Evaluating Household Income and Tobacco Exposure as Moderators of the Association Between Prenatal Cannabis Exposure and Newborn Neurobehavior

Prevalence rates for substance exposure during pregnancy are increasing, with cannabis emerging as one of the most common substances used. Infants with prenatal cannabis exposure face a greater risk of neurobehavioral vulnerabilities. The current study sought to examine the association between prenatal cannabis exposure and newborn neurobehavior, while also considering potential moderators (i.e., tobacco exposure and household income). The study included 115 pregnant individuals and their newborns enrolled in the Atlanta African American Maternal-Child cohort. Researchers quantitatively measured biomarkers of cannabis (COOH-THC) and tobacco smoke (COT) in urine samples collected at enrollment. Self-reported substance use was also collected during the first trimester of pregnancy. Newborn neurobehavior was assessed at 1 month of age (M = 25.3 days' old, SD = 14.41) using the NICU Network Neurobehavioral Scale. There were no significant main effects of self-reported prenatal cannabis use or prenatal COOH-THC concentrations on newborn neurobehavior. Additionally, tobacco exposure did not moderate these associations. Significant interactions were found between household income and prenatal COOH-THC levels in predicting newborn attention and arousal. Specifically, cannabis-exposed newborns exhibited attenuated attention and heightened arousal if they were from low-income households. Our findings highlight the potential role that socioeconomic factors may play in influencing behavior associated with prenatal exposures.