Prenatal opioid exposure is linked to effects well into the elementary years

  • JAMA Netw Open

  • International Clinical Digest
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Takeaway

  • Prenatal opioid exposure is linked to increased risk for fetal growth restriction, preterm birth, ADHD, attenuated physiological development, and conduct disorder/emotional disturbance in childhood.

Why this matters

  • Editorial says risks are not only confined to the opioid but also include “difficult social and environmental circumstances,” and urges focus on interventions rather than tracking down etiology.

Key results

  • Neonatal abstinence syndrome rates increased during the study period, from 24 per 1000 hospital births in 2004, to 60.9 per 1000 in 2008, to >32 per 1000 through 2016. 
  • With opioid exposure, risks increased for (ORs; 95% CIs):
    • Fetal growth restriction: 1.87 (1.41-2.47);
    • Preterm birth: 1.49 (1.19-1.86);
    • Delayed/slowed/absent physiological development: 1.80 (1.17-2.79);
    • Conduct disorder/emotional disturbance at preschool age: 2.13 (1.20-3.77); and
    • ADHD at school age: 2.55 (1.42-4.57).
  • Women with self-reported opioid use had higher likelihood of diabetes (OR, 1.64; 95% CI, 1.19-2.26) and lower BMI (OR, 0.60; 95% CI, 0.47-0.75) compared with those who reported no such use.

Study design

  • Data from the Boston Birth Cohort (begun in 1998) for 8509 mother-child pairs (454 children with prenatal opioid exposure), with 3153 assessed postnatally. 
  • Funding: NIH.

Limitations

  • Self-reported opioid exposure; exposure type (illicit, therapeutic) not specified.
  • Confounding possible, generalizability across demographics not known.