Children exposed to both tobacco and cannabis before birth developed externalizing problems through emotion regulation difficulties, while tobacco-only exposure worked through different pathways involving maternal mood and temperament.
Pediatricians, developmental psychologists, parents concerned about prenatal exposure effects, and early intervention professionals.
Different exposure types = different developmental pathways
What the researchers found
Prenatal tobacco-cannabis co-exposure (PTCE) was associated with externalizing problems through an emotion regulation pathway, while prenatal tobacco exposure (PTE) alone was associated through a combined maternal negative mood and temperament pathway. Both exposures led to heightened externalizing problems at school age, but through distinct developmental mechanisms.
Why it matters
This is the first study to show that tobacco alone versus tobacco-plus-cannabis exposure lead to behavioral problems through entirely different developmental pathways. This means prevention and intervention approaches may need to be tailored based on what a child was exposed to prenatally.
The numbers in context
293 mother-child dyads (48% Black, 27% White, 14% Hispanic). PTE group: n=89. PTCE group: n=105. Controls: n=99. 64.8% WIC recipients. Externalizing problems assessed via maternal and teacher report at school age.
How the study worked
Longitudinal study of 293 diverse mother-child dyads (89 tobacco-exposed, 105 tobacco-cannabis co-exposed, 99 unexposed controls) assessed from infancy through early school age using physiological, observational, and parent/teacher reports.
What this study cannot tell us
Cannot fully separate the effects of cannabis from those of tobacco in the co-exposure group. Self-reported substance use may be inaccurate. The sample, while diverse, was drawn from a specific geographic area.
How to read the evidence
Well-designed longitudinal cohort with diverse sample, multiple assessment methods, and appropriate controls, though cannot isolate cannabis effects from co-exposure.
When this study was published
2026 study.
The bigger picture
Most prenatal substance exposure research treats tobacco and cannabis use together or focuses on one substance. Demonstrating distinct mechanistic pathways for each type of exposure could fundamentally change how pediatric interventions are designed for exposed children.
Questions still open
- Would the emotion regulation pathway be present in cannabis-only prenatal exposure? Could early interventions targeting emotion regulation specifically help children exposed to both substances prenatally?
Common questions
Does prenatal cannabis exposure cause behavioral problems in children?
Why do the different exposures matter?
Read the original research
Developmental Cascades From Prenatal Tobacco, Tobacco-cannabis Co-exposure to Early school-age externalizing Problems.
Research on child and adolescent psychopathology, 54(1), 28
Citation
Perry, Kristin J; Schuetze, Pamela; Eiden, Rina D. (2026). Developmental Cascades From Prenatal Tobacco, Tobacco-cannabis Co-exposure to Early school-age externalizing Problems.. Research on child and adolescent psychopathology, 54(1), 28. https://doi.org/10.1007/s10802-025-01407-w
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