E Danielle Sims,1–3 Sama Anvari,1,2,4,* Yung Lee,1,2,4,* Zainab Samaan,5 Laura Banfield,6 Lehana Thabane,1,7–10 M Constantine Samaan1–4,7



1Department of Pediatrics, McMaster University, Hamilton, ON, Canada; 2Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada; 3Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada; 4Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada; 5Department of Psychiatry and Neurobehavioral Sciences, McMaster University, Hamilton, ON, Canada; 6Health Sciences Library, McMaster University, Hamilton, ON, Canada; 7Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 8Department of Anesthesia, McMaster University, Hamilton, ON, Canada; 9Centre for Evaluation of Medicines, Hamilton, ON, Canada; 10Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, ON, Canada



*These authors contributed equally to this work



Purpose: Several countries are legalizing the use of medicinal cannabis and easing restrictions on its recreational use. While adults have been the primary target of these initiatives, expanding access to cannabis will likely lead to increased use by children. While the effects of cannabis on pediatric neuropsychological and mental health outcomes have been broadly studied, there are limited data on the physical health effects of cannabis, including endocrine health. Animal studies have shown that chronic cannabis use leads to delayed sexual maturation; however, its effects on pubertal outcomes in children are not well studied. This systematic review aimed to assess the effect of cannabis use on pubertal timing and tempo in children.

Methods: We conducted a systematic review with literature searches in MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central, PsycINFO, CINAHL, Web of Science, and SPORTDiscus from inception to February 2018. A gray literature search was also completed in Clinicaltrials.gov and ProQuest Dissertations and Theses A&I. The primary outcome was pubertal timing, while secondary outcomes included pubertal tempo and final height and weight. We had no restrictions on date or language of publication of papers. Two reviewers independently assessed records for eligibility, with a third reviewer resolving disagreements.

Results: Our database and gray literature searches identified 759 records. A total of 29 full-text papers were assessed for eligibility. However, all studies were ultimately excluded as they did not meet the eligibility criteria.

Conclusion: Our results highlight a significant gap in existing literature regarding the effects of cannabis use on puberty. Adequately powered longitudinal studies are urgently needed to provide pediatricians and other health care providers with high-quality information on the potential effects of cannabis on the physical health of children.

Prospective Registrar of Systematic Reviews Registration: PROSPERO no.: CRD42018089397.



Keywords: marijuana, puberty, children, pediatric, tetrahydrocannabinol, cannabis

