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Fong J, Lewis J, Lam M, Kesavan K. Developmental Outcomes after Opioid Exposure in the Fetus and Neonate. Neoreviews 2024; 25:e325-e337. [PMID: 38821910 DOI: 10.1542/neo.25-6-e325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/05/2023] [Accepted: 12/06/2023] [Indexed: 06/02/2024]
Abstract
The overall prevalence of opiate use has been increasing, currently affecting approximately 0.6% of the global population and resulting in a significant proportion of infants being born with prenatal opioid exposure. Animal and human models of prenatal opioid exposure demonstrate detrimental effects on brain anatomy as well as neurodevelopment. Less is known about the neurologic sequelae of postnatal opioid exposure in hospitalized infants. In this review, we summarize our current understanding of the impact of prenatal and postnatal opioid exposure on the brain and on neurodevelopment outcomes. We also identify resources and management strategies that may help mitigate neurodevelopmental delays and deficits associated with opioid exposure in this vulnerable population.
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Affiliation(s)
- Jeanette Fong
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Juanita Lewis
- Department of Pediatrics, Olive View UCLA Medical Center, Sylmar, CA
| | - Melanie Lam
- Department of Pediatrics, University of California, Los Angeles, CA
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Pinchman EV, Lende MN, Feustel P, Lynch T. Evaluating the Association between Prenatal Care Visits and Adverse Perinatal Outcome in Pregnancies Complicated by Opioid Use Disorder. Am J Perinatol 2024; 41:e2225-e2229. [PMID: 37286184 DOI: 10.1055/a-2107-1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between number of prenatal care visits and adverse perinatal outcome among pregnant individuals with opioid use disorder (OUD). STUDY DESIGN This is a retrospective cohort of singleton, nonanomalous pregnancies complicated by OUD that delivered from January 2015 to July 2020 at our academic medical center. Primary outcome was the presence of composite adverse perinatal outcome, defined as one or more of the following: stillbirth, placental abruption, perinatal death, neonatal respiratory distress syndrome, need for morphine treatment, and hyperbilirubinemia. Logistic and linear regression estimated the association between the number of prenatal care visits and the presence of adverse perinatal outcome. A Mann-Whitney U test evaluated the association between number of prenatal care visits and length of hospital stay for the neonate. RESULTS A total of 185 patients were identified, of which 35 neonates required morphine treatment for neonatal opioid withdrawal syndrome. During pregnancy, most individuals were treated with buprenorphine 107 (57.8%), whereas 64 (34.6%) received methadone, 13 (7.0%) received no treatment, and 1 (0.5%) received naltrexone. The median number of prenatal care visits was 8 (interquartile range: 4-10). With each additional visit per 10 weeks of gestational age, the risk of adverse perinatal outcome decreased by 38% (95% confidence interval [CI]: 0.451-0.854). The need for neonatal intensive care and hyperbilirubinemia also significantly decreased with additional prenatal visits. Neonatal hospital stay decreased by a median of 2 days (95% CI: 1-4) for individuals who received more than the median of eight prenatal care visits. CONCLUSION Pregnant individuals with OUD who attend fewer prenatal care visits experience more adverse perinatal outcome. Future research should focus on barriers to prenatal care and interventions to improve access in this high-risk population. KEY POINTS · Use of prenatal care affects newborn outcomes.. · More prenatal care shortens neonatal hospital stay.. · Prenatal care reduces certain adverse outcomes..
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Affiliation(s)
| | - Michelle N Lende
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Paul Feustel
- Department of Neuroscience, Albany Medical College, Albany, New York
| | - Tara Lynch
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
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Zhang Y, Butelman ER, Kreek MJ. Effect of prenatal and early post-natal oxycodone exposure on the reinforcing and antinociceptive effects of oxycodone in adult C57BL/6 J mice. Psychopharmacology (Berl) 2024; 241:359-377. [PMID: 38086926 DOI: 10.1007/s00213-023-06493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/25/2023] [Indexed: 01/24/2024]
Abstract
Abuse of opioids (mu-opioid agonists such as oxycodone) among parents during the gestation and early post-natal period is a concern for the long-term health of the offspring, beyond potential neonatal withdrawal symptoms. However, there is only limited information on such effects. OBJECTIVES We examined how prenatal, and early-post natal oxycodone exposure affected opioid addiction behaviors. METHODS Adult male and female C57BL/CJ mice housed separately were first injected with ascending doses of oxycodone 1 time/day (1 mg/kg × 10 days, 1.5 mg/kg × 10 days, 2 mg/kg × 10 days, s.c.) whereas control mice were injected with saline. Newly formed parental dyads were then housed together and continued to receive ascending doses of oxycodone (3 mg/kg × 10 days, 4 mg/kg × 10 days, 5 mg/kg × 10 days, 6 mg/kg × 10 days or saline, s.c.) or saline during mating and gestation until the birth of the litter. The dams continued to receive oxycodone or saline through lactation, until F1 offspring were weaned. Upon reaching adulthood (12 weeks of age), male and female F1 offspring were examined in intravenous self-administration (IVSA) of oxycodone, on oxycodone-induced conditioned place preference (CPP) and oxycodone-induced antinociception. RESULTS Adult F1 male and female offspring of parental dyads exposed to oxycodone self-administered more oxycodone, compared to offspring of control parental dyads. Ventral and dorsal striatal mRNA levels of genes such as Fkbp5 and Oprm1 were altered following oxycodone self-administration. CONCLUSION Prenatal and early post-natal oxycodone exposure enhanced oxycodone self-administration during adulthood in the C57BL/6 J mice.
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Affiliation(s)
- Yong Zhang
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, Box 171, New York, NY, 10065, USA.
| | - Eduardo R Butelman
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, Box 171, New York, NY, 10065, USA
- Neuropsychoimaging of Addictions and Related Conditions Research Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mary Jeanne Kreek
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, 1230 York Avenue, Box 171, New York, NY, 10065, USA
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Borrelli KN, Wingfield KK, Yao EJ, Zamorano CA, Sena KD, Beierle JA, Roos MA, Zhang H, Wachman EM, Bryant CD. Decreased myelin-related gene expression in the nucleus accumbens during spontaneous neonatal opioid withdrawal in the absence of long-term behavioral effects in adult outbred CFW mice. Neuropharmacology 2023; 240:109732. [PMID: 37774943 PMCID: PMC10598517 DOI: 10.1016/j.neuropharm.2023.109732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Prenatal opioid exposure is a major health concern in the United States, with the incidence of neonatal opioid withdrawal syndrome (NOWS) escalating in recent years. NOWS occurs upon cessation of in utero opioid exposure and is characterized by increased irritability, disrupted sleep patterns, high-pitched crying, and dysregulated feeding. The main pharmacological strategy for alleviating symptoms is treatment with replacement opioids. The neural mechanisms mediating NOWS and the long-term neurobehavioral effects are poorly understood. We used a third trimester-approximate model in which neonatal outbred pups (Carworth Farms White; CFW) were administered once-daily morphine (15 mg/kg, s.c.) from postnatal day (P) day 1 through P14 and were then assessed for behavioral and transcriptomic adaptations within the nucleus accumbens (NAc) on P15. We also investigated the long-term effects of perinatal morphine exposure on adult learning and reward sensitivity. We observed significant weight deficits, spontaneous thermal hyperalgesia, and altered ultrasonic vocalization (USV) profiles following repeated morphine and during spontaneous withdrawal. Transcriptome analysis of NAc from opioid-withdrawn P15 neonates via bulk mRNA sequencing identified an enrichment profile consistent with downregulation of myelin-associated transcripts. Despite the neonatal behavioral and molecular effects, there were no significant long-term effects of perinatal morphine exposure on adult spatial memory function in the Barnes Maze, emotional learning in fear conditioning, or in baseline or methamphetamine-potentiated reward sensitivity as measured via intracranial self-stimulation. Thus, the once daily third trimester-approximate exposure regimen, while inducing NOWS model traits and significant transcriptomic effects in neonates, had no significant long-term effects on adult behaviors.
