{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:33:07Z","timestamp":1792153987751,"version":"4.4.0"},"reference-count":101,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UH3OD023248"],"award-info":[{"award-number":["UH3OD023248"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK076648"],"award-info":[{"award-number":["R01DK076648"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01ES022934"],"award-info":[{"award-number":["R01ES022934"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R00ES028711"],"award-info":[{"award-number":["R00ES028711"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR003167"],"award-info":[{"award-number":["UL1TR003167"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Prenatal exposure to cannabis may influence childhood cognition and behavior, but the epidemiologic evidence is mixed. Even less is known about the potential impact of secondhand exposure to cannabis during early childhood. Objective: This study sought to assess whether prenatal and\/or postnatal exposure to cannabis was associated with childhood cognition and behavior. Study design: This sub-study included a convenience sample of 81 mother\u2013child pairs from a Colorado-based cohort. Seven common cannabinoids (including delta 9-tetrahydrocannabinol (\u03949-THC) and cannabidiol (CBD)) and their metabolites were measured in maternal urine collected mid-gestation and child urine collected at age 5 years. Prenatal and postnatal exposure to cannabis was dichotomized as exposed (detection of any cannabinoid) and not exposed. Generalized linear models examined the associations between prenatal or postnatal exposure to cannabis with the NIH Toolbox and Child Behavior Checklist T-scores at age 5 years. Results: In this study, 7% (n = 6) of the children had prenatal exposure to cannabis and 12% (n = 10) had postnatal exposure to cannabis, with two children experiencing this exposure at both time points. The most common cannabinoid detected in pregnancy was \u03949-THC, whereas the most common cannabinoid detected in childhood was CBD. Postnatal exposure to cannabis was associated with more aggressive behavior (\u03b2: 3.2; 95% CI: 0.5, 5.9), attention deficit\/hyperactivity problems (\u03b2: 8.0; 95% CI: 2.2, 13.7), and oppositional\/defiant behaviors (\u03b2: 3.2; 95% CI: 0.2, 6.3), as well as less cognitive flexibility (\u03b2: \u221215.6; 95% CI: \u221230.0, \u22121.2) and weaker receptive language (\u03b2: \u22129.7; 95% CI: \u221219.2, \u22120.3). By contrast, prenatal exposure to cannabis was associated with fewer internalizing behaviors (mean difference: \u221210.2; 95% CI: \u221220.3, \u22120.2) and fewer somatic complaints (mean difference: \u22125.2, 95% CI: \u22129.8, \u22120.6). Conclusions: Our study suggests that postnatal exposure to cannabis is associated with more behavioral and cognitive problems among 5-year-old children, independent of prenatal and postnatal exposure to tobacco. The potential risks of cannabis use (including smoking and vaping) during pregnancy and around young children should be more widely communicated to parents.<\/jats:p>","DOI":"10.3390\/ijerph20064880","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T02:30:33Z","timestamp":1678415433000},"page":"4880","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Associations between Prenatal and Postnatal Exposure to Cannabis with Cognition and Behavior at Age 5 Years: The Healthy Start Study"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1084-3349","authenticated-orcid":false,"given":"Brianna F.","family":"Moore","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences, Health Science Center, The University of Texas, Austin, TX 78712, USA"},{"name":"Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA"},{"name":"Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaytlyn A.","family":"Salmons","sequence":"additional","affiliation":[{"name":"Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80521, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne T.","family":"Hoyt","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavioral Science, Health Science Center, The University of Texas, Austin, TX 78712, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karli S.","family":"Swenson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Sauder","sequence":"additional","affiliation":[{"name":"Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA"},{"name":"Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison L. B.