurodevelopment, mediating PME effects on growth of functional circuitry sub-serving behaviors critical for academic and social success. The purpose of this study was to investigate the effects of prenatal marijuana on development of early brain functional circuitry prior to prolonged postnatal environmental influences. We measured resting state functional connectivity during unsedated sleep in infants at 2–6 weeks (+MJ: 20 with PME in combination with nicotine, alcohol, opiates, and/or selective serotonin reuptake inhibitors; −MJ: 23 exposed to the same other drugs without marijuana, CTR: 20 drug-free controls). Connectivity of subcortical seed regions with high fetal CB1R expression was examined. Marijuana-specific differences were observed in insula and three striatal connections: anterior insula–cerebellum, right caudate–cerebellum, right caudate–right fusiform gyrus/inferior occipital, left caudate–cerebellum. +MJ neonates had hypo-connectivity in all clusters compared with −MJ and CTR groups. Altered striatal connectivity to areas involved in visual spatial and motor learning, attention, and in fine-tuning of motor outputs involved in movement and language production may contribute to neurobehavioral deficits reported in this at-risk group. Disrupted anterior insula connectivity may contribute to altered integration of interoceptive signals with salience estimates, motivation, decision-making, and later drug use. Compared with CTRs, both +MJ and −MJ groups demonstrated hyper-connectivity of left amygdala seed with orbital frontal cortex and hypo-connectivity of posterior thalamus seed with hippocampus, suggesting vulnerability to multiple drugs in these circuits.
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Affiliation(s)
- Karen Grewen
- Department of Psychiatry, Neurobiology, and Psychology, University of North Carolina Chapel Hill , Chapel Hill, NC , USA
| | - Andrew P Salzwedel
- Department of Radiology, Biomedical Research Imaging Center, University of North Carolina Chapel Hill , Chapel Hill, NC , USA ; Department of Biomedical Sciences and Imaging, Biomedical Imaging Research Institute, Cedars-Sinai Medical Cente , Los Angeles, CA , USA
| | - Wei Gao
- Department of Radiology, Biomedical Research Imaging Center, University of North Carolina Chapel Hill , Chapel Hill, NC , USA ; Department of Biomedical Sciences and Imaging, Biomedical Imaging Research Institute, Cedars-Sinai Medical Cente , Los Angeles, CA , USA
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Abstract
Cannabis sativa (marijuana) is the illicit drug most commonly used during pregnancy. The self-reported prevalence of marijuana use during pregnancy ranges from 2% to 5% in most studies. A growing number of states are legalizing marijuana for medicinal or recreational purposes, and its use by pregnant women could increase even further as a result. Because of concerns regarding impaired neurodevelopment, as well as maternal and fetal exposure to the adverse effects of smoking, women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Obstetrician-gynecologists should be discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during preconception, pregnancy, and lactation. Pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data. There are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged.
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Kilburn TR, Eriksen HLF, Underbjerg M, Thorsen P, Mortensen EL, Landrø NI, Bakketeig LS, Grove J, Sværke C, Kesmodel US. Low to Moderate Average Alcohol Consumption and Binge Drinking in Early Pregnancy: Effects on Choice Reaction Time and Information Processing Time in Five-Year-Old Children. PLoS One 2015; 10:e0138611. [PMID: 26382068 PMCID: PMC4575046 DOI: 10.1371/journal.pone.0138611] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Deficits in information processing may be a core deficit after fetal alcohol exposure. This study was designed to investigate the possible effects of weekly low to moderate maternal alcohol consumption and binge drinking episodes in early pregnancy on choice reaction time (CRT) and information processing time (IPT) in young children. METHOD Participants were sampled based on maternal alcohol consumption during pregnancy. At the age of 60-64 months, 1,333 children were administered a modified version of the Sternberg paradigm to assess CRT and IPT. In addition, a test of general intelligence (WPPSI-R) was administered. RESULTS Adjusted for a wide range of potential confounders, this study showed no significant effects of average weekly maternal alcohol consumption during pregnancy on CRT or IPT. There was, however, an indication of slower CRT associated with binge drinking episodes in gestational weeks 1-4. CONCLUSION This study observed no significant effects of average weekly maternal alcohol consumption during pregnancy on CRT or IPT as assessed by the Sternberg paradigm. However, there were some indications of CRT being associated with binge drinking during very early pregnancy. Further large-scale studies are needed to investigate effects of different patterns of maternal alcohol consumption on basic cognitive processes in offspring.
