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Balalian AA, Graeve R, Richter M, Fink A, Kielstein H, Martins SS, Philbin MM, Factor-Litvak P. Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review. Front Pediatr 2023; 11:1071889. [PMID: 36896405 PMCID: PMC9989202 DOI: 10.3389/fped.2023.1071889] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Aim This systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies. Methods We searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using "Covidence" systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type of neurodevelopmental outcome and the instrument used to assess neurodevelopment. Results Data were extracted from 79 studies. We found significant heterogeneity between studies due to their use of different instruments to explore cognitive skills, motor, and behavioral outcomes among children of different ages. The other sources of heterogeneity included: procedures to assess prenatal exposure to opioids; period of pregnancy in which exposure was assessed; type of opioids assessed (non-medical, medication used for opioid use dis-order, prescribed by health professional), types of co-exposure; source of selection of prenatally exposed study participants and comparison groups; and methods to address lack of comparability between exposed and unexposed groups. Cognitive and motor skills as well as behavior were generally negatively affected by prenatal opioid exposure, but the significant heterogeneity precluded a meta-analysis. Conclusion We explored sources of heterogeneity in the studies assessing the association between prenatal exposure to opioids and neurodevelopmental outcomes. Sources of heterogeneity included different approaches to participant recruitment as well as exposure and outcome ascertainment methods. Nonetheless, overall negative trends were observed between prenatal opioid exposure and neuro-developmental outcomes.
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Affiliation(s)
- Arin A Balalian
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Richard Graeve
- Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Richter
- Social Determinants of Health Group, Department of Sport and Health Sciences, Technical University of Munich (TUM), Germany
| | - Astrid Fink
- Department of Health and Consumer Protection, Kreis Groß-Gerau, Groß-Gerau, Germany
| | - Heike Kielstein
- Institut für Anatomie und Zellbiologie, Martin-Luther-Universität Halle, Halle (Saale), Germany
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Wen X, Lawal OD, Belviso N, Matson KL, Wang S, Quilliam BJ, Meador KJ. Association Between Prenatal Opioid Exposure and Neurodevelopmental Outcomes in Early Childhood: A Retrospective Cohort Study. Drug Saf 2021; 44:863-875. [PMID: 34100263 DOI: 10.1007/s40264-021-01080-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Several studies have reported increasing prevalence of prescription opioid use among pregnant women. However, little is known regarding the effects of maternal opioid use on neurodevelopmental disorders in early childhood in pregnant women with no evidence of opioid use disorders or drug dependence. OBJECTIVE The aim of this study was to quantify the association between prenatal opioid exposure from maternal prescription use and neurodevelopmental outcomes in early childhood. METHODS This retrospective study included pregnant women aged 12-55 years and their live-birth infants born from 2010 to 2012 present in Optum's deidentified Clinformatics® Data Mart database. Eligible infants born to mothers without opioid use disorders or drug dependence were followed till occurrence of neurodevelopmental disorders, loss to follow-up, or study end (December 31, 2017), whichever came first. Propensity score by fine stratification was applied to adjust for confounding by demographic characteristics, obstetric characteristics, maternal comorbid mental and pain conditions, and measures of burden of illnesses and to obtain adjusted hazard ratios (HR) and 95% confidence intervals (CI). Exposed and unexposed infants were compared on the incidence of neurodevelopmental disorders. RESULTS Of 24,910 newborns, 7.6% (1899) were prenatally exposed to prescription opioids. Overall, 1562 children were diagnosed with neurodevelopmental disorders, with crude incidence rates of 2.9 per 100 person-years in exposed children versus 2.5 per 100 person-years in unexposed children. After adjustment, we observed no association between fetal opioid exposure and the risk of neurodevelopmental disorders (HR 1.10; 95% CI 0.92-1.32). However, increased risk of neurodevelopmental disorders were observed in children with longer cumulative exposure duration (HR 1.70; 95% CI 1.05-2.96) or high cumulative opioid doses (HR 1.22; 95% CI 1.01-1.54). CONCLUSION AND RELEVANCE In pregnant women without opioid use disorders or drug dependence, maternal opioid use was not associated with increased risk of neurodevelopmental disorders in early childhood. However, increased risks of early neurodevelopmental disorders were observed in children born to women receiving prescription opioids for longer duration and at higher doses during pregnancy.
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Affiliation(s)
- Xuerong Wen
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA.