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Affiliation(s)
- Kristyn N Borrelli
- Graduate Program for Neuroscience, Boston University, 610 Commonwealth Av, Boston, MA, 02215, USA; T32 Biomolecular Pharmacology PhD Program, Boston University Chobanian & Avedisian School of Medicine, USA; Boston University's Transformative Training Program in Addiction Science, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-317, Boston, MA, 02118, USA
| | - Kelly K Wingfield
- T32 Biomolecular Pharmacology PhD Program, Boston University Chobanian & Avedisian School of Medicine, USA; Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-606, Boston, MA, 02118, USA; Department of Pharmaceutical Sciences, Center for Drug Discovery, Northeastern University, 360 Huntington Av, 140 The Fenway Building, X138, Boston, MA, 02115, USA
| | - Emily J Yao
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-606, Boston, MA, 02118, USA; Department of Pharmaceutical Sciences, Center for Drug Discovery, Northeastern University, 360 Huntington Av, 140 The Fenway Building, X138, Boston, MA, 02115, USA
| | - Catalina A Zamorano
- Boston University's Undergraduate Research Opportunity Program, George Sherman Union, 775 Commonwealth Av, 5th floor, Boston, MA, 02215, USA
| | - Katherine D Sena
- Boston University's Undergraduate Research Opportunity Program, George Sherman Union, 775 Commonwealth Av, 5th floor, Boston, MA, 02215, USA
| | - Jacob A Beierle
- T32 Biomolecular Pharmacology PhD Program, Boston University Chobanian & Avedisian School of Medicine, USA; Boston University's Transformative Training Program in Addiction Science, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-317, Boston, MA, 02118, USA; Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-606, Boston, MA, 02118, USA; Department of Pharmaceutical Sciences, Center for Drug Discovery, Northeastern University, 360 Huntington Av, 140 The Fenway Building, X138, Boston, MA, 02115, USA
| | - Michelle A Roos
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-606, Boston, MA, 02118, USA; Department of Pharmaceutical Sciences, Center for Drug Discovery, Northeastern University, 360 Huntington Av, 140 The Fenway Building, X138, Boston, MA, 02115, USA
| | - Huiping Zhang
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., Boston, MA, 02118, USA
| | - Elisha M Wachman
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA, 02118, USA
| | - Camron D Bryant
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-606, Boston, MA, 02118, USA; Department of Pharmaceutical Sciences, Center for Drug Discovery, Northeastern University, 360 Huntington Av, 140 The Fenway Building, X138, Boston, MA, 02115, USA.
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Kohn BH, Cui Z, Candelaria MA, Buckingham-Howes S, Black MM, Riggins T. Early emotional caregiving environment and associations with memory performance and hippocampal volume in adolescents with prenatal drug exposure. Front Behav Neurosci 2023; 17:1238172. [PMID: 38074523 PMCID: PMC10699310 DOI: 10.3389/fnbeh.2023.1238172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/01/2023] [Indexed: 02/12/2024] Open
Abstract
Early adversities, including prenatal drug exposure (PDE) and a negative postnatal emotional caregiving environment, impact children's long-term development. The protracted developmental course of memory and its underlying neural systems offer a valuable framework for understanding the longitudinal associations of pre- and postnatal factors on children with PDE. This study longitudinally examines memory and hippocampal development in 69 parent-child dyads to investigate how the early caregiving emotional environment affects children with PDE's neural and cognitive systems. Measures of physical health, drug exposure, caregiver stress, depression, and distress were collected between 0 and 24 months At age 14 years, adolescents completed multiple measures of episodic memory, and at ages 14 and 18 years, adolescents underwent magnetic resonance imaging (MRI) scans. Latent constructs of episodic memory and the caregiving environment were created using Confirmatory Factor Analysis. Multiple regressions revealed a negative emotional caregiving environment during infancy was associated with poor memory performance and smaller left hippocampal volumes at 14 years. Better memory performance at 14 years predicted larger right hippocampal volume at 18 years. At 18 years, the association between the emotional caregiving environment and hippocampal volume was moderated by sex, such that a negative emotional caregiving environment was associated with larger left hippocampal volumes in males but not females. Findings suggest that the postnatal caregiving environment may modulate the effects of PDE across development, influencing neurocognitive development.
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Affiliation(s)
- Brooke H. Kohn
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Zehua Cui
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Margo A. Candelaria
- Institute for Innovation and Implementation, University of Maryland School of Social Work, Baltimore, MD, United States
| | | | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- RTI International, Research Triangle Part, Durham, NC, United States
| | - Tracy Riggins
- Department of Psychology, University of Maryland, College Park, MD, United States
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Searles CT, Harder HJ, Vogt ME, Murphy AZ. Perigestational Opioid Exposure Alters Alcohol-Driven Reward Behaviors in Adolescent Rats. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.14.567041. [PMID: 38014019 PMCID: PMC10680700 DOI: 10.1101/2023.11.14.567041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Every fifteen minutes, a baby is born in the U.S. experiencing neonatal opioid withdrawal syndrome (NOWS). Since 2004, the rate of NOWS has increased 7-fold. Clinical studies have established intrauterine exposure to drugs of abuse as a risk factor for adverse health outcomes in adult life, including the propensity for future illicit drug use. Despite extensive knowledge about common mechanisms of action in the neural circuitry that drives opioid and alcohol reward, there is little data on the risks that those born with NOWS face regarding alcohol use later in life. Here, we investigate the impact of perigestational opioid exposure (POE) on the mesolimbic reward system of male and female Sprague Dawley rats at postnatal and adolescent ages. Our laboratory has developed a clinically relevant model for morphine exposure spanning pre-conception to the first week of life. Using this model, we found that POE increased alcohol consumption in female rats under noncontingent conditions, and inversely, reduced alcohol consumption in both male and female rats during operant conditioning sessions. Operant responding was also reduced for sucrose, suggesting that the impact of POE on reward-seeking behaviors is not limited to drugs of abuse. Expression of µ-opioid receptors was also significantly altered in the nucleus accumbens and medial habenula, regions previously shown to play a significant role in reward/aversion circuitry. Significance Statement Early life exposure to opioids is known to alter future drug behavior in rats. In the present study, female rats exposed to morphine via their mothers throughout and after pregnancy exhibited increased alcohol consumption when allowed to consume freely. During operant conditioning, however, male and female rats exposed to gestational morphine decreased consumption of alcohol as well as sucrose. We also observed that gestational morphine exposure altered µ-opioid receptor expression in reward-related brain regions. Our study provides the first evidence of changes in alcohol-directed reward behavior in a gestational opioid exposure rat model.
