Prenatal Cannabis Use (PCU) and Development of Offspring Brain and Behavior During Early Life (0-18 Months)

29个州、关岛和波多黎各领地以及哥伦比亚特区已经将 医疗和/或娱乐性大麻使用。同时，δ-9四氢大麻酚（THC） 增加了，而对与经常使用有关的危害的看法变得更加宽容， 强调必须集中精力评估大麻使用对健康和行为的影响。 特别是，人们越来越担心产前检查升级的潜在不良后果， 大麻使用（PCU）。近4%的美国孕妇报告上个月使用大麻，占1.6- 在过去的十年中，增长了一倍。PCU对新生儿结局的潜在影响，包括 大脑和早期儿童发育里程碑已被证明很难研究，部分原因是PCU共同 与其他药物一起使用，最明显的是烟草，因此很难描述PCU的具体影响。 此外，PCU还与其他母亲精神疾病（犯罪，外化行为）共病 作为家庭脆弱性的问题物质使用，可以混淆的解释因果关系的PCU 对后代大脑和行为的影响该提案通过招募新的研究人员来解决目前文献中的挑战。 一家城市医院门诊部的孕妇，病历显示，约80%的妇女 使用大麻的妇女不使用其他药物，使用大麻的其他约20%的妇女报告使用 烟草，但很少或没有酒精或其他药物。最近有大麻使用史的孕妇将 选择;仅报告产前大麻使用的女性（PCU，n=200）将与 报告无产前药物使用（NPCU，n=200），以评价PCU在（目标1）分娩中的作用 特性（例如，出生体重）和新生儿神经行为（例如，兴奋性）;（目的2）新生儿皮质下 150例PCU和100例社会人口学匹配的PCU的形态学和结构与功能连接 NPCU婴儿;（目的3）婴儿在6、12和18个月大时的社会情感行为和气质， 以及母婴互动;以及（目标4）大脑结构和连通性与 婴儿早期的行为分析将控制其他产科特征的指数，以及 产妇心理社会健康、家族史和家庭环境的综合指数。预期在 设计，在妊娠早期招募的妇女将被跟踪，其后代直到18个月 产后，提供风险和保护性影响，伴随PCU的详细特征。PCU， 烟草和其他毒品的使用将得到生物化学验证。报告PCU的女性更有可能是社交型的 经济上处于不利地位，因此，幼儿社会情感困难的经济负担可能 在这个群体中尤为突出。这项研究的结果将直接影响这一群体的福祉。 它还将为制定合理的公共卫生政策提供信息 关于美国大麻的使用。

Twenty-nine states, the territories of Guam and Puerto Rico, and the District of Columbia have legalized medical and/or recreational cannabis use. Concurrently, the potency of delta-9 tetrahydrocannabinol (THC) has increased while perceptions regarding harms associated with regular use have become more permissive, underscoring the importance of focused effort to evaluate the impact of cannabis use on health and behavior. In particular, there is growing concern about potential adverse consequences of escalations in prenatal cannabis use (PCU). Nearly 4% of pregnant U.S. women report past month cannabis use, representing a 1.6- fold increase in the past decade. The potential impact of PCU on neonatal outcomes, including the neonatal brain, and early childhood developmental milestones has proven difficult to study in part because PCU co- occurs with other drug use, most notably tobacco, making it difficult to delineate the specific effects of PCU. Further, PCU is comorbid with other maternal psychiatric illness (delinquency, externalizing behavior) as well as familial vulnerability to problem substance use that can confound the interpretation of causal effects of PCU on offspring brain and behavior. This proposal addresses current challenges in the literature by recruiting pregnant women from an urban hospital outpatient clinic, where medical records show that ~80% of women who use cannabis do not use other drugs, with the other ~20% of women who use cannabis reporting using tobacco but very little to no alcohol or other drugs. Pregnant women with a recent history of cannabis use will be selected; women reporting prenatal cannabis use only (PCU, n=200) will be compared with women reporting no prenatal substance use (NPCU, n=200), to evaluate the role of PCU in (Aim 1) birth characteristics (e.g., birthweight) and neonatal neurobehavior (e.g., excitability); (Aim 2) neonatal subcortical morphology and structural and functional connectivity in 150 PCU and 100 sociodemographically matched NPCU infants; (Aim 3) infant social-emotional behavior and temperament at 6, 12 and 18 months of age, as well as mother-infant interactions; and (Aim 4) the extent to which brain structure and connectivity is related to infant behavior during early life. Analyses will control for an index of other obstetric characteristics as well as composite indices of maternal psychosocial health, family history and home environment. Prospective in design, women recruited within the 1st trimester will be followed, with their offspring until 18 months postpartum, affording detailed characterization of risk and protective influences that accompany PCU. PCU, tobacco and other drug use will be biochemically validated. Women reporting PCU are more likely to be socio- economically disadvantaged and thus, the economic burden of early childhood social-emotional difficulties may be particularly pronounced in this group. Results from this study will directly impact the well-being of this understudied population and their infants; it will also inform the development of a rational public health policy on cannabis use in the United States.