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Affiliation(s)
- Tina R. Kilburn
- Department of Research, Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
- * E-mail:
| | | | | | - Poul Thorsen
- Department of Obstetrics and Gynaecology, Lillebælt Hospital, Kolding, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Leiv S. Bakketeig
- National Institute of Public Health, University of Oslo, Oslo, Norway
| | - Jakob Grove
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Claus Sværke
- Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fernandes M, Yang X, Li JY, Cheikh Ismail L. Smoking during pregnancy and vision difficulties in children: a systematic review. Acta Ophthalmol 2015; 93:213-23. [PMID: 25545121 DOI: 10.1111/aos.12627] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/11/2014] [Indexed: 01/11/2023]
Abstract
Cigarette smoking during pregnancy is a major public health concern. Intra-uterine exposure to maternal cigarette smoking is associated with increased risks of growth and neurodevelopmental problems during childhood and later life. Few studies have focussed on visual difficulties in children in the context of maternal smoking during pregnancy. A systematic search of online databases was carried out between February and May 2013 to examine the trend in visual outcomes in children exposed to maternal cigarette smoking during intra-uterine life. Twenty-four non-randomized studies were identified. Each study was rated for quality using the Newcastle-Ottawa Scale. Most studies (n = 18) reported fetal exposure to active or passive maternal cigarette smoking to be associated with an increased risk of adverse visual outcomes in children. In particular, there were higher rates of strabismus, refractive errors and retinopathy among children of women who smoked during pregnancy. These findings suggest that fetal exposure to cigarette smoke is a significant risk factor for visual problems during later life and that certain visual faculties, such as the intraocular muscles and retinal neurons, are more affected than others. The findings provide evidence in support of public health policies aimed at reducing fetal exposure to smoking by advising both women and their partners to quit smoking during pregnancy.
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Affiliation(s)
- Michelle Fernandes
- Nuffield Department of Obstetrics and Gynecology, and Oxford Maternal and Perinatal Health Institute Green Templeton College University of Oxford Oxford UK
| | - Xiao Yang
- Nuffield Department of Population Health University of Oxford Oxford UK
| | - Jinying Y. Li
- Department of Ophthalmology Peking University Shenzhen Hospital Shenzhen Guangdong China
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics and Gynecology, and Oxford Maternal and Perinatal Health Institute Green Templeton College University of Oxford Oxford UK
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37
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Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol 2014; 41:877-94. [PMID: 25459779 PMCID: PMC4254522 DOI: 10.1016/j.clp.2014.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pro-marijuana advocacy efforts exemplified by the "medical" marijuana movement, coupled with the absence of conspicuous public health messages about the potential dangers of marijuana use during pregnancy, could lead to greater use of today's more potent marijuana, which could have significant short- and long-term consequences. This article reviews the current literature regarding the effects of prenatal marijuana use on the pregnant woman and her offspring.
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Affiliation(s)
- Tamara D. Warner
- University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985
| | - Dikea Roussos-Ross
- University of Florida, Department of Obstetrics and Gynecology, P.O. Box 100294, Gainesville, FL 32610-0294, (352) 273-7660
| | - Marylou Behnke
- University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985
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38
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Golding J, Emmett P, Iles-Caven Y, Steer C, Lingam R. A review of environmental contributions to childhood motor skills. J Child Neurol 2014; 29:1531-47. [PMID: 24170258 PMCID: PMC4004720 DOI: 10.1177/0883073813507483] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although much of children's motor skills have a heredity component, at least half of the variance is likely to be influenced by the environment. It is important to ascertain features of the environment that are responsible so that toxins can be avoided, children at risk can be identified, and beneficial interventions initiated. This review outlines the results of published studies and recommends the areas where further research is required. We found much confusion with little comparability concerning the ages or measures used. Few studies had sufficient power and few allowed for confounders. We found that research to date implicates associations with prenatal drinking ≥4 drinks of alcohol per day; diabetes; taking antidepressant drugs; being deficient in iodine or iron; dietary fish; and postnatal depression. The child appearing to be most at risk was born of low birth weight (but not due to preterm delivery) or with neonatal problems.