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7
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Borrelli KN, Wingfield KK, Yao EJ, Zamorano CA, Sena KD, Beierle JA, Roos MA, Zhang H, Wachman EM, Bryant CD. Decreased myelin-related gene expression in the nucleus accumbens during spontaneous neonatal opioid withdrawal in the absence of long-term behavioral effects in adult outbred CFW mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.04.552033. [PMID: 37609129 PMCID: PMC10441327 DOI: 10.1101/2023.08.04.552033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Prenatal opioid exposure is a major health concern in the United States, with the incidence of neonatal opioid withdrawal syndrome (NOWS) escalating in recent years. NOWS occurs upon cessation of in utero opioid exposure and is characterized by increased irritability, disrupted sleep patterns, high-pitched crying, and dysregulated feeding. The main pharmacological strategy for alleviating symptoms is treatment with replacement opioids. The neural mechanisms mediating NOWS and the long-term neurobehavioral effects are poorly understood. We used a third trimester-approximate model in which neonatal outbred pups (Carworth Farms White; CFW) were administered once-daily morphine (15 mg/kg, s.c.) from postnatal day (P) day 1 through P14 and were then assessed for behavioral and transcriptomic adaptations within the nucleus accumbens (NAc) on P15. We also investigated the long-term effects of perinatal morphine exposure on adult learning and reward sensitivity. We observed significant weight deficits, spontaneous thermal hyperalgesia, and altered ultrasonic vocalization (USV) profiles following repeated morphine and during spontaneous withdrawal. Transcriptome analysis of NAc from opioid-withdrawn P15 neonates via bulk mRNA sequencing identified an enrichment profile consistent with downregulation of myelin-associated transcripts. Despite the neonatal behavioral and molecular effects, there were no significant long-term effects of perinatal morphine exposure on adult spatial memory function in the Barnes Maze, emotional learning in fear conditioning, or in baseline or methamphetamine-potentiated reward sensitivity as measured via intracranial self-stimulation. Thus, the once daily third trimester-approximate exposure regimen, while inducing NOWS model traits and significant transcriptomic effects in neonates, had no significant long-term effects on adult behaviors. HIGHLIGHTS We replicated some NOWS model traits via 1x-daily morphine (P1-P14).We found a downregulation of myelination genes in nucleus accumbens on P15.There were no effects on learning/memory or reward sensitivity in adults.
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Affiliation(s)
- Kristyn N. Borrelli
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
- Graduate Program for Neuroscience, Boston University, 610 Commonwealth Av, Boston, MA 02215
- Boston University’s Transformative Training Program in Addiction Science, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-317, Boston, MA 02118
| | - Kelly K. Wingfield
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
- T32 Biomolecular Pharmacology PhD Program, Boston University Chobanian and Avedisian School of Medicine
| | - Emily J. Yao
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
| | - Catalina A. Zamorano
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
- Boston University’s Undergraduate Research Opportunity Program, George Sherman Union, 775 Commonwealth Av, 5 floor, Boston, MA 02215
| | - Katherine D. Sena
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
- Boston University’s Undergraduate Research Opportunity Program, George Sherman Union, 775 Commonwealth Av, 5 floor, Boston, MA 02215
| | - Jacob A. Beierle
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
- T32 Biomolecular Pharmacology PhD Program, Boston University Chobanian and Avedisian School of Medicine
- Boston University’s Transformative Training Program in Addiction Science, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St., L-317, Boston, MA 02118
| | - Michelle A. Roos
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
| | - Huiping Zhang
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., Boston, MA 02118
| | - Elisha M. Wachman
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118
| | - Camron D. Bryant
- Laboratory of Addiction Genetics, Department of Pharmacology, Physiology & Biophysics, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., L-606B, Boston, MA 02118
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, 72 E. Concord St., Boston, MA 02118
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Benninger KL, McAllister JM, Merhar SL. Neonatal Opioid Withdrawal Syndrome: An Update on Developmental Outcomes. Clin Perinatol 2023; 50:17-29. [PMID: 36868704 DOI: 10.1016/j.clp.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Infants and children with prenatal opioid exposure generally have development within the normal range; however, they seem to be at risk for behavioral problems and for lower scores on cognitive, language, and motor assessments than children without prenatal opioid exposure. It is as of yet unclear whether prenatal opioid exposure itself causes issues with development and behavior, or whether it is simply correlated, due to other confounding factors.
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Affiliation(s)
- Kristen L Benninger
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Crossroad, WB 5203, Columbus, OH 43215, USA.
| | - Jennifer M McAllister
- Cincinnati Children's Hospital Perinatal Institute, University of Cincinnati College of Medicine, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229, USA
| | - Stephanie L Merhar
- Cincinnati Children's Hospital Perinatal Institute, University of Cincinnati College of Medicine, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229, USA
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Chin EM, Kitase Y, Madurai NK, Robinson S, Jantzie LL. In utero methadone exposure permanently alters anatomical and functional connectivity: A preclinical evaluation. Front Pediatr 2023; 11:1139378. [PMID: 36911026 PMCID: PMC9995894 DOI: 10.3389/fped.2023.1139378] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
The opioid epidemic is an ongoing public health crisis, and children born following prenatal opioid exposure (POE) have increased risk of long-term cognitive and behavioral sequelae. Clinical studies have identified reduced gray matter volume and abnormal white matter microstructure in children with POE but impacts on whole-brain functional brain connectivity (FC) have not been reported. To define effects of POE on whole brain FC and white matter injury in adult animals, we performed quantitative whole-brain structural and functional MRI. We used an established rat model of POE in which we have previously reported impaired executive function in adult rats analogous to persistent neurocognitive symptoms described in humans with POE. Pregnant Sprague-Dawley rat dams received continuous methadone (12 mg/kg/day) vs. saline infusion for 28 days via osmotic mini-pumps, exposing rats to pre- and postnatal opioid until weaning. At young adult age (P60), POE and saline exposed offspring underwent in vivo MRI included diffusion tensor imaging and functional MRI (fMRI). Results indicate that fractional anisotropy (FA) was decreased in adult animals with POE [n = 11] compared to animals that received saline [n = 9] in major white matter tracts, including the corpus callosum (p < 0.001) and external capsule (p < 0.01). This change in FA was concomitant with reduced axial diffusivity in the external capsule (p < 0.01) and increased radial diffusivity in the corpus callosum (p < 0.01). fMRI analyses reveal brainwide FC was diffusely lower in POE (p < 10-6; 10% of variance explained by group). Decreased connectivity in cortical-cortical and cortico-basal ganglia circuitry was particularly prominent with large effect sizes (Glass's Δ > 1). Taken together, these data confirm POE reduces brainwide functional connectivity as well as microstructural integrity of major white matter tracts. Altered neural circuitry, dysregulated network refinement, and diffuse network dysfunction have been implicated in executive function deficits that are common in children with POE. FC may serve as a translatable biomarker in children with POE.
