Birth, cognitive and behavioral effects of intrauterine cannabis exposure in infants and children: A systematic review and meta-analysis

Longitudinal Associations Between Cannabis Use during Pregnancy and Child Cognitive, Motor, and Language Development at 2 Years Old

OBJECTIVES

The objectives of this study are to describe cannabis use during pregnancy, identify associated factors, examine the associations between prenatal cannabis use and the cognitive, motor and language development of 2-year-old children, and determine whether these associations differ according to child sex.

METHODS

Data from 1489 mother-infant dyads from the 3D prospective pregnancy and birth cohort Study (2010-2012) were used. Prenatal cannabis use was measured during interviews in each trimester of pregnancy. Cognitive and motor development were assessed by The Bayley Scales of Infant and Toddler Development (BSID-III) and language development by the MacArthur-Bates Communicative Development Inventories at 2 years of age. Multiple linear regressions and differential analyses by child sex were performed.

RESULTS

2.6% of women reported using cannabis during pregnancy, the majority of whom stopped after the first trimester. Prenatal cannabis use was associated with lower socioeconomic status, prenatal use of alcohol and tobacco, and more distress symptoms during the first trimester of pregnancy. Results showed no significant associations between prenatal cannabis use (yes/no) and developmental indicators (Cognitive: B = 0.016, 95% CI [-0.268, 0.299]; Fine motor: B = 0.029, 95% CI [-0.271, 0.328]; Gross motor: B = 0.060, 95% CI [-0.143, 0.544]; Language: B = 0.200, 95% CI [-0.229, 0,465]). Contrary to our hypothesis, a positive association between cannabis use and language development was found in girls only.

CONCLUSION

The study, consisting of a large sample and developmental indicators independent of parental assessment, highlights the need for more studies on prenatal cannabis exposure documented by biomarkers.

Substance use and use disorders during pregnancy and the postpartum period

Substance use and substance use disorders among pregnant and postpartum individuals have risen dramatically, necessitating enhanced clinician education and intervention strategies. This expert review offers obstetricians and gynecologists a comprehensive overview of substance use during the prenatal and postpartum periods. We discuss the epidemiology, maternal and fetal adverse effects, as well as treatment approaches for major substances: nicotine, cannabis, alcohol, benzodiazepines, stimulants, and opioids. Additionally, we address the ethical and legal implications of substance use during pregnancy and emphasize the importance of equitable and nonstigmatizing care. By integrating evidence-based practices, we aim to support obstetricians and gynecologists in providing optimal care for pregnant and postpartum individuals affected by substance use disorders.

Maternal cannabis use disorder and offspring behavioral outcomes: findings from a linked data cohort study

Few studies have explored the association between maternal gestational cannabis use and disruptive behavioural disorders (DBDs) in offspring, often relying on self-reported data and small samples. This study aimed to assess the relationship between maternal cannabis use disorder (CUD) during pregnancy and postpartum periods and the risk of disruptive behaviours in offspring. We conducted a population-based retrospective cohort study using linked health data from New South Wales, Australia, for live births between 2003 and 2005. Mothers with CUD were compared to those without, and the risk of DBDs in offspring was estimated. Both CUD and disruptive behavioural disorders were identified using the International Classification of Disease (ICD) codes. Generalised Linear Models (GLMs) with log-binomial regression were fitted to estimate disruptive behavioural disorder risk in children. Statistical significance was set at p < 0.05. After adjusting for key confounders, this study revealed significantly higher risks of disruptive behavioural disorders in children of mothers with CUD during the antenatal [risk ratio (RR) = 3.56, 95 % CI 2.42-5.05], perinatal [RR = 3.55, 95 % CI 2.45-4.98], and postnatal [RR = 2.95, 95 % CI 1.23-6.16] periods compared to non-exposed counterparts. These findings underscore the importance of preconception, antenatal, and postnatal counselling on maternal cannabis use to mitigate neurobehavioral risks in children.

