Clinical Takeaway
Children exposed to cannabis during the peripregnancy period showed associations with behavioral and developmental differences in early childhood, and these associations varied depending on whether ASD symptoms were present. The findings suggest that cannabis use from preconception through delivery may not carry uniform risk across all children, with those already showing ASD symptoms potentially representing a distinct subgroup. Pregnant individuals and those planning pregnancy should be counseled to avoid cannabis use given the potential for developmental harm.
#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 clarifies whether prenatal cannabis exposure’s neurodevelopmental effects are specific to autism spectrum disorder or represent broader developmental concerns, which is critical for counseling reproductive-aged women about cannabis use during pregnancy. Understanding differential associations between cannabis exposure and developmental outcomes in children with versus without ASD symptoms may identify whether certain populations face elevated risk and inform targeted clinical guidance in obstetric and pediatric 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 SEED cohort addresses an important public health question about peripregnancy cannabis exposure and neurodevelopmental outcomes, several factors warrant careful interpretation before clinical application. The cross-sectional design and reliance on maternal recall of cannabis use introduce significant recall bias and confounding by unmeasured variables such as underlying psychiatric conditions, socioeconomic stress, and concurrent substance use that may independently influence both exposure patterns and child development. The heterogeneous definition of “ASD symptoms” across the study population and lack of clarity on dose, frequency, timing, and route of cannabis use limit our ability to establish dose-response relationships or identify critical exposure windows. Until prospective studies with objective exposure biomarkers and rigorous covariate adjustment become available, clinicians should counsel women of childbearing age that current evidence suggests avoiding cannabis during the periconception and pregnancy period, while acknowledging this guidance rests on observational data rather than definitive causal evidence. This conversation is particularly important for pregnant patients using cannabis for hyperem
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