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA"},{"name":"Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Wilkening","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory L.","family":"Kinney","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas M.","family":"Neophytou","sequence":"additional","affiliation":[{"name":"Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80521, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8095-612X","authenticated-orcid":false,"given":"Cristina","family":"Sempio","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jost","family":"Klawitter","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Christians","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Dabelea","sequence":"additional","affiliation":[{"name":"Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO 80045, USA"},{"name":"Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA"},{"name":"Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2770","DOI":"10.1111\/add.15472","article-title":"Trends in cannabis use among adults with children in the home in the United States, 2004\u20132017: Impact of state-level legalization for recreational and medical use","volume":"116","author":"Goodwin","year":"2021","journal-title":"Addiction"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1001\/jama.2019.7982","article-title":"Self-reported Medical and Nonmedical Cannabis Use Among Pregnant Women in the United States","volume":"322","author":"Volkow","year":"2019","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/ADM.0000000000000581","article-title":"Validity of Self-reported Cannabis Use Among Pregnant Females in Northern California","volume":"14","author":"Sarovar","year":"2020","journal-title":"J. Addict. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/AOG.0000000000003028","article-title":"Prenatal Marijuana Use by Self-Report and Umbilical Cord Sampling in a State with Marijuana Legalization","volume":"133","author":"Metz","year":"2019","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.4278\/ajhp.141215-QUAL-625","article-title":"Perinatal Illicit Drug and Marijuana Use","volume":"31","author":"Chang","year":"2017","journal-title":"Am. J. Health Promot."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1038\/pr.2016.261","article-title":"Detecting biomarkers of secondhand marijuana smoke in young children","volume":"81","author":"Wilson","year":"2017","journal-title":"Pediatr. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1038\/s41390-020-0958-7","article-title":"Secondhand marijuana exposure in a convenience sample of young children in New York City","volume":"89","author":"Sangmo","year":"2021","journal-title":"Pediatr. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/0892-0362(95)00006-D","article-title":"Prenatal alcohol, marijuana, and tobacco use: Infant mental and motor development","volume":"17","author":"Richardson","year":"1995","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/0892-0362(94)90114-7","article-title":"Effect of prenatal marijuana exposure on the cognitive development of offspring at age three","volume":"16","author":"Day","year":"1994","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/CHI.0b013e318160b3f0","article-title":"Prenatal marijuana exposure and intelligence test performance at age 6","volume":"47","author":"Goldschmidt","year":"2008","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.ntt.2009.08.004","article-title":"Continued effects of prenatal cocaine use: Preschool development","volume":"31","author":"Richardson","year":"2009","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0892-0362(99)00046-X","article-title":"Visuoperceptual functioning differs in 9- to 12-year olds prenatally exposed to cigarettes and marihuana","volume":"22","author":"Fried","year":"2000","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.ntt.2011.02.013","article-title":"Early adolescent executive functioning, intrauterine exposures and own drug use","volume":"33","author":"Soenksen","year":"2011","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.ntt.2004.04.004","article-title":"Effects of prenatal marijuana on response inhibition: An fMRI study of young adults","volume":"26","author":"Smith","year":"2004","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.ntt.2004.06.007","article-title":"Four-year language outcomes of children exposed to cocaine in utero","volume":"26","author":"Lewis","year":"2004","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0892-0362(03)00029-1","article-title":"Differential effects on cognitive functioning in 13- to 16-year-olds prenatally exposed to cigarettes and marihuana","volume":"25","author":"Fried","year":"2003","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S0892-0362(02)00193-9","article-title":"Prenatal alcohol and marijuana exposure: Effects on neuropsychological outcomes at 10 years","volume":"24","author":"Richardson","year":"2002","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.infbeh.2005.03.002","article-title":"Prenatal cocaine exposure and infant cognition","volume":"28","author":"Singer","year":"2005","journal-title":"Infant Behav. Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jpeds.2008.01.001","article-title":"Prenatal cocaine exposure: Drug and environmental effects at 9 years","volume":"153","author":"Singer","year":"2008","journal-title":"J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ntt.2004.04.003","article-title":"Prenatal marijuana and alcohol exposure and academic achievement at age 10","volume":"26","author":"Goldschmidt","year":"2004","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ntt.2011.08.009","article-title":"School achievement in 14-year-old youths prenatally exposed to marijuana","volume":"34","author":"Goldschmidt","year":"2012","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1001\/jamapsychiatry.2020.2902","article-title":"Associations Between Prenatal Cannabis Exposure and Childhood Outcomes: Results from the ABCD Study","volume":"78","author":"Paul","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/0892-0362(88)90032-3","article-title":"12- and 24-month neurobehavioural follow-up of children prenatally exposed to marihuana, cigarettes and alcohol","volume":"10","author":"Fried","year":"1988","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S0892-0362(97)00091-3","article-title":"Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana","volume":"20","author":"Fried","year":"1998","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.ntt.2010.06.004","article-title":"Effects of prenatal tobacco, alcohol and marijuana exposure on processing speed, visual-motor coordination, and interhemispheric transfer","volume":"32","author":"Willford","year":"2010","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_26","first-page":"49","article-title":"36- and 48-month neurobehavioral follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol","volume":"11","author":"Fried","year":"1990","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/17450128.2011.648967","article-title":"Intrauterine substance exposures and Wechsler Individual Achievement Test-II scores at 11 years of age","volume":"7","author":"Augustyn","year":"2012","journal-title":"Vulnerable Child. Youth Stud."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0163-6383(99)80002-2","article-title":"Neonatal Visual Information Processing in Cocaine-Exposed and Non-Exposed Infants","volume":"22","author":"Singer","year":"1999","journal-title":"Infant Behav. Dev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1001\/jama.287.15.1952","article-title":"Cognitive and motor outcomes of cocaine-exposed infants","volume":"287","author":"Singer","year":"2002","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/j.1530-0277.2003.tb04401.x","article-title":"Executive functioning in preschool-age children prenatally exposed to alcohol, cocaine, and marijuana","volume":"27","author":"Noland","year":"2003","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ntt.2007.12.006","article-title":"The effects of prenatal cocaine use on infant development","volume":"30","author":"Richardson","year":"2008","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_32","first-page":"120","article-title":"Five-year follow-up of rural Jamaican children whose mothers used marijuana during pregnancy","volume":"40","author":"Hayes","year":"1991","journal-title":"West Indian Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/0892-0362(91)90047-Z","article-title":"Prenatal exposure to cannabis: A preliminary report of postnatal consequences in school-age children","volume":"13","author":"Fried","year":"1991","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_34","first-page":"383","article-title":"60- and 72-month follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol: Cognitive and language assessment","volume":"13","author":"Fried","year":"1992","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1207\/S15326942DN2401_05","article-title":"Prenatal cocaine\/polydrug exposure and infant performance on an executive functioning task","volume":"24","author":"Noland","year":"2003","journal-title":"Dev. Neuropsychol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ntt.2004.09.003","article-title":"Level of prenatal cocaine exposure and 48-month IQ: Importance of preschool enrichment","volume":"27","author":"Frank","year":"2005","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.ntt.2005.02.001","article-title":"Prenatal drug exposure and selective attention in preschoolers","volume":"27","author":"Noland","year":"2005","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1093\/jpepsy\/jsj028","article-title":"Prenatal cocaine exposure and children\u2019s language functioning at 6 and 9.5 years: Moderating effects of child age, birthweight, and gender","volume":"31","author":"Beeghly","year":"2006","journal-title":"J. Pediatr. Psychol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1207\/s15326942dn3003_8","article-title":"Learning disabilities and intellectual functioning in school-aged children with prenatal cocaine exposure","volume":"30","author":"Morrow","year":"2006","journal-title":"Dev. Neuropsychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/09297040600888753","article-title":"Visuospatial working memory in school-aged children exposed in utero to cocaine","volume":"13","author":"Mayes","year":"2007","journal-title":"Child Neuropsychol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1037\/0012-1649.44.4.919","article-title":"Children\u2019s cognitive ability from 4 to 9 years old as a function of prenatal cocaine exposure, environmental risk, and maternal verbal intelligence","volume":"44","author":"Bennett","year":"2008","journal-title":"Dev. Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ntt.2010.07.004","article-title":"The effects of prenatal cocaine exposure and gender on inhibitory control and attention","volume":"33","author":"Carmody","year":"2011","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S0892-0362(97)00015-9","article-title":"Reading and language in 9- to 12-year olds prenatally exposed to cigarettes and marijuana","volume":"19","author":"Fried","year":"1997","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ntt.2004.10.006","article-title":"School performance of children with gestational cocaine exposure","volume":"27","author":"Hurt","year":"2005","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.ntt.2009.08.002","article-title":"Children with and without gestational cocaine exposure: A neurocognitive systems analysis","volume":"31","author":"Hurt","year":"2009","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ntt.2010.06.006","article-title":"The effects of prenatal cocaine on language development at 10 years of age","volume":"33","author":"Lewis","year":"2011","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ntt.2010.07.006","article-title":"The effects of prenatal marijuana exposure on delinquent behaviors are mediated by measures of neurocognitive functioning","volume":"33","author":"Day","year":"2011","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.ntt.2005.12.008","article-title":"Effects of prenatal marijuana on visuospatial working memory: An fMRI study in young adults","volume":"28","author":"Smith","year":"2006","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ntt.2015.03.002","article-title":"Effects of prenatal cocaine exposure on adolescent development","volume":"49","author":"Richardson","year":"2015","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ntt.2016.05.010","article-title":"Prenatal marijuana exposure impacts executive functioning into young adulthood: An fMRI study","volume":"58","author":"Smith","year":"2016","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/AOG.0000000000004632","article-title":"Prenatal Nicotine or Cannabis Exposure and Offspring Neurobehavioral Outcomes","volume":"139","author":"Smid","year":"2022","journal-title":"Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.drugalcdep.2011.03.004","article-title":"Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls","volume":"118","author":"Hudziak","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ntt.2018.09.003","article-title":"Prenatal tobacco and marijuana co-use: Impact on newborn neurobehavior","volume":"70","author":"Stroud","year":"2018","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0892-0362(92)90036-A","article-title":"A follow-up study of attentional behavior in 6-year-old children exposed prenatally to marihuana, cigarettes, and alcohol","volume":"14","author":"Fried","year":"1992","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S0892-0362(00)00066-0","article-title":"Effects of prenatal marijuana exposure on child behavior problems at age 10","volume":"22","author":"Goldschmidt","year":"2000","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.ntt.2005.03.010","article-title":"Prenatal marijuana exposure: Effect on child depressive symptoms at ten years of age","volume":"27","author":"Gray","year":"2005","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/01.chi.0000184930.18552.4d","article-title":"Predictors and correlates of high levels of depression and anxiety symptoms among children at age 10","volume":"45","author":"Leech","year":"2006","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ntt.2018.07.003","article-title":"Co-use of tobacco and marijuana during pregnancy: Pathways to externalizing behavior problems in early childhood","volume":"69","author":"Godleski","year":"2018","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.jaac.2010.12.004","article-title":"Prenatal alcohol exposure is associated with conduct disorder in adolescence: Findings from a birth cohort","volume":"50","author":"Larkby","year":"2011","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0892-0362(98)00042-7","article-title":"Prenatal substance exposure: Effects on attention and impulsivity of 6-year-olds","volume":"21","author":"Leech","year":"1999","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0163-6383(89)90006-4","article-title":"The effect of prenatal alcohol, marijuana, and tobacco exposure on neonatal behavior","volume":"12","author":"Richardson","year":"1989","journal-title":"Infant Behav. Dev."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.jpeds.2006.08.046","article-title":"Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period","volume":"149","author":"Guinsburg","year":"2006","journal-title":"J. Pediatr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"101348","DOI":"10.1016\/j.appdev.2021.101348","article-title":"Behavioral and Cognitive Differences in Early Childhood related to Prenatal Marijuana Exposure","volume":"77","author":"Murnan","year":"2021","journal-title":"J. Appl. Dev. Psychol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3019","DOI":"10.1017\/S0033291720005061","article-title":"Prenatal choline, cannabis, and infection, and their association with offspring development of attention and social problems through 4 years of age","volume":"52","author":"Hunter","year":"2021","journal-title":"Psychol. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"107089","DOI":"10.1016\/j.ntt.2022.107089","article-title":"Prenatal cannabis exposure predicts attention problems, without changes on fMRI in adolescents","volume":"91","author":"Cioffredi","year":"2022","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"5064","DOI":"10.1007\/s10803-021-05339-4","article-title":"Peri-Pregnancy Cannabis Use and Autism Spectrum Disorder in the Offspring: Findings from the Study to Explore Early Development","volume":"52","author":"DiGuiseppi","year":"2022","journal-title":"J. Autism Dev. Disord."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.drugalcdep.2017.11.038","article-title":"Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences","volume":"185","author":"Eiden","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Wade, N.E., McCabe, C.J., Wallace, A.L., Gonzalez, M.R., Hoh, E., Infante, M.A., Mejia, M.H., and Haist, F. (2022). Clouding Up Cognition? Secondhand Cannabis and Tobacco Exposure Related to Cognitive Functioning in Youth. Biol. Psychiatry Glob. Open Sci., in press.","DOI":"10.1016\/j.bpsgos.2022.01.010"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/pr.2013.204","article-title":"Preterm birth-associated neurodevelopmental impairment estimates at regional and global levels for 2010","volume":"74","author":"Blencowe","year":"2013","journal-title":"Pediatr. Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1093\/ije\/dyaa252","article-title":"Educational note: Addressing special cases of bias that frequently occur in perinatal epidemiology","volume":"50","author":"Neophytou","year":"2021","journal-title":"Int. J. Epidemiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1093\/aje\/kwr230","article-title":"On the Pitfalls of Adjusting for Gestational Age at Birth","volume":"174","author":"Wilcox","year":"2011","journal-title":"Am. J. Epidemiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/FTD.0000000000000427","article-title":"An Atmospheric Pressure Chemical Ionization MS\/MS Assay Using Online Extraction for the Analysis of 11 Cannabinoids and Metabolites in Human Plasma and Urine","volume":"39","author":"Klawitter","year":"2017","journal-title":"Ther. Drug Monit."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1212\/WNL.0b013e3182872ded","article-title":"Cognition assessment using the NIH Toolbox","volume":"80","author":"Weintraub","year":"2013","journal-title":"Neurology"},{"key":"ref_74","first-page":"169","article-title":"Executive Function in Preschool Children: Test-Retest Reliability","volume":"12","author":"Beck","year":"2011","journal-title":"J. Cogn. Dev. Off. J. Cogn. Dev. Soc."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1017\/S1355617715000351","article-title":"Demographically Corrected Normative Standards for the English Version of the NIH Toolbox Cognition Battery","volume":"21","author":"Casaletto","year":"2015","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_76","unstructured":"Achenbach, T.M., and Rescorla, L.A. (2000). Manual for the ASEBA Preschool Forms and Profiles, University of Vermont, Research Center for Children, Youth, & Families."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2795","DOI":"10.1158\/1055-9965.EPI-10-0497","article-title":"Urine cotinine underestimates exposure to the tobacco-derived lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in passive compared with active smokers","volume":"19","author":"Benowitz","year":"2010","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/j.1369-1600.2007.00074.x","article-title":"Perinatal exposure to delta-9-tetrahydrocannabinol causes enduring cognitive deficits associated with alteration of cortical gene expression and neurotransmission in rats","volume":"12","author":"Campolongo","year":"2007","journal-title":"Addict. Biol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1038\/sj.bjp.0707442","article-title":"The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin","volume":"153","author":"Pertwee","year":"2008","journal-title":"Br. J. Pharmacol."},{"key":"ref_80","first-page":"451","article-title":"Identifying critical windows of exposure for children\u2019s health","volume":"108","author":"Selevan","year":"2000","journal-title":"Environ. Health Perspect."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S0140-6736(10)62226-X","article-title":"Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: A systematic review of observational studies","volume":"377","author":"Fleming","year":"2011","journal-title":"Lancet"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.tics.2015.07.008","article-title":"Adolescence as a Sensitive Period of Brain Development","volume":"19","author":"Fuhrmann","year":"2015","journal-title":"Trends Cogn. Sci."