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Affiliation(s)
- Jean Golding
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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39
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Beeghly M, Rose-Jacobs R, Martin BM, Cabral HJ, Heeren TC, Frank DA. Level of intrauterine cocaine exposure and neuropsychological test scores in preadolescence: subtle effects on auditory attention and narrative memory. Neurotoxicol Teratol 2014; 45:1-17. [PMID: 24978115 DOI: 10.1016/j.ntt.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/13/2014] [Accepted: 06/18/2014] [Indexed: 12/12/2022]
Abstract
Neuropsychological processes such as attention and memory contribute to children's higher-level cognitive and language functioning and predict academic achievement. The goal of this analysis was to evaluate whether level of intrauterine cocaine exposure (IUCE) alters multiple aspects of preadolescents' neuropsychological functioning assessed using a single age-referenced instrument, the NEPSY: A Developmental Neuropsychological Assessment (NEPSY) (Korkman et al., 1998), after controlling for relevant covariates. Participants included 137 term 9.5-year-old children from low-income urban backgrounds (51% male, 90% African American/Caribbean) from an ongoing prospective longitudinal study. Level of IUCE was assessed in the newborn period using infant meconium and maternal report. 52% of the children had IUCE (65% with lighter IUCE, and 35% with heavier IUCE), and 48% were unexposed. Infants with Fetal Alcohol Syndrome, HIV seropositivity, or intrauterine exposure to illicit substances other than cocaine and marijuana were excluded. At the 9.5-year follow-up visit, trained examiners masked to IUCE and background variables evaluated children's neuropsychological functioning using the NEPSY. The association between level of IUCE and NEPSY outcomes was evaluated in a series of linear regressions controlling for intrauterine exposure to other substances and relevant child, caregiver, and demographic variables. Results indicated that level of IUCE was associated with lower scores on the Auditory Attention and Narrative Memory tasks, both of which require auditory information processing and sustained attention for successful performance. However, results did not follow the expected ordinal, dose-dependent pattern. Children's neuropsychological test scores were also altered by a variety of other biological and psychosocial factors.
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Affiliation(s)
- Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
| | - Brett M Martin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
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Gooijers J, Swinnen SP. Interactions between brain structure and behavior: the corpus callosum and bimanual coordination. Neurosci Biobehav Rev 2014; 43:1-19. [PMID: 24661987 DOI: 10.1016/j.neubiorev.2014.03.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/30/2014] [Accepted: 03/13/2014] [Indexed: 12/12/2022]
Abstract
Bimanual coordination skills are required for countless everyday activities, such as typing, preparing food, and driving. The corpus callosum (CC) is the major collection of white matter bundles connecting both hemispheres that enables the coordination between the two sides of the body. Principal evidence for this brain-behavior relationship in humans was first provided by research on callosotomy patients, showing that sectioning (parts of) the CC affected interactions between both hands directly. Later, new noninvasive in vivo imaging techniques, such as diffusion tensor imaging, have energized the study of the link between microstructural properties of the CC and bimanual performance in normal volunteers. Here we discuss the principal factors (such as age, pathology and training) that mediate the relationship between specific bimanual functions and distinct anatomical CC subdivisions. More specifically, the question is whether different bimanual task characteristics can be mapped onto functionally distinct CC subregions. We review the current status of this mapping endeavor, and propose future perspectives to inspire research on this unique link between brain structure and behavior.
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Affiliation(s)
- J Gooijers
- KU Leuven, Department of Kinesiology, Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - S P Swinnen
- KU Leuven, Department of Kinesiology, Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001 Leuven, Belgium; KU Leuven, Leuven Research Institute for Neuroscience & Disease (LIND), Belgium.