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Affiliation(s)
- Eric M. Chin
- Department of Neurodevelopmental Medicine, Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yuma Kitase
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nethra K. Madurai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenandoah Robinson
- Department of Neurodevelopmental Medicine, Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lauren L. Jantzie
- Department of Neurodevelopmental Medicine, Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Correspondence: Lauren L. Jantzie
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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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11
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Samarghandian S, Rajabi S, Aschner M, Noferesti V, Farkhondeh T. Oxidative stress and apoptotic index modifications in the hippocampus of rat pups born to mothers exposed to buprenorphine during lactation. Toxicol Rep 2022; 9:2050-2054. [PMID: 36518388 PMCID: PMC9742962 DOI: 10.1016/j.toxrep.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background The effect of opioids administration during lactation on nervous system has not fully understood. Objective The aim of this study was to evaluate the buprenorphine (BUP) impact on oxidative stress indexes and apoptotic gene expression in the hippocampus of neonates exposed to this drug through breastfeeding. Methods Lactating female rats were subcutaneously injected with BUP (1 or 0.5 mg/kg). After 28 days, the pups were anesthetized, then their hippocampus were obtained for measurement of oxidative stress parameters [glutathione (GSH), thiobarbituric acid reactive substances (TBARS), total antioxidant capacity (TAC) and superoxide dismutase (SOD)] and gene expression of apoptotic indices (Bcl2, Bax and caspase 3). Results This study showed that BUP (0.5 and 1 mg/kg) could not markedly change oxidative stress indices levels and apoptotic markers expression in the hippocampus of pups versus controls. Conclusion This study did not find BUP effect on the apoptosis and oxidative stress indices in the hippocampus of pups born to mothers exposed to this drug during lactation.
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Affiliation(s)
- Saeed Samarghandian
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Shahnaz Rajabi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Vahid Noferesti
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahereh Farkhondeh
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
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12
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Deoni SC, Beauchemin J, Volpe A, Dâ Sa V. The COVID-19 Pandemic and Early Child Cognitive Development: A Comparison of Development in Children Born During the Pandemic and Historical References. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.08.10.21261846. [PMID: 34401887 PMCID: PMC8366807 DOI: 10.1101/2021.08.10.21261846] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To characterize cognitive function in young children under 3 years of age over the past decade, and test whether children exhibit different cognitive development profiles through the COVID-19 pandemic. Study Design Neurocognitive data (Mullen Scales of Early Learning, MSEL) were drawn from 700 healthy and neurotypically developing children between 2011 to 2021 without reported positive tests or clinical diagnosis of SARS-CoV-2 infection. We compared MSEL composite measures (general cognition, verbal, and non-verbal development) to test if those measured during 2020 and 2021 differed significantly from historical 2011-2019 values. We also compared MSEL values in a sub-cohort comprising infants 0-16 months of age born during the pandemic vs. infants born prior. In all analyses, we also included measures of socioeconomic status, birth outcome history, and maternal stress. Results A significant decrease in mean population MSEL measures was observed in 2021 compared to historical references. Infants born during the pandemic exhibited significantly reduced verbal, non-verbal, and overall cognitive performance compared to children born pre-pandemic. Maternal stress was not found to be associated with observed declines but a higher socioeconomic status was found to be protective. Conclusions Results reveal a striking decline in cognitive performance since the onset of the COVID-19 pandemic with infants born since mid-2020 showing an average decrease of 27-37 points. Further work is merited to understand the underlying causative factors.
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13
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Konijnenberg C, Melinder A. Verbal and nonverbal memory in school-aged children born to opioid-dependent mothers. Early Hum Dev 2022; 171:105614. [PMID: 35772183 DOI: 10.1016/j.earlhumdev.2022.105614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The potential long-term developmental effects of prenatal methadone and buprenorphine exposure during pregnancy are still largely unknown. AIMS We investigated memory function in school-aged children of women enrolled in opioid maintenance therapy (OMT) during pregnancy. STUDY DESIGN Prospective longitudinal cohort study. SUBJECTS Participants included 41 children (aged 9-11 years), 20 of which had histories of prenatal methadone or buprenorphine exposure. OUTCOME MEASURES Verbal and non-verbal memory function was assessed using four subtests from the Test of Memory and Learning - Second edition (TOMAL-2). RESULTS The OMT group scored lower on both the two non-verbal as well as the two verbal memory tasks, all p-values <.05. Group differences remained for three out of the four subtests after controlling for general IQ. Including maternal tobacco use during pregnancy increased the explanatory power of the model, R2 change of 0.07, p = .04. CONCLUSIONS Children prenatally exposed to methadone or buprenorphine had significantly lower memory performance, however, this association may in part be explained by maternal tobacco use during pregnancy. Consequently, smoking cessation programs should be systematically integrated into opioid maintenance therapy programs for pregnant women.
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Affiliation(s)
- C Konijnenberg
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway; Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Oslo, Norway.
| | - A Melinder
- Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Oslo, Norway; Oslo University Hospital, Child- and Adolescents Mental Health, Oslo, Norway
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14
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Rutherford K, Maxwell J, Fry L, Holland P, Rigon A, Lankford A. Perceived Clinical Characteristics of Children With History of Opioid Exposure: A Speech-Language Pathology Perspective. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1801-1816. [PMID: 35767339 DOI: 10.1044/2022_ajslp-21-00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This research was conducted to describe the clinical characteristics of children with a history of opioid exposure as perceived by the speech-language pathologists (SLPs) treating them. METHOD Three focus groups were conducted. Participants consisted of 20 SLPs working in the schools in West Virginia who had experienced working with children with a confirmed or suspected history of opioid exposure. A thematic, qualitative analysis was conducted, whereby focus group sessions were transcribed verbatim and information was coded, organized into themes, and interpreted. RESULTS Themes of perceived clinical characteristics (speech, language, executive function, and other developmental delays) are reported to address the research question. Additionally, themes derived from the data regarding perceived significant differentiators (greater severity/needs, inconsistent performance, and atypical manifestation) and perceived confounding characteristics (safety and well-being, aspects of home environment, and effects on school environment) that are often reported in children with a history or suspected history of opioid exposure are presented. CONCLUSIONS Perceived clinical characteristics of this population, both intrinsic and situational, highlight the complex profile of this population and demonstrate the importance of considering each child from a multidimensional perspective. Additional research is needed to represent the profile of these children more completely and to identify successful supports that will improve their speech and language outcomes, educational achievement, and their overall quality of life.
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Affiliation(s)
| | | | - Lisa Fry
- Marshall University, Huntington, WV
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15
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Maxwell J, Rutherford K, Holland P, Fry L, Rigon A, Lankford A. Perceptions of Speech-Language Pathologists' Service Provision in the Opioid Epidemic: A Focus Group Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1672-1686. [PMID: 35503957 DOI: 10.1044/2022_ajslp-21-00337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This research intended to identify current practices being implemented with children who have a history or suspected history of opioid exposure, as well as challenges faced by speech-language pathologists in the schools. METHOD Focus group data from three groups totaling 20 speech-language pathologists (SLPs) working in schools in West Virginia, also used in a previous study, were analyzed using qualitative thematic analysis to better understand SLP service provision to children with a history or suspected history of opioid exposure. RESULTS Results revealed two primary themes, reported as (a) service delivery in action (current practice trends and challenges) and (b) affective/cognitive manifestations (uncertainty about their role and various emotions expressed) of the SLPs who participated in the focus groups. CONCLUSIONS This study revealed important clinical implications derived from the reports of participants. Particularly, the importance of communication and advocacy in the care of these children and the need to rethink what our scope of practice means when working with this vulnerable population are discussed.
