Associations Between Prenatal Cannabis Exposure and Childhood Outcomes Results From the ABCD Study
Associations Between Prenatal Cannabis Exposure and Childhood Outcomes Results From the ABCD Study
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DOI：
10.1001/jamapsychiatry.2020.2902
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发表时间：
2020-09-23
期刊：
影响因子：
25.8
通讯作者：
Bogdan, Ryan
中科院分区：
文献类型：
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作者：
Paul, Sarah E.;Hatoum, Alexander S.;Bogdan, Ryan
重要性 鉴于孕妇吸食大麻的情况不断增加，美国卫生局局长最近发布了一项反对在怀孕期间吸食大麻的建议。目的 评估怀孕期间使用大麻是否与后代不良后果相关。设计、背景和参与者 在这项横断面研究中，数据来自正在进行的纵向青少年大脑和认知发展研究的基线会议，该研究在 2016 年 6 月 1 日至 2018 年 10 月 15 日期间从美国 22 个地点招募了 11875 名 9 至 11 岁的儿童以及父母或照顾者。主要结果和测量儿童精神病理学症状（即精神病样经历[PLE]和内化、外化、注意力、思维和社会问题）、认知、睡眠、出生体重、出生胎龄、体重指数和大脑结构（即颅内总体积、白质体积和灰质体积）。协变量包括家庭变量（例如收入和家族精神病理学）、怀孕变量（例如产前接触酒精和烟草）和儿童变量（例如物质使用）。结果 在未缺失产前大麻暴露数据的 11489 名儿童（5997 名男孩 [52.2%]；平均 [SD] 年龄，9.9 [0.6] 岁）中，655 名 (5.7%) 在产前接触过大麻。相对于没有接触，仅在怀孕前（413 [3.6%]）和怀孕后（242 [2.1%]）接触大麻与后代更大的精神病理学特征（即 PLE 和内化、外化、注意力、思想和社会问题）、睡眠问题和体重指数以及较低的认知和灰质体积（所有 |beta| > 0.02；所有错误发现率 [FDR] 校正 P < .03）。相对于未暴露和仅在知晓怀孕前暴露，仅在知晓怀孕后暴露才与较低的出生体重以及颅内总体积和白质体积相关（所有 |beta| > 0.02；所有 FDR 校正 P < .04）。当包括潜在的混杂协变量时，母亲知道怀孕后的暴露仍然与更大的 PLE 以及外化、注意力、思想和社会问题相关（所有 beta > 0.02；FDR 校正 P < .02）。当考虑到潜在的混杂变量时，仅在母亲知道怀孕之前暴露与不暴露在任何结果上没有差异（所有 |beta| < 0.02；FDR 校正 P > .70）。结论和相关性这项研究表明，产前接触大麻及其相关因素与童年中期更大的精神病理学风险相关。应劝阻怀孕期间使用大麻。问题 产前接触大麻与儿童结局相关吗？研究结果 这项对 11489 名儿童（其中 655 名在产前接触过大麻）的横断面分析发现，即使在考虑了潜在的混杂变量之后，母亲知道怀孕后接触大麻与童年中期更大的精神病理学相关。这意味着产前接触大麻可能会增加患精神病的风险；与美国外科医生最近的建议一致，这些数据表明临床医生和药房应劝阻怀孕期间使用大麻。这项横断面研究使用青少年大脑和认知发展研究的数据来评估怀孕期间使用大麻是否与后代的不良后果相关。
Importance In light of increasing cannabis use among pregnant women, the US Surgeon General recently issued an advisory against the use of marijuana during pregnancy. Objective To evaluate whether cannabis use during pregnancy is associated with adverse outcomes among offspring. Design, Setting, and Participants In this cross-sectional study, data were obtained from the baseline session of the ongoing longitudinal Adolescent Brain and Cognitive Development Study, which recruited 11875 children aged 9 to 11 years, as well as a parent or caregiver, from 22 sites across the United States between June 1, 2016, and October 15, 2018. Exposure Prenatal cannabis exposure prior to and after maternal knowledge of pregnancy. Main Outcomes and Measures Symptoms of psychopathology in children (ie, psychotic-like experiences [PLEs] and internalizing, externalizing, attention, thought, and social problems), cognition, sleep, birth weight, gestational age at birth, body mass index, and brain structure (ie, total intracranial volume, white matter volume, and gray matter volume). Covariates included familial (eg, income and familial psychopathology), pregnancy (eg, prenatal exposure to alcohol and tobacco), and child (eg, substance use) variables. Results Among 11489 children (5997 boys [52.2%]; mean [SD] age, 9.9 [0.6] years) with nonmissing prenatal cannabis exposure data, 655 (5.7%) were exposed to cannabis prenatally. Relative to no exposure, cannabis exposure only before (413 [3.6%]) and after (242 [2.1%]) maternal knowledge of pregnancy were associated with greater offspring psychopathology characteristics (ie, PLEs and internalizing, externalizing, attention, thought and, social problems), sleep problems, and body mass index, as well as lower cognition and gray matter volume (all |beta| > 0.02; all false discovery rate [FDR]-correctedP < .03). Only exposure after knowledge of pregnancy was associated with lower birth weight as well as total intracranial volume and white matter volumes relative to no exposure and exposure only before knowledge (all |beta| > 0.02; all FDR-correctedP < .04). When including potentially confounding covariates, exposure after maternal knowledge of pregnancy remained associated with greater PLEs and externalizing, attention, thought, and social problems (all beta > 0.02; FDR-correctedP < .02). Exposure only prior to maternal knowledge of pregnancy did not differ from no exposure on any outcomes when considering potentially confounding variables (all |beta| < 0.02; FDR-correctedP > .70). Conclusions and Relevance This study suggests that prenatal cannabis exposure and its correlated factors are associated with greater risk for psychopathology during middle childhood. Cannabis use during pregnancy should be discouraged.Question Is prenatal exposure to cannabis associated with child outcomes? Findings This cross-sectional analysis of 11489 children (655 exposed to cannabis prenatally) found that prenatal cannabis exposure after maternal knowledge of pregnancy was associated with greater psychopathology during middle childhood, even after accounting for potentially confounding variables. Meaning Prenatal cannabis exposure may increase risk for psychopathology; consistent with recent recommendations by the Surgeon General of the United States, these data suggest that cannabis use during pregnancy should be discouraged by clinicians and dispensaries.This cross-sectional study uses data from the Adolescent Brain and Cognitive Development Study to evaluate whether cannabis use during pregnancy is associated with adverse outcomes among offspring.