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Tortoriello G, Morris CV, Alpar A, Fuzik J, Shirran SL, Calvigioni D, Keimpema E, Botting CH, Reinecke K, Herdegen T, Courtney M, Hurd YL, Harkany T. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J 2014; 33:668-85. [PMID: 24469251 DOI: 10.1002/embj.201386035] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Children exposed in utero to cannabis present permanent neurobehavioral and cognitive impairments. Psychoactive constituents from Cannabis spp., particularly Δ(9)-tetrahydrocannabinol (THC), bind to cannabinoid receptors in the fetal brain. However, it is unknown whether THC can trigger a cannabinoid receptor-driven molecular cascade to disrupt neuronal specification. Here, we show that repeated THC exposure disrupts endocannabinoid signaling, particularly the temporal dynamics of CB1 cannabinoid receptor, to rewire the fetal cortical circuitry. By interrogating the THC-sensitive neuronal proteome we identify Superior Cervical Ganglion 10 (SCG10)/stathmin-2, a microtubule-binding protein in axons, as a substrate of altered neuronal connectivity. We find SCG10 mRNA and protein reduced in the hippocampus of midgestational human cannabis-exposed fetuses, defining SCG10 as the first cannabis-driven molecular effector in the developing cerebrum. CB1 cannabinoid receptor activation recruits c-Jun N-terminal kinases to phosphorylate SCG10, promoting its rapid degradation in situ in motile axons and microtubule stabilization. Thus, THC enables ectopic formation of filopodia and alters axon morphology. These data highlight the maintenance of cytoskeletal dynamics as a molecular target for cannabis, whose imbalance can limit the computational power of neuronal circuitries in affected offspring.
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Affiliation(s)
- Giuseppe Tortoriello
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
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O'Brien PL. Performance measurement: a proposal to increase use of SBIRT and decrease alcohol consumption during pregnancy. Matern Child Health J 2014; 18:1-9. [PMID: 23483413 PMCID: PMC3711957 DOI: 10.1007/s10995-013-1257-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Alcohol consumption during pregnancy has negative implications for maternal and child health. Appropriate early universal Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant women is necessary to identify women at risk and reduce the likelihood of continued drinking. Because SBIRT is not consistently used, the development and use of performance measures to assure implementation of SBIRT are key steps towards intervention and reduction of alcohol consumption during pregnancy. Practice guidelines provide ample support for specific instruments designed for SBIRT in prenatal care. An examination of existing performance measures related to alcohol consumption during pregnancy, however, reveals no comprehensive published performance measure designed to quantify the use of SBIRT for alcohol use in prenatal care. Process performance measures were developed that can determine the proportion of pregnant women who are screened during the course of prenatal care and the proportion of women requiring either brief intervention or referral to substance use disorder treatment who received those interventions. The measures require use of screening instruments validated for use with pregnant women. The two proposed measures would represent a significant step in efforts to assure appropriate intervention for women who drink during pregnancy, hold accountable providers who do not employ SBIRT, and provide a basis from which necessary systemic changes might occur. Pregnancy is a time when many women are motivated to stop drinking. That opportunity should be seized, with timely intervention offering assistance for pregnant women who have not stopped drinking of their own accord.
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Affiliation(s)
- Peggy L O'Brien
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
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43
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Glass L, Ware AL, Mattson SN. Neurobehavioral, neurologic, and neuroimaging characteristics of fetal alcohol spectrum disorders. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:435-462. [PMID: 25307589 DOI: 10.1016/b978-0-444-62619-6.00025-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Alcohol consumption during pregnancy can have deleterious consequences for the fetus, including changes in central nervous system development leading to permanent neurologic alterations and cognitive and behavioral deficits. Individuals affected by prenatal alcohol exposure, including those with and without fetal alcohol syndrome, are identified under the umbrella of fetal alcohol spectrum disorders (FASD). While studies of humans and animal models confirm that even low to moderate levels of exposure can have detrimental effects, critical doses of such exposure have yet to be specified and the most clinically significant and consistent consequences occur following heavy exposure. These consequences are pervasive, devastating, and can result in long-term dysfunction. This chapter summarizes the neurobehavioral, neurologic, and neuroimaging characteristics of FASD, focusing primarily on clinical research of individuals with histories of heavy prenatal alcohol exposure, although studies of lower levels of exposure, particularly prospective, longitudinal studies, will be discussed where relevant.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Ashley L Ware
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA.