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Affiliation(s)
| | | | | | - Lisa Fry
- Marshall University, Huntington, WV
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16
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Trifkovič KČ, Mičetić-Turk D, Kmetec S, Strauss M, Dahlen HG, Foster JP, Fijan S. Efficacy of Direct or Indirect Use of Probiotics for the Improvement of Maternal Depression during Pregnancy and in the Postnatal Period: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10060970. [PMID: 35742022 PMCID: PMC9223194 DOI: 10.3390/healthcare10060970] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/21/2022] Open
Abstract
The mother and infant form a unique bond, with maternal mental health affecting the interactions with the infant and infant behaviours impacting maternal mental health. One of the possible mechanisms influencing maternal mental health is the manipulation of the gut-brain axis by consuming probiotic supplements. Probiotics can also have an indirect influence on maternal mental health via the modulation of the infant microbiome and consequently improving the infant’s health and thus, indirectly leading to an improvement in maternal mood. This systematic review evaluated the efficacy of probiotics on maternal mental health by searching for randomised controlled trials via international databases: Cochrane Library, PubMed, Scopus, ScienceDirect, and Web of Science until January 2022. A meta-analysis was performed using the Cochrane Collaboration methodology where possible. We found seven clinical trials that included the word probiotics and addressed maternal depression and/or anxiety. Of these, five trials investigated the influence of maternal probiotic supplementation on the gut-brain axis. Two trials investigated the indirect influence of probiotics on maternal depression via supplementation of probiotics by infants and subsequent influence on the crying of colicky infants. Meta-analysis of two studies of pregnant and postnatal women and two studies of infants consuming probiotics on the outcome of the Edinburgh Postnatal Depression Scale for mothers showed no statistical difference. The findings indicate that maternal depression is very complex and is influenced by various bidirectional factors. One of the factors that can improve maternal mental health is probiotics, however, careful consideration must be given to correct strain selection as strain-specific effectiveness was observed. Further well-designed, robust clinical studies are warranted.
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Affiliation(s)
- Klavdija Čuček Trifkovič
- Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia; (K.Č.T.); (S.K.); (M.S.)
| | - Dušanka Mičetić-Turk
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia;
| | - Sergej Kmetec
- Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia; (K.Č.T.); (S.K.); (M.S.)
| | - Maja Strauss
- Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia; (K.Č.T.); (S.K.); (M.S.)
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, NSW 2751, Australia; (H.G.D.); (J.P.F.)
| | - Jann P. Foster
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, NSW 2751, Australia; (H.G.D.); (J.P.F.)
- Ingham Research Institute, Liverpool, NSW 2170, Australia
- NSW Centre for Evidence Based Health Care: A JBI Affiliated Group, Parramatta, NSW 2751, Australia
| | - Sabina Fijan
- Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia; (K.Č.T.); (S.K.); (M.S.)
- Correspondence:
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17
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Long-term effects of medication for opioid use disorder in children. JAAPA 2022; 35:1-4. [DOI: 10.1097/01.jaa.0000823148.49509.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Radhakrishnan R, Vishnubhotla RV, Zhao Y, Yan J, He B, Steinhardt N, Haas DM, Sokol GM, Sadhasivam S. Global Brain Functional Network Connectivity in Infants With Prenatal Opioid Exposure. Front Pediatr 2022; 10:847037. [PMID: 35359894 PMCID: PMC8964084 DOI: 10.3389/fped.2022.847037] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Infants with prenatal opioid and substance exposure are at higher risk of poor neurobehavioral outcomes in later childhood. Early brain imaging in infancy has the potential to identify early brain developmental alterations that may help predict behavioral outcomes in these children. In this study, using resting-state functional MRI in early infancy, we aim to identify differences in global brain network connectivity in infants with prenatal opioid and substance exposure compared to healthy control infants. METHODS AND MATERIALS In this prospective study, we recruited 23 infants with prenatal opioid exposure and 29 healthy opioid naïve infants. All subjects underwent brain resting-state functional MRI before 3 months postmenstrual age. Covariate Assisted Principal (CAP) regression was performed to identify brain networks within which functional connectivity was associated with opioid exposure after adjusting for sex and gestational age. Associations of these significant networks with maternal comorbidities were also evaluated. Additionally, graph network metrics were assessed in these CAP networks. RESULTS There were four CAP network components that were significantly different between the opioid exposed and healthy control infants. Two of these four networks were associated with maternal psychological factors. Intra-network graph metrics, namely average flow coefficient, clustering coefficient and transitivity were also significantly different in opioid exposed infants compared to healthy controls. CONCLUSION Prenatal opioid exposure is associated with alterations in global brain functional networks compared to non-opioid exposed infants, with intra-network alterations in graph network modeling. These network alterations were also associated with maternal comorbidity, especially mental health. Large-scale longitudinal studies can help in understanding the clinical implications of these early brain functional network alterations in infants with prenatal opioid exposure.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ramana V Vishnubhotla
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yi Zhao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jingwen Yan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bing He
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Nicole Steinhardt
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gregory M Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Senthilkumar Sadhasivam
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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19
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Aramjoo H, Yousefizadeh S, Aschner M, Roshanravan B, Farkhondeh T, Samarghandian S. Oxidative Stress Indices Changes in the Hearts of Rat Pups in Response to Maternal Buprenorphine Treatment during Gestation and Lactation. Cardiovasc Toxicol 2022; 22:29-34. [PMID: 34599474 DOI: 10.1007/s12012-021-09686-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
This study aimed to assess the effects of Buprenorphine (BUP) on oxidative parameters in pups born to mothers exposed to the drug during gestation and lactation. Pregnant and lactating rats received BUP, 0.5 or 0.1 mg/kg subcutaneously for 21 and 28 days, respectively. At the end of the study, the pups were anesthetized, and the hearts were dissected out to measure oxidative stress indices, including the levels of Malondialdehyde (MDA), Nitric oxide (NO), Glutathione (GSH), and the activity of Superoxide dismutase (SOD). Our findings indicated that BUP did not alter MDA, NO, GSH levels, nor SOD activity in the cardiac tissue of pups exposed to this drug during the fetal period and through breast milk. We suggest performing additional studies to determine the association between BUP and oxidative modifications in cardiac tissues of pups born to mothers under BUP therapy during gestation and lactation.
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Affiliation(s)
- Hamed Aramjoo
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Shahnaz Yousefizadeh
- Department of Laboratory and Clinical Sciences, Faculty of Para-Veterinary, Ilam University, Ilam, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, USA
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Tahereh Farkhondeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran.
| | - Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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20
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Vassoler FM, Wimmer ME. Consequences of Parental Opioid Exposure on Neurophysiology, Behavior, and Health in the Next Generations. Cold Spring Harb Perspect Med 2021; 11:a040436. [PMID: 32601130 PMCID: PMC8485740 DOI: 10.1101/cshperspect.a040436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substance abuse and the ongoing opioid epidemic represents a large societal burden. This review will consider the long-term impact of opioid exposure on future generations. Prenatal, perinatal, and preconception exposure are reviewed with discussion of both maternal and paternal influences. Opioid exposure can have long-lasting effects on reproductive function, gametogenesis, and germline epigenetic programming, which can influence embryogenesis and alter the developmental trajectory of progeny. The potential mechanisms by which preconception maternal and paternal opioid exposure produce deleterious consequences on the health, behavior, and physiology of offspring that have been identified by clinical and animal studies will be discussed. The timing, nature, dosing, and duration of prenatal opioid exposure combined with other important environmental considerations influence the extent to which these manipulations affect parents and their progeny. Epigenetic inheritance refers to the transmission of environmental insults across generations via mechanisms independent of the DNA sequence. This topic will be further explored in the context of prenatal, perinatal, and preconception opioid exposure for both the maternal and paternal lineage.
