Prenatal Cannabis Exposure Linked to Self-Regulation Problems That Emerge as Children Grow

From 1,061 screened articles, 33 were included. Diminished regulatory abilities were more common in infants after prenatal cannabis exposure, while specific regulatory problems (behavioral, emotional) were more frequently found after age 2. Mechanisms included changes in methylation and expression of endocannabinoid, dopaminergic, and opioid system genes, increased cortisol reactivity, altered immune markers, and changes in brain structure and connectivity.

Systematic review following PRISMA guidelines, searching Medline, Web of Science, and PsycInfo. Included studies of children ages 0-6 with preconception, prenatal, or postnatal cannabis exposure. Investigated regulatory abilities, regulatory problems, and neurobiological mechanisms. Registered with PROSPERO.

Self-regulation, the ability to control attention, emotions, and behavior, is foundational for child development. This review shows that prenatal cannabis exposure may undermine these abilities through multiple neurobiological pathways, with effects that become more apparent as children reach ages where self-regulation demands increase.

The age-dependent pattern, with problems emerging more clearly after age 2, has important implications for early screening. Children exposed prenatally may appear normal in infancy but develop behavioral and emotional regulation difficulties as developmental demands increase, creating a false sense of reassurance during the first years of life.

Limited number of studies meeting criteria. Small sample sizes in many studies. Lack of control for maternal psychopathology in most studies. Cannabis exposure poorly quantified in many studies. Cannot fully separate cannabis effects from co-occurring risk factors.