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF02246436","article-title":"Behavioural consequences of maternal exposure to natural cannabinoids in rats","volume":"122","author":"Navarro","year":"1995","journal-title":"Psychopharmacology"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s00213-008-1162-3","article-title":"Effects of perinatal exposure to delta-9-tetrahydrocannabinol on the emotional reactivity of the offspring: A longitudinal behavioral study in Wistar rats","volume":"198","author":"Trezza","year":"2008","journal-title":"Psychopharmacology"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/jnr.25136","article-title":"Impact of prenatal cannabis exposure on functional connectivity of the salience network in children","volume":"101","author":"Faraj","year":"2023","journal-title":"J. Neurosci. Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"816","DOI":"10.3389\/fpsyg.2020.00816","article-title":"Totality of the Evidence Suggests Prenatal Cannabis Exposure Does Not Lead to Cognitive Impairments: A Systematic and Critical Review","volume":"11","author":"Torres","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1002\/bdr2.1766","article-title":"Update on the developmental consequences of cannabis use during pregnancy and lactation","volume":"112","author":"Grant","year":"2020","journal-title":"Birth Defects Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/ppe.12505","article-title":"Effects of prenatal marijuana exposure on neuropsychological outcomes in children aged 1\u201311 years: A systematic review","volume":"32","author":"Sharapova","year":"2018","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.biopsych.2016.01.004","article-title":"Changes in Cannabis Potency Over the Last 2 Decades (1995\u20132014): Analysis of Current Data in the United States","volume":"79","author":"ElSohly","year":"2016","journal-title":"Biol. Psychiatry"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.drugalcdep.2017.03.025","article-title":"Marijuana and tobacco co-use among a nationally representative sample of US pregnant and non-pregnant women: 2005\u20132014 National Survey on Drug Use and Health findings","volume":"177","author":"Schauer","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"629716","DOI":"10.1155\/2013\/629716","article-title":"Developmental Effects of Exposures to Environmental Factors: The Polish Mother and Child Cohort Study","volume":"2013","author":"Polanska","year":"2013","journal-title":"BioMed Res. Int."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ntt.2014.06.003","article-title":"Prenatal tobacco exposure and response inhibition in school-aged children: An event-related potential study","volume":"44","author":"Boucher","year":"2014","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"den Haan, P.J., de Kroon, M.L.A., van Dokkum, N.H., Kerstjens, J.M., Reijneveld, S.A., and Bos, A.F. (2019). Risk factors for emotional and behavioral problems in moderately-late preterms. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216468"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1007\/s10995-011-0766-0","article-title":"Long-term effects of prenatal cigarette smoke exposure on behavior dysregulation among 14-year-old offspring of teenage mothers","volume":"16","author":"Cornelius","year":"2012","journal-title":"Matern. Child Health J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1017\/S2040174416000039","article-title":"Prenatal smoking and childhood behavior problems: Is the association mediated by birth weight?","volume":"7","author":"Parker","year":"2016","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1007\/s00787-014-0651-7","article-title":"The association between prenatal environment and children\u2019s mental health trajectories from 2 to 14 years","volume":"24","author":"Tearne","year":"2015","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1001\/jamapsychiatry.2013.127","article-title":"Maternal smoking during pregnancy and offspring conduct problems: Evidence from 3 independent genetically sensitive research designs","volume":"70","author":"Gaysina","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jpsychires.2018.02.020","article-title":"Pregnancy risk factors in relation to oppositional-defiant and conduct disorder symptoms in the Avon Longitudinal Study of Parents and Children","volume":"101","author":"Ruisch","year":"2018","journal-title":"J. Psychiatr. Res."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1136\/jech.2003.008466","article-title":"Bias","volume":"58","author":"Llorca","year":"2004","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1002\/cbdv.200790152","article-title":"Human cannabinoid pharmacokinetics","volume":"4","author":"Huestis","year":"2007","journal-title":"Chem. Biodivers."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.drugalcdep.2018.11.028","article-title":"Beliefs and attitudes regarding prenatal marijuana use: Perspectives of pregnant women who report use","volume":"196","author":"Chang","year":"2019","journal-title":"Drug Alcohol Depend."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4880\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:51:46Z","timestamp":1760122306000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4880"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,10]]},"references-count":101,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20064880"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20064880","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,10]]}}}