Clinical Takeaway
Children exposed to cannabis during the peripregnancy period showed associations with behavioral and developmental differences in offspring, and these associations varied depending on whether ASD symptoms were present. The findings suggest that cannabis use from preconception through delivery may not carry the same risk profile across all developmental groups. Women who are pregnant or planning to become pregnant should be counseled to avoid cannabis use entirely, as no safe level of prenatal exposure has been established.
#30 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
Prenatal cannabis exposure has been inconsistently associated with neurodevelopmental outcomes, and this study addresses a critical gap by examining whether developmental and behavioral effects differ between children with and without ASD symptoms, which could inform more targeted clinical counseling and risk stratification. Understanding whether peripregnancy cannabis use confers differential risk based on ASD status is essential for obstetric providers to deliver evidence-based guidance during pregnancy planning and prenatal care. These findings could refine our understanding of cannabis teratogenicity and help identify which exposed children require early developmental surveillance.
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.
👶 This study contributes important nuance to the prenatal cannabis exposure literature by examining whether developmental and behavioral associations differ between children with and without ASD symptoms, moving beyond simple prevalence comparisons. However, several methodological considerations warrant caution in clinical interpretation: the observational design cannot establish causation, maternal cannabis use is often correlated with other substance use and socioeconomic factors that independently affect neurodevelopment, and the study relies on retrospective reporting of peripregnancy exposure which is subject to recall bias and social desirability bias. The heterogeneity of cannabis products, potency, dosing, and timing of exposure during pregnancy also limits our ability to identify dose-response relationships or critical developmental windows. From a clinical standpoint, while this work suggests the relationship between prenatal cannabis and child neurodevelopment may be more complex than previously thought, pregnant patients and those planning pregnancy should still be counseled that cannabis use during this critical window carries potential risks that are not fully characterized, and that current evidence does not support its safety for