| | - Oluwadolapo D Lawal
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Nicholas Belviso
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Kelly L Matson
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Shuang Wang
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Brian J Quilliam
- College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, California, CA, USA
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Robbins LS, Perez WM, Casey BM, Blanchard CT, Tita AT, Harper LM. Intrapartum opioid analgesia and childhood neurodevelopmental outcomes among infants born preterm. Am J Obstet Gynecol MFM 2021; 3:100372. [PMID: 33831589 DOI: 10.1016/j.ajogmf.2021.100372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are concerns regarding neurobehavioral changes in infants exposed to parenteral opioids during labor; however, long-term neurodevelopment remains unstudied. OBJECTIVE We aimed to examine the association between parenteral opioids used as labor analgesia and perinatal outcomes and childhood neurodevelopment until 2 years of age among infants born prematurely. We hypothesized that intrapartum exposure to parenteral opioids is associated with impaired neurodevelopment and adverse perinatal outcomes. STUDY DESIGN This was a secondary analysis of a multicenter, randomized controlled trial assessing magnesium for the prevention of cerebral palsy in infants at risk for preterm birth. Women delivering a singleton, nonanomalous, live infant before 37 weeks' gestation were considered for inclusion. Women were excluded if they had missing exposure or primary outcome data, were exposed to general anesthesia, or reported use of heroin or unspecified illicit drugs. Women reporting use of nonopioid illicit drugs such as cocaine and marijuana were not excluded. Groups were compared based on exposure or nonexposure to parenteral opioids (intravenous or intramuscular) used as labor analgesia. The primary outcome was any psychomotor or mental developmental delay at 24 months according to the Bayley Scales of Infant Development II. Secondary outcomes were the Bayley Scales of Infant Development II subdomains and adverse perinatal outcomes. Multivariable logistic regression models were performed and adjusted odds ratios with 95% confidence intervals were estimated. RESULTS Of the 1404 women included, 535 (38%) received parenteral opioids as labor analgesia. Women receiving parenteral opioids were more likely to be younger, Hispanic, and present with cervical dilation ≥4 cm. Parenteral opioid recipients had lower rates of illicit nonopioid drug or tobacco use, a lower rate of cesarean delivery, lower educational level and were less likely to be undergoing induction. Women receiving parenteral opioids who underwent cesarean delivery were less likely to do so because of a nonreassuring fetal status. In the unadjusted and adjusted analyses, there were no significant differences in the primary outcomes of psychomotor or mental developmental delay at 2 years of age (adjusted odds ratio, 0.96; confidence interval, 0.76-1.20). The only significant difference in secondary outcomes was a shorter O2 requirement duration in the parenteral opioid group (2 vs 4 days; P=.002). CONCLUSION Among a population of preterm infants vulnerable to neurologic impairment, intrapartum exposure to parenteral opioids was not associated with an increased risk for neurodevelopmental delay up to 2 years of age, nor did these infants have worse perinatal outcomes.
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Affiliation(s)
- Lindsay S Robbins
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper).
| | - William M Perez
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
| | - Brian M Casey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper)
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
| | - Lorie M Harper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
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Kim HM, Bone RM, McNeill B, Lee SJ, Gillon G, Woodward LJ. Preschool Language Development of Children Born to Women with an Opioid Use Disorder. CHILDREN-BASEL 2021; 8:children8040268. [PMID: 33807265 PMCID: PMC8066299 DOI: 10.3390/children8040268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/15/2022]
Abstract
Increasing evidence suggests that prenatal exposure to opioids may affect brain development, but limited data exist on the effects of opioid-exposure on preschool language development. Our study aimed to characterize the nature and prevalence of language problems in children prenatally exposed to opioids, and the factors that support or hinder language acquisition. A sample of 100 children born to pregnant women in methadone maintenance treatment and 110 randomly identified non-exposed children were studied from birth to age 4.5 years. At 4.5 years, 89 opioid-exposed and 103 non-exposed children completed the preschool version of the Clinical Evaluation of Language Fundamentals (CELF-P) as part of a comprehensive neurodevelopmental assessment. Children prenatally exposed to opioids had poorer receptive and expressive language outcomes at age 4.5 years compared to non-opioid exposed children. After adjustment for child sex, maternal education, other pregnancy substance use, maternal pregnancy nutrition and prenatal depression, opioid exposure remained a significant independent predictor of children’s total CELF-P language score. Examination of a range of potential intervening factors showed that a composite measure of the quality of parenting and home environment at age 18 months and early childhood education participation at 4.5 years were important positive mediators.
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Affiliation(s)
- Hyun Min Kim
- School of Health Sciences, University of Canterbury, Christchurch 8041, New Zealand; (R.M.B.); (S.J.L.); (L.J.W.)
- Child Well-Being Research Institute, University of Canterbury, Christchurch 8041, New Zealand; (B.M.); (G.G.)
- Correspondence:
| | - Reisha M. Bone
- School of Health Sciences, University of Canterbury, Christchurch 8041, New Zealand; (R.M.B.); (S.J.L.); (L.J.W.)
| | - Brigid McNeill
- Child Well-Being Research Institute, University of Canterbury, Christchurch 8041, New Zealand; (B.M.); (G.G.)
- School of Teacher Education, University of Canterbury, Christchurch 8041, New Zealand
| | - Samantha J. Lee
- School of Health Sciences, University of Canterbury, Christchurch 8041, New Zealand; (R.M.B.); (S.J.L.); (L.J.W.)
- Child Well-Being Research Institute, University of Canterbury, Christchurch 8041, New Zealand; (B.M.); (G.G.)
| | - Gail Gillon
- Child Well-Being Research Institute, University of Canterbury, Christchurch 8041, New Zealand; (B.M.); (G.G.)
| | - Lianne J. Woodward
- School of Health Sciences, University of Canterbury, Christchurch 8041, New Zealand; (R.M.B.); (S.J.L.); (L.J.W.)
- Child Well-Being Research Institute, University of Canterbury, Christchurch 8041, New Zealand; (B.M.); (G.G.)
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