Exposure to Cannabis in Womb Associated With Behavioral Issues in Tweens, Study Finds

Children who were exposed to cannabis in the womb appear to be at a heightened risk of behavioral problems into at least early adolescence, suggests a report published Monday in JAMA Pediatrics. The findings—which are based on data collected as part of the Adolescent Brain and Cognitive Development Study (ABCD Study)—add to a growing body of evidence about the risks of cannabis use during pregnancy.

According to a media release from the National Institute on Drug Abuse, cannabis use among pregnant women increased from 3% in 2002 to 7% in 2017. In 2018, 4.7% of pregnant women reported cannabis use; 5.4% reported cannabis use in 2019.

A 2020 study by Ryan Bogdan, Ph.D., of Washington University in St Louis and colleagues found that children whose mothers used cannabis after learning they were pregnant were slightly more likely to have sleep, attention, and social problems at ages 9 and 10, among other issues. To determine if these associations remained as the children grew older, David A.A. Baranger, Ph.D., Bogdan, and colleagues followed up with these youth one and two years later. (As was done in the 2020 study, children and caregivers provided feedback on the Child Behavior Checklist and the Prodromal Questionnaire–Brief Child Version.)

The analysis included 10,631 individuals and 30,091 longitudinal assessments (baseline: n = 10,624; mean age, 9.9 years; one-year follow-up: n = 10,094; mean age, 10.9 years; two-year follow-up: n = 9,373; mean age, 12.0 years). The analysis revealed no significant changes in the rate of psychiatric conditions as the children aged.

“[Prenatal cannabis exposure] is associated with persisting vulnerability to broad-spectrum psychopathology as children progress through early adolescence,” Baranger and colleagues wrote. “Increased psychopathology may lead to greater risk for psychiatric disorders and problematic substance use as children enter peak periods of vulnerability in later adolescence.”

For related information, see the Psychiatric News article “Exposure to Alcohol, Cannabis in Womb Can Have Long-Term Consequences.”

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Prenatal Choline Supplements May Decrease Later Attention, Social Problems in Children

Children born to mothers who take a high-dose choline supplement during pregnancy may be less likely to experience attention and social problems later in life, according to a study published Monday in AJP in Advance.

“The main significance of our findings is that we’ve shown that it is potentially possible to intervene prenatally to improve brain development in a safe way that is reflected in behavior that predicts increased resilience and decreased psychiatric illness later in life,” lead author Randal Ross, M.D., a professor of psychiatry at the University of Colorado School of Medicine, told Psychiatric News. “The earlier in development you intervene, the greater the potential benefits and lower the costs.”

Past studies suggest that children who later develop psychiatric disorders with an attentional component (such as attention-deficit/hyperactivity disorder, autism spectrum disorder, and schizophrenia) display developmental deficits from an early age. For instance, diminished auditory response inhibition in newborns has been found to be associated with their parent’s psychosis, the greatest risk factor for future psychotic illness.

In a previous study, Ross and colleagues found that newborns born to healthy mothers who had taken prenatal phosphatidylcholine supplements (3,600 mg each morning and 2,700 mg each evening) were more likely to display healthy adult levels of auditory inhibition than those whose mothers had taken a placebo throughout pregnancy. As a follow-up to this study, the researchers asked the parents to rate the behavioral development of their children at age 40 months.

Of the 100 pregnant women enrolled in the initial trial, 86 delivered children from whom researchers recorded auditory evoked potentials at 1 month. The parents of 49 of these children later completed the Child Behavior Checklist, where they rated their 3-year-olds on measures of attention, aggression, withdrawal, and more.

Parent ratings on the Child Behavior Checklist attention and withdrawn subscale were significantly lower in those children who had been treated with choline compared with those who had been treated with placebo. The 40-month Child Behavior Checklist ratings were also related to newborn auditory response inhibition, with significant effects on scores for both the withdrawn subscale and total problems.

“The outcome of the fetal stage of brain development has lifelong consequences for mental function, and there is little prospect of reversing these developmental problems later in life when mental illnesses appear,” Ross and colleagues wrote. “Thus, perinatal intervention, even before individuals at risk for mental illness can be identified, is the only opportunity for potentially reversing this initial major aspect of the pathogenesis of mental illness. A primary, low-cost, low-risk intervention during fetal development will not prevent all cases of mental illness, but even a partial decrease in their incidence or severity would have substantial global value.”

(Image: pio3/Shutterstock)

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PQRS Penalty Correction

Information that was published in this week’s Psychiatric News Update regarding the deadline to avoid a penalty related to the reporting of Physician Quality Reporting System (PQRS) measures was incorrect. Based on your practice’s Medicare patient volume, it may not be possible to take action to avoid a penalty at this time. For more information about PQRS, click here.