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Affiliation(s)
- Fair M Vassoler
- Tufts University, Cummings School of Veterinary Medicine, Grafton, Massachusetts 01536, USA
| | - Mathieu E Wimmer
- Department of Psychology and Program in Neuroscience, Temple University, Philadelphia, Pennsylvania 19122, USA
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21
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Lowe JR, Hund L, Rodriguez DE, Qamruddin A, Leeman L, Stephen JM, Bakhireva LN. Maternal verbal scaffolding: association with higher language skills for 20-month-old children with prenatal polysubstance exposure. Early Hum Dev 2021; 160:105423. [PMID: 34252844 PMCID: PMC9084305 DOI: 10.1016/j.earlhumdev.2021.105423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of children with prenatal polysubstance exposure is increasing. Supportive mother-child interaction is a protective factor, which can ameliorate adverse effects of prenatal polysubstance exposure on developmental outcomes. AIM To examine the role of maternal verbal scaffolding on cognitive and language development in children with prenatal polysubstance exposure. STUDY DESIGN Pregnant women were recruited, and we prospectively followed mother-child dyads to 20 months of age. This analysis included 66 dyads (33 healthy controls and 33 with prenatal polysubstance exposure). Multivariable linear regression modelling was used to examine the cross-sectional association between maternal scaffolding and Bayley Scales of Infant and Toddler Development (BSID-III) score, as well as an interaction between the study group and scaffolding score. OUTCOME MEASURES The BSID-III cognitive and language score was used. Videotaped mother-child play was coded to obtain a maternal verbal scaffolding score. Effect sizes were measured using average differences in scores between groups. RESULTS There was no evidence of an association between study group and maternal scaffolding scores. Children in the polysubstance exposure group had lower cognitive and language scores compared to controls, but this association was not statistically significant after controlling for maternal education. Maternal scaffolding was predictive of language scores, with scores increasing by 1.24 points on average (95% CI: 0.42, 2.06) for every 1-point increase in scaffolding score after adjustment for covariates. There was no evidence of a study group-by-scaffolding interaction with respect to the language or cognitive scores. CONCLUSIONS Maternal scaffolding during play was associated with language development in children with and without prenatal polysubstance exposure.
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Affiliation(s)
- Jean R. Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA,Corresponding author at: University of New Mexico/Department of Pediatrics, MSC 105590, 1 University, Albuquerque, NM 87131, USA. (J.R. Lowe)
| | - Lauren Hund
- School of Law, University of New Mexico, Albuquerque, NM, USA
| | - Dominique E. Rodriguez
- Substance Use Research and Education (SURE) Center, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | | | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA,Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Julia M. Stephen
- The Mind Research Network a division of Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Ludmila N. Bakhireva
- Substance Use Research and Education (SURE) Center, University of New Mexico College of Pharmacy, Albuquerque, NM, USA,Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA,Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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22
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Schuetze P, Godleski S, Sassaman J. Prenatal exposure to opioids: Associations between the caregiving environment and externalizing behaviors. Neurotoxicol Teratol 2021; 87:107019. [PMID: 34403741 DOI: 10.1016/j.ntt.2021.107019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
Maternal opioid use during pregnancy is a rapidly growing public health crisis and is associated with a range of adverse developmental outcomes including externalizing behaviors among exposed children. Recent work has highlighted the role of indirect pathways from prenatal opioid exposure to behavioral outcomes through aspects of the caregiving environment, including parenting. This review highlights maternal sensitivity and related aspects of the caregiving environment that may impact the development of externalizing behaviors among children with a history of prenatal exposure to opioids. We conclude by providing suggestions for future directions in research examining development among children with prenatal opioid exposure.
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Affiliation(s)
- Pamela Schuetze
- Department of Psychology, Buffalo State College, The State University of New York, USA; The Pennsylvania State University, USA.
| | | | - Jenna Sassaman
- Department of Psychology, College of Liberal Arts, The Pennsylvania State University, USA
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23
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Labella MH, Eiden RD, Tabachnick AR, Sellers T, Dozier M. Infant neurodevelopmental outcomes of prenatal opioid exposure and polysubstance use. Neurotoxicol Teratol 2021; 86:107000. [PMID: 34116198 PMCID: PMC8277730 DOI: 10.1016/j.ntt.2021.107000] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prenatal opioid exposure has been linked to adverse birth outcomes and delays in infant development. Existing literature is limited by a simple group-differences approach as well as inadequate controls for sociodemographic factors and polysubstance exposure co-occurring with prenatal opioid use. METHOD The current study assessed cumulative opioid exposure (duration of prescribed and illicit opioid use) as a predictor of infant birth outcomes and mother-reported developmental status at three and six months of age, controlling for polysubstance exposure. Participants were predominantly low-income pregnant and peripartum women, oversampled for mothers receiving medication-assisted treatment (MAT) for opioid use disorder. Prenatal opioid and non-opioid substance use were reported by mothers using a Timeline Follow-Back Interview completed during the third trimester and updated postnatally (infant age six months). RESULTS Developmental scores were in the normal range. However, total opioid exposure was positively related to premature birth and inversely related to mother-reported developmental status in specific domains. Associations with three-month fine motor skills and six-month communication skills were robust to controls for polysubstance exposure and sociodemographic covariates. CONCLUSIONS Results suggest unique effects of prenatal opioid exposure on the early development of fine motor and communication skills. Similar findings were obtained for prescribed and illicit opioid use, underscoring developmental risks of both MAT and untreated substance use. Exploratory analyses investigating type and timing of MAT suggest directions for future research.
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Affiliation(s)
- Madelyn H Labella
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States.
| | - Rina D Eiden
- Department of Psychology, Penn State University, 140 Moore Building, University Park, PA 16801, United States
| | - Alexandra R Tabachnick
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States
| | - Tabitha Sellers
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States
| | - Mary Dozier
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States
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Maternal pre- and postnatal substance use and attachment in young children: A systematic review and meta-analysis. Dev Psychopathol 2021; 34:1231-1248. [PMID: 33858537 DOI: 10.1017/s0954579421000134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Maternal substance use has often been associated with insecure and disorganized child attachment. We evaluated this association with a meta-analysis of young children and, further, systematically reviewed mediating and moderating factors between maternal substance use and child attachment. We performed a systematic database search of quantitative English language studies on child attachment that included substance-using mothers and their children below 6 years of age. Eleven studies (N = 1,841) met the inclusion criteria and were included in the meta-analysis of attachment security and seven (N = 1,589) studies were included in the meta-analysis of attachment disorganization. We found that maternal substance use was negatively associated with secure attachment in children, but the effect size was small (r = -.10). The association with disorganized attachment was not significant (r = .15). Related to moderating and mediating factors (k = 6), we found evidence on the role of teratogenic and sociological factors on child attachment. Most importantly, the impact of cumulative risks was vital. However, literature was scarce, and studies varied in risk of bias, leaving many unanswered questions on other potential factors underlying the development of attachment in these high-risk children. We discuss the results considering clinical implications and future directions.
