Contextualized Effects of Maternal Cannabis During Pregnancy on Childhood Alcohol Sipping in the Adolescent Brain Cognitive Development Project

Background and Aims: Prenatal cannabis exposure (PCE) has been associated with early cannabis initiation, continued use, and escalation of use; however, little is known about the association between PCE and alcohol experimentation. The current study (1) examined links between PCE, familial/maternal confounding factors via a propensity score for PCE, and childhood alcohol sipping behavior and (2) examined the mediating relationship between PCE, externalizing and internalizing behaviors, and alcohol sipping. Methods: A total of 11,878 children were included from the Adolescent Brain Cognitive Development (ABCD) study sample. Based on parent or caregiver report, 697 children were included within the PCE group. A propensity score approach was utilized to account for familial and environmental confounders. Childhood behavioral outcomes and alcohol sipping behavior were evaluated using a series of logistic regression models where models first examined the effects of PCE in isolation and after accounting for confounders. Results: Prior to accounting for familial and environmental confounders, mothers reporting of cannabis use during pregnancy was nominally associated with a 36% increase in risk for alcohol sipping in children (OR = 1.36 (SE = .15), 95% CI [1.01,1.85]). However, after accounting for confounders using propensity scores, the prior indicated effect was in fact inflated and PCE was not associated with alcohol sipping. Mediation analysis suggested that the association between PCE and propensity of PCE with alcohol sipping are mediated by externalizing behaviors, but not internalizing behaviors. Conclusions: PCE effects on adolescent alcohol sipping are indirect and are confounded with maternal behaviors before and during pregnancy.Keywords: prenatal cannabis exposure, alcohol sipping, externalizing, substance experimentation, development, propensity score