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Simmons RW, Nguyen TT, Levy SS, Thomas JD, Mattson SN, Riley EP. Children with heavy prenatal alcohol exposure exhibit deficits when regulating isometric force. Alcohol Clin Exp Res 2012; 36:302-9. [PMID: 22014260 PMCID: PMC3578740 DOI: 10.1111/j.1530-0277.2011.01625.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Production of isometric (i.e., constant) force is an essential component of performing everyday functional tasks, yet no studies have investigated how this type of force is regulated in children with confirmed histories of heavy prenatal alcohol exposure. METHODS Children 7 to 17 years old with heavy prenatal alcohol exposure (n = 25) and without exposure (n = 18) applied force to a load cell to generate an isometric force that matched a criterion target force displayed on a computer monitor. Two levels of target force were investigated in combination with 3 levels of visual feedback frequency that appeared on the computer monitor as a series of yellow dots. Force was maintained for 20 seconds and participants completed 6 trials per test condition. RESULTS Root-mean-square error, signal-to-noise ratio, and sample entropy indexed response accuracy, response variability, and signal complexity, respectively. The analyses revealed that in comparison with controls, children with gestational ethanol exposure were significantly less accurate and more variable in regulating their force output and generated a response signal with greater regularity and less complexity in the time domain. CONCLUSIONS Children with prenatal alcohol exposure experience significant deficits in isometric force production that may impede their ability to perform basic motor skills and activities in everyday tasks.
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Affiliation(s)
- Roger W Simmons
- Motor Control Laboratory, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California 92182, USA.
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[The Fetal Tobacco Syndrome - A statement of the Austrian Societies for General- and Family Medicine (ÖGAM), Gynecology and Obstetrics (ÖGGG), Hygiene, Microbiology and Preventive Medicine (ÖGHMP), Pediatrics and Adolescence Medicine (ÖGKJ) as well as Pneumology (ÖGP)]. Wien Klin Wochenschr 2011; 124:129-45. [PMID: 22189489 DOI: 10.1007/s00508-011-0106-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 11/13/2011] [Indexed: 10/14/2022]
Abstract
Over more than 50 years, the nocuous effects of smoking in pregnancy on the fetus are well known. In the first years of science the focus was primarily on restricted fetal growth while in more recent years over 10.000 studies investigated the incomparably big sum of detrimental effects for the unborn's health. In this statement we want to present the recent scientific findings on this topic. The statement is aimed to show all doctors who treat pregnant women the present situation and evidence. In the beginning we give a short overview about the epidemiological situation in Europe. Then we present step by step the health effects with regards to pathophysiology and clinics. Furthermore the reader will learn about possibilities for smoking cessation in pregnancy. The problem of passive-smoking in pregnancy will be dealt with in a separate chapter. At present there is strong evidence that pregnant smoking has a detrimental effect on birth-weight, placenta-associated disease, stillbirth, sudden infant death syndrome (SIDS), childhood overweight, clefts, lung function, asthma, cardiovascular diseases and mental developmental disorders. These factors can be summarized by the term Fetal Tobacco Syndrome. There is supply for more studies for less investigated health effects. Pregnancy is a chance to stop smoking as most women show a high motivation in this period. Hence doctors of all disciplines should inform pregnant women about the detrimental effects of smoking on their unborn child and show them possibilities for smoking cessation.
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Morris CV, DiNieri JA, Szutorisz H, Hurd YL. Molecular mechanisms of maternal cannabis and cigarette use on human neurodevelopment. Eur J Neurosci 2011; 34:1574-83. [PMID: 22103415 PMCID: PMC3226730 DOI: 10.1111/j.1460-9568.2011.07884.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Prenatal development is highly sensitive to maternal drug use due to the vulnerability for disruption of the fetal brain with its ongoing neurodevelopment, resulting in lifelong consequences that can enhance risk for psychiatric disorders. Cannabis and cigarettes are the most commonly used illicit and licit substances, respectively, among pregnant women. Although the behavioral consequences of prenatal cannabis and cigarette exposure have been well-documented in epidemiological and clinical studies, only recently have investigations into the molecular mechanisms associated with the developmental impact of early drug exposure been addressed. This article reviews the literature relevant to long-term gene expression disturbances in the human fetal brain in relation to maternal cannabis and cigarette use. To provide translational insights, we discuss animal models in which protracted molecular consequences of prenatal cannabis and cigarette exposure can be better explored and which enable future evaluation of epigenetic pathways, such as DNA methylation and histone modification, that could potentially maintain abnormal gene regulation and related behavioral disturbances. Altogether, this information may help to address the current gaps of knowledge regarding the impact of early drug exposure that set in motion lifelong molecular disturbances that underlie vulnerability to psychiatric disorders.