Cannabis and psychopathology: 2024 Snapshot of a meandering journey

Background

Cannabis has been associated with psychopathology since ancient times, but controversies continue despite important advances in the field. This article is the fourth one in our decadal series of review articles that have been providing an update snapshot of the meandering journey of the research findings in this area.

Aims

This narrative review of a comprehensive literature search over the past 10 years aims to provide an update and current understanding, while raising unanswered questions for the future, focusing on the following areas: (a) nosological changes in cannabis-related psychiatric syndromes; (b) psychopathology associated with the newer category of synthetic cannabinoids; (c) cannabis withdrawal syndrome); (d) cannabis and psychosis; (e) cannabis and mood disorders; (f) cannabis and suicidality; (g) prenatal cannabis use and psychopathology in the offspring; (h) effect of recent liberal policy overhaul on cannabis control in certain countries/areas on psychopathology and adverse outcomes; (i) cannabis and cognition; and (j) cannabis, psychopathology, and genetics.

Methods

The data search strategies involved a combination of electronic databases and manual hand-searching of relevant publications and cross-references using selected search terms. The primary electronic search focused on Medline and PubMed Central databases but extended to databases such as Google Scholar, PsychINFO, Scopus, and Ovid for specific sections. Key references identified through electronic and manual searches provided additional material. Inclusion criteria for the review spanned studies published between January 2014 and June 2024, with more emphasis placed on recent studies (post-2020) while ensuring historical coverage.

Results

The narrative review aimed to be comprehensive, including a broad range of research without strict methodological exclusions. Strengths and limitations of cited research are discussed when applicable, maintaining consistency with three prior reviews. We focused on psychopathology and psychiatric syndromes, human (rather than animal) studies, and applied (rather than basic) research. We have only focused on policy with reference to psychopathology and not on that entire area because that would be beyond the scope of this article. There are important updates in all the areas covered. There are newer syndromal entities in ICD-11, which also includes synthetic cannabinoids for the first time. Cannabis withdrawal syndrome has been better characterized. The association between cannabis and psychosis has been robustly established especially for very high-potency cannabis and for vulnerable populations, particularly young people. Work is in progress elucidating the causal mechanisms. The links between cannabis and mood disorders as well as suicidality and cognitive impairment are better characterized, though questions remain. Recent liberalizing policies on cannabis have produced newer findings on prenatal and accidental cannabis use (with deleterious effects on the offspring) and on later psychopathology (mixed findings, but a documented increase in emergency visits related to recent cannabis use). This is an area which will require active monitoring for new data.

Conclusion

The field of cannabis use and psychopathology continues to collect new data and settle some old controversies while raising new questions, which are important to address in view of the wide use of cannabis worldwide and its implications for public health.

Systematic review: the impact of maternal pre-and postnatal cannabis use on the behavioral and emotional regulation in early childhood

Prenatal exposure to alcohol and tobacco has been associated with child regulatory abilities and problems, but less is known about the associations with cannabis exposure. This review seeks to address this gap primarily focusing on the effects of maternal cannabis use on the child. Thus, we investigate the association between pre- and postnatal cannabis exposure of the child and regulatory abilities and problems, as well as the underlying neurobiological mechanisms potentially mediating the associations. According to the PRISMA guidelines, a systematic literature review was performed based on a systematic literature search through Medline (PubMed), Web of Science and PsycInfo, including studies assessing children aged 0-6 years with cannabis exposure in the preconception, pre-or postnatal period (preconception, pre- and postnatal cannabis exposure [PCE]) and investigating child regulatory abilities, regulatory problems or neurobiological mechanisms. Of n = 1061 screened articles, n = 33 were finally included. Diminished regulatory abilities are more likely to be found in infants after PCE, while specific regulatory problems tend to be more frequently found after two years of age. Possible mechanisms are related to changes in methylation and expression of key genes involved in endocannabinoid, dopaminergic and opioid systems, increased cortisol reactivity and altered Secretory Immunoglobulin A levels. Furthermore, PCE has been associated with changes in brain structure and connectivity. Current findings indicate that PCE is associated with both age-dependent alterations in self-regulation and neurobiological changes in young children. However, evidence is limited due to the number of studies, small sample sizes and lack of control for maternal psychopathology. Longitudinal studies including psychometric data from mothers are needed in order to further understand the implications of PCE.Trial registration: The review is registered with PROSPERO (ID: CRD42023425115).

