Prenatal tobacco exposure affected girls' behavior more than boys', and toddler behavior problems predicted mothers' increased cannabis use
A longitudinal study of 247 mothers and children found that prenatal tobacco exposure produced stronger behavioral effects in girls than boys, and discovered a bidirectional relationship where toddler behavior problems at age 2 predicted increased maternal cannabis use a year later.
Quick Facts
What This Study Found
Researchers followed 247 low-income mothers and their children from pregnancy through age 3, tracking prenatal substance exposure and child behavior problems.
Prenatal tobacco exposure showed stronger effects in girls: girls in the tobacco-exposed group had higher internalizing problems, anxiety/depression, and attention problems compared to other groups. The association between cigarettes per day during pregnancy and behavioral problems at age 3 was stronger for girls than boys.
A particularly striking finding was a bidirectional relationship between maternal cannabis use and child behavior. Higher maternal cannabis use during the infant-toddler period predicted higher behavior problems at age 2. But the relationship went both ways: those behavior problems at age 2 then predicted higher maternal cannabis use a year later, suggesting a feedback loop.
The joint effects of tobacco and cannabis exposure did not consistently produce worse outcomes than tobacco alone.
Key Numbers
247 mother-child pairs. Three groups: tobacco + cannabis (97), tobacco only (81), control (69). Assessments at each trimester and 5 postnatal timepoints through age 3. Girls showed stronger effects than boys for prenatal tobacco exposure.
How They Did This
Longitudinal cohort study of 247 mothers and children (97 prenatal tobacco + cannabis, 81 tobacco only, 69 non-exposed). Assessed during each trimester and at 2, 9, 16 months, 2 years, and 3 years. Primarily young, unmarried, low-income, minority participants.
Why This Research Matters
The bidirectional finding is clinically important: not only does maternal substance use affect child behavior, but difficult child behavior may drive increased maternal substance use, creating a cycle that could escalate without intervention targeting both the parent and child.
The Bigger Picture
This study is one of few to examine the bidirectional relationship between maternal substance use and child behavior over time. The finding that child behavior problems predict subsequent increases in maternal cannabis use highlights the importance of family-level interventions rather than focusing solely on maternal behavior.
What This Study Doesn't Tell Us
Sample was primarily low-income, young, and minority, limiting generalizability. The three groups (tobacco+cannabis, tobacco only, control) could not fully separate individual substance effects. Cannabis use was self-reported. The sample size limited statistical power for detecting smaller effects and interaction terms.
Questions This Raises
- ?Does the bidirectional cycle between child behavior problems and maternal cannabis use continue beyond age 3?
- ?Would early intervention targeting difficult toddler behavior reduce subsequent maternal substance use?
- ?Are the sex-differential effects of prenatal tobacco exposure replicated in larger samples?
Trust & Context
- Key Stat:
- Behavior problems at age 2 predicted increased maternal cannabis use a year later
- Evidence Grade:
- This longitudinal cohort with multiple assessment points provides moderate evidence, limited by relatively small sample size and specific demographic characteristics.
- Study Age:
- Published in 2018. Research on prenatal substance exposure and child development continues to expand.
- Original Title:
- Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences.
- Published In:
- Drug and alcohol dependence, 185, 82-92 (2018)
- Authors:
- Eiden, Rina D(8), Zhao, Junru, Casey, Meghan, Shisler, Shannon, Schuetze, Pamela, Colder, Craig R
- Database ID:
- RTHC-01649
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Were the effects of prenatal exposure the same for boys and girls?
No. Girls showed stronger effects from prenatal tobacco exposure, including higher internalizing problems, anxiety/depression, and attention problems at age 3. The association between cigarettes per day and behavioral problems was stronger for girls.
What was the bidirectional finding?
Higher maternal cannabis use during infancy predicted higher behavior problems in the child at age 2. Those behavior problems then predicted the mother increasing her cannabis use a year later, suggesting a feedback cycle.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-01649APA
Eiden, Rina D; Zhao, Junru; Casey, Meghan; Shisler, Shannon; Schuetze, Pamela; Colder, Craig R. (2018). Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences.. Drug and alcohol dependence, 185, 82-92. https://doi.org/10.1016/j.drugalcdep.2017.11.038
MLA
Eiden, Rina D, et al. "Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences.." Drug and alcohol dependence, 2018. https://doi.org/10.1016/j.drugalcdep.2017.11.038
RethinkTHC
RethinkTHC Research Database. "Pre- and postnatal tobacco and cannabis exposure and child b..." RTHC-01649. Retrieved from https://rethinkthc.com/research/eiden-2018-pre-and-postnatal-tobacco
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.