Evidence on the effect of in-utero cannabis exposure in neonates

The global prevalence of cannabis use during pregnancy is increasing, driven by perceived therapeutic benefits and greater societal acceptance. Concurrently, the psychoactive potency of cannabis products has risen significantly, due to increase in concentrations of Tetrahydrocannabinol (THC) from 5% to 30%. THC crosses the placenta, disrupts the endocannabinoid system critical for neurodevelopment, and accumulates in fetal tissues. THC is transferred into breast milk, with breastfed infants receiving ~2.5% of the maternal dose, raising concerns regarding neurodevelopmental consequences. An increasing number of studies and metanalysis have demonstrated association of prenatal cannabis exposure with low birth weight, preterm birth, neonatal intensive care unit admission, and reduced Apgar scores. Longitudinal studies show brain alterations in offspring, affecting memory, attention, and executive function. The inability to conduct randomized controlled trials due to ethical constraints necessitates reliance on observational studies, underscoring the need for rigorous longitudinal research to delineate causality.