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25
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Koren G. Prenatal Opioid Exposure and Motor Cortex Volume. JAMA Pediatr 2021; 175:428-429. [PMID: 33492343 DOI: 10.1001/jamapediatrics.2020.5317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gideon Koren
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Motherisk Israel Program, Shamir Medical Center, Zrifin, Israel
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26
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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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27
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Jaekel J, Kim HM, Lee SJ, Schwartz A, Henderson JMT, Woodward LJ. Emotional and Behavioral Trajectories of 2 to 9 Years Old Children Born to Opioid-Dependent Mothers. Res Child Adolesc Psychopathol 2021; 49:443-457. [PMID: 33433780 PMCID: PMC7943531 DOI: 10.1007/s10802-020-00766-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2020] [Indexed: 12/20/2022]
Abstract
Maternal opioid use in pregnancy has increased dramatically. Knowledge about children's longer-term emotional and behavioral development after prenatal opioid exposure is scarce. A regional sample of 89 opioid-exposed and 104 non-exposed comparison children were studied prospectively at ages 2, 4.5, and 9 years using the Strengths and Difficulties Questionnaire (SDQ) completed by primary caregivers. Across all childhood assessments, opioid-exposed children obtained significantly higher total difficulties scores than non-exposed comparison children. Growth curve modeling revealed that, relative to their same age peers, opioid-exposed children's emotional and behavioral difficulties significantly worsened over time. Moreover, fixed effects estimates showed that total difficulties trajectories were poorer for children subject to higher prenatal risk (Est = 1.78, 95% CI = [0.46, 3.09]) who were born to mothers with high levels of social adversity (1.11 [0.51, 1.71]), and were then raised in families characterized by high levels of psychosocial risk (1.94 [0.90, 2.98]) and unstable caregiving (1.91 [0.33, 3.48]). A complex set of pre- and postnatal processes contribute to opioid-exposed children's emotional and behavioral development. Efforts to mitigate the long-term consequences of opioid use in pregnancy need to consider both children's and their caregivers' biopsychosocial risks.
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Affiliation(s)
- Julia Jaekel
- Department of Child & Family Studies, University of Tennessee Knoxville, Knoxville, USA. .,Department of Psychology, University of Tennessee Knoxville, Knoxville, USA. .,Department of Psychology, University of Warwick, Coventry, UK.
| | - Hyun M Kim
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Samantha J Lee
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Ashlyn Schwartz
- Department of Public Health, University of Tennessee Knoxville, Knoxville, USA
| | | | - Lianne J Woodward
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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Macfie J, Towers CV, Fortner KB, Stuart GL, Zvara BJ, Kurdziel-Adams G, Kors SB, Noose SK, Gorrondona AM, Cohen CT. Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Addict Behav Rep 2020; 12:100315. [PMID: 33364323 PMCID: PMC7752716 DOI: 10.1016/j.abrep.2020.100315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
A professional organization does not recommend opioid detoxification in pregnancy. Medically-assisted treatment (MAT) is recommended to reduce relapse and dropout. We sampled 55 pregnant women who misused opioids who chose detoxification or MAT. There was no dropout in either group and more relapse with MAT than detoxification. Replication and follow-up are needed to assess relative rates of relapse postpartum.
The American College of Obstetricians and Gynecologists recommends medication-assisted treatment (MAT) for pregnant women who misuse opioids rather than detoxification because of possible relapse and dropout from treatment (ACOG, 2017). In a prospective study, fifty-five pregnant women with an opioid use disorder were offered a choice of MAT or detoxification. Ethical concerns precluded random assignment. We assessed dropout, treatment outcome, relapse, other illicit drug use, infant neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Of 55 women, 13 initially chose MAT and 42 women chose detoxification. All women received behavioral support. No one dropped out of treatment prior to delivery. All women who chose MAT initially remained on MAT. Of women who chose detoxification, 23% switched to MAT, 30% tapered below initial MAT doses, and 45% fully detoxified by delivery. There was a significant difference in opioid relapse between women on MAT (26%) and those who detoxified (0%), but no differences for other illicit drug use. Infants of women on MAT were more likely to have neonatal NOWS (91%) than infants of women who tapered below initial MAT doses but did not fully detoxify (62%). Infants of mothers who tapered (62%) were more likely to have NOWS than infants of women who fully detoxified (0%). Women on MAT reported significantly lower sexual abuse severity than did women who tapered or detoxified. It is critical to replicate the current findings and to follow up with mothers and their infants postpartum to ascertain the long-term impact of tapering or detoxification during pregnancy.
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Affiliation(s)
- Jenny Macfie
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Craig V Towers
- High Risk Obstetrical Consultants, Knoxville, TN, United States
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, United States
| | - Gregory L Stuart
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Bharathi J Zvara
- Gillings School of Global Public Health, University of North Carolina, United States
| | | | - Stephanie B Kors
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Samantha K Noose
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Andrea M Gorrondona
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Chloe T Cohen
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
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29
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Arter SJ, Tyler B, McAllister J, Kiel E, Güler A, Cameron Hay M. Longitudinal Outcomes of Children Exposed to Opioids In-utero: A Systematic Review. J Nurs Scholarsh 2020; 53:55-64. [PMID: 33225521 DOI: 10.1111/jnu.12609] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose was to summarize evidence of long-term outcomes of children, 2 years and older, exposed to opioids in-utero. DESIGN This was a systematic review. Studies were identified by searching the following electronic databases: PubMed, EBSCO HOST/Medline, and Web of Science. Articles were published between 1979 and 2019. METHODS This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. Two sets of two independent reviewers extracted data and assessed study quality according to National Institutes of Health quality assessment tools. RESULTS Forty-three articles met inclusion criteria. Synthesis of articles identified trends toward worse outcomes for children with in-utero opioid exposure in all areas, most notably related to academic success, behavior, cognition, hospitalizations, and vision. CONCLUSIONS Findings reinforce the necessity of continued research in this area with improved study design. Despite limitations in the current body of evidence, findings from this review are vital knowledge for clinicians, because children exposed to opioids in-utero are clearly vulnerable to a wide variety of suboptimal health and developmental outcomes. CLINICAL RELEVANCE Recognition of all outcomes across childhood associated with in-utero opioid exposure will inform improved identification and interventions tailored to the most pressing needs of affected children. Despite the need for continued research, there is sufficient evidence to necessitate close, individualized follow-up throughout childhood.