Prenatal cannabis exposure and the risk for neuropsychiatric anomalies in the offspring: a systematic review and meta-analysis

OBJECTIVE

To evaluate the association between cannabis use during pregnancy and the risk for long-term neuropsychiatric pathology in the offspring.

DATA SOURCES

MEDLINE, EMBASE, and Cochrane library databases were systematically searched until January 22, 2024, with no language or date restrictions.

STUDY ELIGIBILITY CRITERIA

Studies were eligible for inclusion if they reported quantitative data on any long-term neuropsychiatric outcome in offspring whose mothers used cannabis during pregnancy for medical or recreational use, by any route and at any trimester, in comparison to offspring of women who abstained from cannabis use during pregnancy. All observational study designs were included in the analysis.

STUDY APPRAISAL AND SYNTHESIS METHODS

A systematic review and meta-analysis were performed according to the PRISMA and MOOSE guidelines. The data was extracted independently by 2 reviewers. The following offspring outcomes were of interest: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, anxiety, psychotic disorders, as well as cannabis and other substance use. Odds ratios (OR) and 95% confidence intervals (CI) were pooled for each neuropsychiatric outcome in the offspring of women exposed to cannabis during pregnancy compared with nonexposed. Data were pooled using random-effects models.

RESULTS

Eighteen eligible observational studies were included in the systematic review, and 17 were included in the final quantitative analysis, representing 534,445 participants. After adjusting for confounders, the pooled OR for ADHD was 1.13 (95% CI 1.01-1.26); for ASD, the pooled OR was 1.04 (95% CI 0.74-1.46); for psychotic symptoms, the pooled OR was 1.29 (95% CI 0.97-1.72); for anxiety, the pooled OR was 1.34 (95% CI 0.79-2.29); for depression, the pooled OR was 0.72 (95% CI 0.11-4.57); and for offspring's cannabis use, the pooled OR was 1.20 (95% CI 1.01-1.42).

CONCLUSION

Prenatal cannabis exposure is not associated with an increased risk of ASD, psychotic symptoms, anxiety, or depression in offspring. However, it may slightly elevate the risk of ADHD and predispose offspring to cannabis consumption. Despite these findings, caution is warranted regarding cannabis use during pregnancy. Further research is imperative, especially given the increasing potency of cannabis in recent years.

CBD and THC in Special Populations: Pharmacokinetics and Drug-Drug Interactions

Cannabinoid use has surged in the past decade, with a growing interest in expanding cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) applications into special populations. Consequently, the increased use of CBD and THC raises the risk of drug-drug interactions (DDIs). Nevertheless, DDIs for cannabinoids, especially in special populations, remain inadequately investigated. While some clinical trials have explored DDIs between therapeutic drugs like antiepileptic drugs and CBD/THC, more potential interactions remain to be examined. This review summarizes the published studies on CBD and THC-drug interactions, outlines the mechanisms involved, discusses the physiological considerations in pharmacokinetics (PK) and DDI studies in special populations (including pregnant and lactating women, pediatrics, older adults, patients with hepatic or renal impairments, and others), and presents modeling approaches that can describe the DDIs associated with CBD and THC in special populations. The PK of CBD and THC in special populations remain poorly characterized, with limited studies investigating DDIs involving CBD/THC in these populations. Therefore, it is critical to evaluate potential DDIs between CBD/THC and medications that are commonly used in special populations. Modeling approaches can aid in understanding these interactions.