Prenatal Tobacco-Cannabis Co-Exposure Affected Children's Emotion Regulation Through Ongoing Maternal Risk Factors

Direct effects from prenatal exposure on early school age emotion regulation were not significant. Instead, a chronic risk pathway was supported: continued postnatal maternal negative emotional functioning (depression, anger/hostility, emotion dysregulation) and substance exposure mediated the association. Toddlers showing respiratory sinus arrhythmia withdrawal were more susceptible to the positive effects of sensitive parenting.

Prospective cohort of 247 mother-infant dyads (53% male, 51% Black, 31% White, 19% Hispanic) recruited in the first trimester into three groups: prenatal tobacco exposure (n=81), prenatal tobacco-cannabis co-exposure (n=97), and no substance exposure (n=69). Follow-up through early school age.

This study shifts the narrative from prenatal exposure as the sole risk to ongoing postnatal environment as the critical pathway. It suggests that helping mothers maintain stability after birth may be more important than focusing exclusively on prenatal substance cessation.

The finding that sensitive parenting can buffer the effects of prenatal exposure in physiologically reactive children offers a concrete intervention target. Rather than only preventing prenatal exposure, supporting positive parenting may protect children who have already been exposed.

Cannot separate tobacco from cannabis effects cleanly. Self-report measures for maternal functioning. The three groups differed at baseline in ways that may confound results. Attrition over the long follow-up period.