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Affiliation(s)
- Claudia V Morris
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
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Molecular model of cannabis sensitivity in developing neuronal circuits. Trends Pharmacol Sci 2011; 32:551-61. [PMID: 21757242 DOI: 10.1016/j.tips.2011.05.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/27/2011] [Accepted: 05/02/2011] [Indexed: 11/21/2022]
Abstract
Prenatal cannabis exposure can complicate in utero development of the nervous system. Cannabis impacts the formation and functions of neuronal circuitries by targeting cannabinoid receptors. Endocannabinoid signaling emerges as a signaling cassette that orchestrates neuronal differentiation programs through the precisely timed interaction of endocannabinoid ligands with their cognate cannabinoid receptors. By indiscriminately prolonging the 'switched-on' period of cannabinoid receptors, cannabis can hijack endocannabinoid signals to evoke molecular rearrangements, leading to the erroneous wiring of neuronal networks. Here, we formulate a hierarchical network design necessary and sufficient to describe the molecular underpinnings of cannabis-induced neural growth defects. We integrate signalosome components, deduced from genome- and proteome-wide arrays and candidate analyses, to propose a mechanistic hypothesis of how cannabis-induced ectopic cannabinoid receptor activity overrides physiological neurodevelopmental endocannabinoid signals, affecting the timely formation of synapses.
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Wu CS, Jew CP, Lu HC. Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain. FUTURE NEUROLOGY 2011; 6:459-480. [PMID: 22229018 PMCID: PMC3252200 DOI: 10.2217/fnl.11.27] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cannabis is the most commonly used illicit substance among pregnant women. Human epidemiological and animal studies have found that prenatal cannabis exposure influences brain development and can have long-lasting impacts on cognitive functions. Exploration of the therapeutic potential of cannabis-based medicines and synthetic cannabinoid compounds has given us much insight into the physiological roles of endogenous ligands (endocannabinoids) and their receptors. In this article, we examine human longitudinal cohort studies that document the long-term influence of prenatal exposure to cannabis, followed by an overview of the molecular composition of the endocannabinoid system and the temporal and spatial changes in their expression during brain development. How endocannabinoid signaling modulates fundamental developmental processes such as cell proliferation, neurogenesis, migration and axonal pathfinding are also summarized.
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Affiliation(s)
- Chia-Shan Wu
- The Cain Foundation Laboratories, Jan & Dan Duncan Neurological Research Institute at Texas Children's Hospital, 1250 Moursund St Suite 1225, Houston, TX 77030, USA
| | - Christopher P Jew
- The Cain Foundation Laboratories, Jan & Dan Duncan Neurological Research Institute at Texas Children's Hospital, 1250 Moursund St Suite 1225, Houston, TX 77030, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hui-Chen Lu
- The Cain Foundation Laboratories, Jan & Dan Duncan Neurological Research Institute at Texas Children's Hospital, 1250 Moursund St Suite 1225, Houston, TX 77030, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
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Willford J, Day R, Aizenstein H, Day N. Caudate asymmetry: a neurobiological marker of moderate prenatal alcohol exposure in young adults. Neurotoxicol Teratol 2010; 32:589-94. [PMID: 20609385 DOI: 10.1016/j.ntt.2010.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 06/25/2010] [Accepted: 06/27/2010] [Indexed: 10/19/2022]
Abstract
This study identified structural changes in the caudate nucleus in offspring of mothers who drank moderate levels of alcohol during pregnancy. In addition, the effect of duration of alcohol use during pregnancy was assessed. Young adults were recruited from the Maternal Health Practices and Child Development Project. Three groups were evaluated: prenatal alcohol exposure (PAE) during all three trimesters (3T), PAE during the first trimester only (1T), and controls with no PAE (0T). Magnetic resonance images were processed using the automated labeling pathway technique. Volume was measured as the number (gray+white) and relative percentage (caudate count/whole brain count x 100) of voxels. Asymmetry was calculated by subtracting the caudate volume on the left from the right and dividing by the total (L-R/L+R). Data analyses controlled for gender, handedness, and prenatal tobacco and marijuana exposures. There were no significant differences between the groups for whole brain, left, or right volumes. There was a dose-response effect across the three exposure groups both in terms of magnitude and direction of asymmetry. In the 3T group, the left caudate was larger relative to the right caudate compared to the 0T group. The average magnitude of caudate asymmetry for the 1T group was intermediate between the 0T and 3T groups. Subtle anatomical changes in the caudate are detected at the moderate end of the spectrum of prenatal alcohol exposure.
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Affiliation(s)
- Jennifer Willford
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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