Prenatal Tobacco and Alcohol Exposure and Cortical Change among Youths

Abstract

Importance: The associations of prenatal alcohol exposure (PAE) and prenatal tobacco exposure (PTE) with adolescent neuroanatomical development are typically evaluated cross-sectionally. It is unclear whether observed effects persist throughout life or reflect different developmental trajectories. Objective: To examine whether PAE and PTE are associated with early-adolescent cortical structure and development. Design, Setting, and Participants: This cohort study included children aged 9 to 12 years who participated in the Adolescent Brain Cognitive Development (ABCD) Study's first 2 neuroimaging time points (data collected 2016-2021) at 21 US study sites. Data analysis was conducted from March 2024 to March 2025. Exposures: PAE and PTE, based on caregiver reports of alcohol and tobacco use during pregnancy, both before and after pregnancy recognition. Main Outcomes and Measures: Cortical thickness (in millimeters) and cortical surface area (in millimeters squared) measured approximately 2 years apart, across 68 bilateral cortical regions. Summary scores from the Behavioral Inhibition and Behavioral Activation Scale, the Child Behavior Checklist, the Sleep Disturbances Scale for Children, and the Urgency, Perseverance, Premeditation, and Sensation Seeking Scale were collected. Results: At baseline data collection, the 5417 youth participants (2912 [53.8%] assigned male at birth; 724 [13.4%] Black, 1048 [19.3%] Hispanic, and 3640 [67.2%] White) had a mean (SD) age of 9.9 (0.6) years; the mean (SD) age at the second appointment was 11.9 (0.6) years. Cortical thickness decreased with age. Cortical surface area either expanded or contracted with age, depending on region. PAE was not associated with cortical structure (main correlation) or development (PAE × age interaction). PTE had false discovery rate-corrected main correlations with cortical thickness in the bilateral parahippocampal and left lateral orbitofrontal cortices (eg, right parahippocampal: |rp| = 0.04; P