Clinical Takeaway
Maternal cannabis use during the peripregnancy period was associated with behavioral and developmental differences in children, with effects varying depending on whether the child showed symptoms of autism spectrum disorder. These findings add to a growing body of evidence suggesting that cannabis exposure before and during pregnancy may affect early childhood neurodevelopment. Women who are pregnant or planning to become pregnant should be advised to avoid cannabis use.
#28 Associations of maternal peripregnancy cannabis use with behavioral and developmental outcomes in children with and without symptoms of autism spectrum disorder: Study to Explore Early Development.
Citation: DiGuiseppi Carolyn et al.. Associations of maternal peripregnancy cannabis use with behavioral and developmental outcomes in children with and without symptoms of autism spectrum disorder: Study to Explore Early Development.. Autism research : official journal of the International Society for Autism Research. 2025. PMID: 39660543.
Design: 0 Journal: 0 N: 4 Recency: 2 Pop: 3 Human: 1 Risk: 0
This study addresses a critical gap in understanding whether prenatal cannabis exposure differentially affects neurodevelopmental outcomes based on autism symptom status, which has direct implications for counseling pregnant patients and informing regulatory guidance on cannabis use during pregnancy. The findings could clarify whether observed associations between maternal cannabis use and ASD represent a causal mechanism or reflect confounding factors, thereby improving clinical risk stratification for affected pregnancies. Given increasing cannabis legalization and use among reproductive-age women, evidence-based clinical guidance on peripregnancy exposure is essential for informed shared decision-making in obstetric practice.
Abstract: Some studies report increased prevalence of autism spectrum disorder (ASD) and associated symptoms with prenatal cannabis exposure. We examined whether associations of maternal cannabis use from 3 months preconception through delivery (“peripregnancy”) with behavior and development in the offspring varied with the presence of ASD symptoms. Children ages 30-68 months with ASD symptoms (i.e., met study criteria for ASD or had ASD symptoms on standardized assessments or community ASD diagnosis, N = 2734) and without ASD symptoms (other developmental delay/disorders or general population sample, N = 3454) were evaluated with the Child Behavior Checklist and Mullen Scales of Early Learning. We examined cannabis use during three time periods: peripregnancy, pregnancy, and only preconception. Peripregnancy cannabis exposure was reported for 6.0% of children with and 4.6% of children without ASD symptoms. Preconception-only cannabis use (versus no use) was associated with more aggressive behavior, emotional reactivity, and sleep problems in children with ASD symptoms, but not in children without ASD symptoms. Cannabis use during pregnancy was associated with increased attention and sleep problems in children with ASD symptoms; these associations did not differ significantly by ASD symptoms. Peripregnancy cannabis use was not associated with child developmental abilities regardless of ASD symptoms. In summary, associations of peripregnancy cannabis use with some behavioral outcomes differed in children with and without ASD symptoms. With rising cannabis use among pregnant women, future studies that examine a range of developmental risks associated with timing and patterns of cannabis use prior to conception as well as during pregnancy could inform clinical guidance.
🧠 While this study from the Study to Explore Early Development cohort adds to our understanding of peripregnancy cannabis exposure and neurodevelopmental outcomes, several important limitations warrant clinical caution in interpretation. The cross-sectional nature of the data, reliance on maternal self-report of cannabis use (which typically underestimates actual consumption), and inability to control for confounding variables such as concurrent substance use, maternal mental health conditions, and socioeconomic factors all complicate our ability to establish causation or identify true dose-response relationships. Additionally, the study’s focus on stratifying outcomes by ASD symptom presence raises questions about reverse causality and selection bias, as families with children showing developmental concerns may report cannabis exposure differently than comparison groups. Given the current evidence suggesting potential associations between prenatal cannabis use and neurodevelopmental outcomes, coupled with the known teratogenic potential of THC and the lack of safety data in pregnancy, a conservative clinical approach remains prudent: providers should counsel women of reproductive age and pregnant patients that current evidence