Prenatal Cannabis Exposure and Executive Function and Aggressive Behavior at Age 5 Years
In this month's Reading Between the Lines, we reviewed a recent article published by Keim et al., titled "Prenatal Cannabis Exposure and Executive Function and Aggressive Behavior at Age 5 Years." The authors report that children exposed to cannabis during pregnancy exhibited lower executive function and increased aggression at age five. While the topic is critical and timely, both our epidemiologist and EMPOWER moms have important insights about the strengths, limitations, and real-world implications of this study.
What was the study design?
The study used a cohort of about 250 pregnant people recruited from Ohio State University’s Wexner Medical Center to assess whether prenatal cannabis exposure is linked to children’s behavior at age five. Findings showed an association between prenatal cannabis exposure and higher aggression and lower executive function in some domains.
What do you think about the findings?
Epidemiologist’s View
The study employed an ambidirectional cohort design with sound statistical methods. However, key limitations reduce the reliability of its conclusions. There was likely misclassification of both cannabis exposure (measured only once) and the child outcomes (assessed on a single day), which weakens the ability to establish a true relationship.
EMPOWER Moms’ View
While the findings suggest potential risks, they do not establish that cannabis use during pregnancy causes these developmental issues. Contextual factors such as parenting strengths, family dynamics, and social support are important variables that were absent from this study.
Who Does This Study Represent?
Epidemiologist’s View
The sample was drawn from a large academic medical center serving a diverse regional population. However, generalizability is limited, especially for populations outside non-Hispanic Black and White communities, as other racial and ethnic groups were underrepresented.
EMPOWER Moms’ View
The participants didn’t authentically reflect people who use cannabis during pregnancy. It also lacked information on dosage, frequency, or timing of cannabis use—key details that make a difference in understanding potential effects.
Was measurement of the exposure and outcome appropriate?
Epidemiologist’s View
The study is prone to bias due to one-time measurements of both exposure and outcome. This snapshot approach overlooks the variability of cannabis use and child behavior over time. There are also concerns about relying on lab-based measures that may not reflect children's typical behavior.
EMPOWER Moms’ View
The study misses perspectives from caregivers and the broader environment of the children. Children's behavior is shaped by many factors — home life, parenting style, stress, trauma, and even how comfortable they feel in a lab setting. One mom commented, “This gives me crack baby era vibes,” referring to past flawed research that stigmatized families without considering structural and social factors. "The "Crack Baby" narrative was built on racist, unproven science that has since been debunked and discredited. What we now know is that the real harm came not from prenatal substance use alone, but from the criminalization, family separation, and systemic oppression that followed. That era fueled lasting harm that we are still working to undo today.”
A Balanced View: Recognizing Both Strengths and Limitations
While the EMPOWER moms and our epidemiologist raised serious concerns about how this study could be misinterpreted or weaponized, it is also important to recognize aspects of the study that are meaningful and worth building upon.
First, the study addresses a genuinely important question. With prenatal cannabis use on the rise, understanding potential effects on child development is a reasonable and necessary area of research. The authors should be credited for focusing on a topic that has real-world relevance.
Additionally, caregiver reports and laboratory-based assessments of child behavior were used in this study. Using more than one method, even if imperfect, shows an attempt to capture complex behavioral outcomes from different perspectives. The inclusion of a more racially and socioeconomically diverse sample than many similar studies is another positive step. While the sample lacked broader racial and ethnic representation, it did include a substantial proportion of Black and low-income participants—groups often underrepresented in child development research.
The epidemiologist also noted that the study design—a prospective cohort—is generally stronger than retrospective or cross-sectional designs when trying to understand the timing of events (in this case, cannabis use during pregnancy and later child behavior). The authors further applied rigorous statistical methods and tried to adjust for confounding factors, including exposure to other substances.
Importantly, the researchers were transparent about many of the study's limitations. They acknowledged concerns about misclassification, measurement error, and generalizability, leaving the door open for more careful and inclusive future research. Furthermore, the researchers used outdated studies to support their findings versus providing any new evidence that cannabis use during pregnancy affects children’s behavior.
Despite these strengths, both the epidemiologist and EMPOWER moms agree that the findings must be interpreted cautiously. Without including lived/living experience, exploring resilience, or fully contextualizing cannabis use during pregnancy, this type of research risks perpetuating stigma and missing opportunities to truly support families.
How Could This Study Affect Families?
Epidemiologist’s View
Using this study to influence policy or clinical guidelines could increase stigma and punitive practices toward pregnant individuals who use cannabis. Punishment rather than support may discourage people from seeking prenatal care, worsening outcomes for both parents and children.
EMPOWER Moms’ View
For many of us, this study triggers fears about surveillance, child welfare involvement, and discrimination — particularly for Black and low-income parents. One mom shared, “Articles like this lead to more testing of women... It grinds my gears.” Many agreed that research like this often reinforces stigma and fails to promote supportive or harm reduction-focused policies.
Does It Reflect Lived/Living Experience?
EMPOWER Moms’ View
The study felt disconnected from our experiences. It ignores resilience, like supportive parenting and community strength, which many families demonstrate despite hardships. A mom summed it up: “It doesn’t show us what helps kids thrive — it just looks for deficits.”
What Should Researchers Do Next?
Epidemiologist’s Recommendations
Measure cannabis use multiple times across pregnancy.
Use repeated child assessments over time.
Involve people with lived/living experience in designing future studies.
EMPOWER Moms’ Suggestions
Research what helps families thrive.
Focus on harm reduction and strengths, not just risks.
Be cautious about how research might be used to justify harmful policies.
Final Thoughts
At EMPOWER, we believe research can and should help improve health without increasing fear or stigma. Studies on substance use during pregnancy must ask the right questions, include the voices of people with lived and living experiences, and recognize the complexity of parenting in today’s world.
Empower Project Partner Authors
Nichole Nidey, Arielle Estes, Michelle Gabbard
