Children exposed to both Superstorm Sandy and maternal cannabis use prenatally had a synergistic 31-fold increased risk of disruptive behavioral disorders and a 7-fold increased risk of anxiety disorders, far exceeding what either exposure alone would predict.
Pregnant individuals in disaster-affected areas, prenatal care providers, disaster mental health responders.
31-fold risk of behavioral disorders with dual prenatal exposure to disaster and cannabis
What the researchers found
Among 163 children tracked from ages 2-5, those exposed to both Superstorm Sandy and maternal cannabis use (8% of sample) had a 31-fold increased risk of disruptive behavioral disorders and a 7-fold increased risk of anxiety disorders compared to those exposed to neither. The synergy index showed effects were multiplicative, not just additive: DBD synergy index 2.06 (p = 0.03), anxiety synergy index 2.60 (p = 0.004). Children with dual exposure also had the highest parenting stress and lowest social support.
Why it matters
This study demonstrates that prenatal adversities do not simply add up but can multiply each other's effects. The "double-hit" model suggests that fetuses exposed to both stress and cannabis face compounding biological insults that dramatically increase psychiatric risk in early childhood.
The numbers in context
163 children. 40.5% exposed to Superstorm Sandy. 24.5% exposed to maternal cannabis. 8% exposed to both. Dual exposure: 31-fold DBD risk, 7-fold anxiety risk. Synergy index for DBD: 2.06 (p = 0.03). Synergy index for anxiety: 2.60 (p = 0.004).
How the study worked
Longitudinal cohort of 163 children (53.4% girls) tracked from ages 2-5. Offspring grouped by prenatal exposure: neither, maternal cannabis only, Superstorm Sandy only, or both. DSM-IV disorders assessed via structured clinical interviews. Synergy indices calculated to test multiplicative interaction.
What this study cannot tell us
Small sample, especially the dual-exposure group (n = 13). Cannot determine if cannabis use increased after the storm. Observational design with potential confounding. DSM-IV disorders in 2-5 year olds may be less reliable. Short follow-up period.
How to read the evidence
Longitudinal design with structured clinical assessment, but very small dual-exposure group (n = 13) limits statistical reliability.
When this study was published
Published 2023, following children born around the time of Superstorm Sandy (2012).
The bigger picture
With climate change increasing natural disaster frequency and cannabis use rising among women, especially those under stress, this "double-hit" finding has growing public health relevance. It suggests that prenatal cannabis prevention messaging may be especially important in disaster-affected communities.
Questions still open
- Did stressed mothers increase cannabis use after the storm, or were these patterns already established?
- Do the synergistic effects persist or intensify as children enter school age?
Common questions
Can stress and cannabis during pregnancy combine to affect the child?
How common was dual exposure?
Read the original research
Association of maternal exposure to Superstorm Sandy and maternal cannabis use with development of psychopathology among offspring: the Stress in Pregnancy Study.
BJPsych open, 9(3), e94
Citation
Nomura, Yoko; Ham, Jacob; Pehme, Patricia M; Wong, Waiman; Pritchett, Lexi; Rabinowitz, Sima; Foldi, Nancy S; Hinton, Veronica J; Wickramaratne, Priya J; Hurd, Yasmin L. (2023). Association of maternal exposure to Superstorm Sandy and maternal cannabis use with development of psychopathology among offspring: the Stress in Pregnancy Study.. BJPsych open, 9(3), e94. https://doi.org/10.1192/bjo.2022.595
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