This is a prospective study of the pregnancy outcome of 564 women who represented the spectrum of prenatal marijuana use. Women were interviewed at prenatal months 4 and 7, and with their offspring, at delivery, 8, and 18 months, 3, 6, and 10 years. The cohort is a general population sample of low income women and their children; half are Caucasian and half African-American. At each of these eight time points, we have measured demographic status, the psychological, social, and household environment, maternal and paternal substance use, and the substance use of the male partner in the household. We determined the children's cognitive, behavioral, academic, and physical status. At age 10, we also evaluated the child's pubertal and neuropsychological development, mood, delinquent behavior, their substance use, and the substance abuse of their peers. We have identified significant effects of prenatal marijuana exposure on the development of the central nervous system of the offspring. Changes in EEG-sleep, behavior, mood, cognitive, and neuropsychological development have been found. At birth and 3 years, we found abnormalities on the sleep-EEG. Deficits in cognitive development, short-term memory, verbal, and quantitative reasoning have been documented at 3, 6, and 10 years. Exposed offspring were also rated as more active and less attentive at these ages. At age 10, prenatal exposure predicted poorer performance by the child on the neuropsychological evaluation, measures of reading comprehension, and on the teachers' evaluations of school performance and attendance. In addition, at age 10, the exposed children rated themselves as more depressed and anxious. At 10 years of age, the offspring have begun to experiment with substance use and to exhibit other problem behaviors. Prenatally exposed children reported higher rates of theft, property damage, violence, and status offenses, after controlling for risk factors in the environment. They had more peers who used alcohol, tobacco, and marijuana. Offspring who were exposed prenatally and who were exposed to higher levels of substance use in the household reported significantly more delinquent behavior than children who had only one or none of these exposures. At the proposed follow-up, the children will be 14 years old. We will determine the effects of prenatal exposure and the combined effects of exposure and the environment on CNS development. At this age, we will also evaluate the factors that predict the initiation and patterns of substance use among these children. This cohort, which has been well-characterized since the fourth month of gestation, provides a unique opportunity to study the risk factors associated with the adolescents' substance use, in addition to assessing the long-term effects of prenatal marijuana use.
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