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Affiliation(s)
- Sara J Arter
- Assistant Professor, Department of Nursing, Miami University, Hamilton, OH, USA
| | - Brian Tyler
- Postdoctoral Fellow, Department of Anthropology, Miami University, Oxford, OH, USA
| | - Jennifer McAllister
- Medical Director, West Chester Hospital Special Care Nursery; Medical Director, University of Cincinnati Newborn Nursery; Medical Director, Neonatal Opioid Withdrawal Syndrome Follow-Up Clinic, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elizabeth Kiel
- Associate Professor, Department of Psychology, Miami University, Oxford, OH, USA
| | - Ayse Güler
- PhD student, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - M Cameron Hay
- Professor and Chair, Anthropology; Director, Global Health Research Innovation Center, Miami University, Oxford, OH, USA
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30
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Abstract
Prenatal opioid exposure adversely impacts upon fetal growth and places the newborn at risk of neonatal opioid withdrawal. The severity and duration of opioid withdrawal cannot be predicted in the individual baby and may be contributed to by other drugs including benzodiazepines and alcohol as well as cigarette smoking. Mitigating factors include breastfeeding, rooming in and absence of maternal polypharmacy. Less well recognised are a variety of other complications associated with prenatal opioid exposure including epigenetic changes, effects on neurophysiological function and structural alterations to the developing brain. The visual system is significantly affected, with changes to both clinical and electrophysiological function persisting at least to mid-childhood. Longer term neurodevelopmental and behavioural outcomes are confounded by multiple factors including poverty, parent-child interaction and small study numbers, but systematic reviews consistently demonstrate poorer outcomes for those children and young people prenatally exposed to opioids. Crucially, manifestation of neonatal withdrawal is not a prerequisite for important long term problems including behavioural, emotional or motor function disorder, sensory or speech disorder, strabismus and nystagmus. A body of evidence supports an independent adverse effect of prenatal opioid exposure upon fetal brain development, mediated via a systemic neuro-inflammatory process. Children prenatally exposed to opioids should remain under appropriate follow up, at least until school entry, as difficulties may only become apparent in mid-childhood. Future studies of the management of opioid use disorder in pregnancy, including maintenance methadone, must include longer term outcomes for the baby.
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Affiliation(s)
- Helen Mactier
- Princess Royal Maternity, Glasgow, UK; College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Ruth Hamilton
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Department of Clinical Physics and Bio-engineering, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
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31
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Wouldes TA, Woodward LJ. Neurobehavior of newborn infants exposed prenatally to methadone and identification of a neurobehavioral profile linked to poorer neurodevelopmental outcomes at age 24 months. PLoS One 2020; 15:e0240905. [PMID: 33064777 PMCID: PMC7567379 DOI: 10.1371/journal.pone.0240905] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
The abuse of prescription opioids and heroin by women of childbearing age over the past decade has resulted in a five-fold increase in the number of infants born opioid-dependent. Daily opioid substitution treatment with methadone is associated with less maternal illicit opioid use and improved antenatal care. However, research on the neurobehavioral effects of daily prenatal exposure to methadone on the infant is limited. Using the NICU Network Neurobehavioral Scale (NNNS), we compared the neurobehavior at birth of 86 infants born to opioid-dependent mothers receiving methadone treatment (MMT) with 103 infants unexposed to methadone. Generalized linear models, adjusted for covariates, showed methadone exposed infants had significantly poorer attention, regulation, and quality of movement. They were also significantly more excitable, more easily aroused, exhibited more non-optimal reflexes, hypertonicity, and total signs of stress abstinence. Maternal MMT was also associated with more indices of neonatal abstinence, including: CNS, visual, genitourinary (GI), and state. Latent profile analysis of the NNNS summary scores revealed four distinct neurobehavioral profiles with infants characterized by the most disturbed neurobehavior at birth having the poorest clinical outcomes at birth, and poorer cognitive and motor development at 24 months of age.
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Affiliation(s)
- Trecia A. Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lianne J. Woodward
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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32
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Rocha NACF, Dos Santos Silva FP, Dos Santos MM, Dusing SC. Impact of mother-infant interaction on development during the first year of life: A systematic review. J Child Health Care 2020; 24:365-385. [PMID: 31337225 DOI: 10.1177/1367493519864742] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this project were to systematically review the impact of mother-infant interaction on the development of infants 12 months or younger and determine factors that mediate this relationship and early development. We systematically reviewed the literature and identified 21 papers which fulfilled inclusion and exclusion criteria. The majority of the studies found significant association between mother-infant interaction and language, cognition, motor, and social development during the first year of life. Only seven studies assessed motor development and four studies found significant relationship between motor development and mother-infant interaction. Prematurity, infant age, multiples births, maternal anxiety, maternal opioid exposure, history of foster care, and criminal record were the only factors found to mediate the relationship between mother-infant interaction and social, cognitive, and language development. The quality of the interactions between a mother and infant can both positively and negatively influence cognitive, language, and social outcomes during the first year of life. Additional research is needed to determine the influence of mother-infant interaction on motor development. Future research is needed on the efficacy of interventions designed to alter mother-infant interaction with the ultimate goal of achieving positive developmental outcomes during the first year of life.
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Affiliation(s)
- Nelci Adriana Cicuto Ferreira Rocha
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos - SP, Brazil
| | - Fernanda Pereira Dos Santos Silva
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos - SP, Brazil
| | - Mariana Martins Dos Santos
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos - SP, Brazil
| | - Stacey C Dusing
- Departments of Physical Therapy and Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
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Mahic M, Hernandez-Diaz S, Wood M, Kieler H, Odsbu I, Nørgaard M, Öztürk B, Bateman BT, Hjellvik V, Skurtveit S, Handal M. In utero opioid exposure and risk of infections in childhood: A multinational Nordic cohort study. Pharmacoepidemiol Drug Saf 2020; 29:1596-1604. [PMID: 32767610 DOI: 10.1002/pds.5088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/19/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE There is an increasing number of children with in utero exposure to opioids. Knowledge about opioid safety in pregnancy, particularly for outcomes later in childhood is scarce. It has been suggested that opioids can modulate immune system and increase the risk of infections. Our goal was to study the impact of in utero opioid exposure on the immune system and the risk of infections in childhood. METHODS This population-based cohort study used nationwide registers from Denmark, Norway, and Sweden. Among pregnant women we identified users of opioids for two different indications, opioids used in opioid maintenance therapy (OMT) and opioids used for treatment of pain. We followed the exposed children and studied susceptibility for infections measured as number of antibiotic prescriptions expressed as Incidence rate ratios (IRRs) and diagnoses in specialist health care expressed as hazard ratios (HRs). RESULTS After adjustment we did not observe increased risk for filling antibiotic prescriptions in children exposed to OMT opioids compared with OMT discontinuers (IRR, 1.08; 95% CI 0.81-1.44 in Norway and Sweden, and IRR, 0.74; 95% CI 0.63-0.88 in Denmark), or for diagnosis of infection in specialist health care (HR 0.83; 95% CI 0.55-1.26 in Norway and Sweden, and 0.82; 95% CI 0.62-1.10 in Denmark). CONCLUSIONS In this population-based cohort study, we did not observe increased risk of infections among children prenatally exposed to OMT opioids when compared to OMT discontinuers, nor long-term analgesic opioids exposed when compared to short-term analgesic opioids exposed.
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Affiliation(s)
- Milada Mahic
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mollie Wood
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Laboratory Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Marte Handal
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
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Lee SJ, Bora S, Austin NC, Westerman A, Henderson JMT. Neurodevelopmental Outcomes of Children Born to Opioid-Dependent Mothers: A Systematic Review and Meta-Analysis. Acad Pediatr 2020; 20:308-318. [PMID: 31734383 DOI: 10.1016/j.acap.2019.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children born to opioid-dependent mothers are at risk of adverse neurodevelopment. The magnitude of this risk remains inconclusive. OBJECTIVE To conduct a meta-analysis of studies that assessed neurodevelopmental outcomes of children aged 0 to 12 years born to opioid-dependent mothers, compared with children born to nonopioid-dependent mothers, across general cognitive, language, motor, and social-emotional domains. DATA SOURCES PubMed, CINAHL, PsycINFO, and Google Scholar databases. STUDY ELIGIBILITY CRITERIA English-language publications between January 1993 and November 2018, including prenatally opioid-exposed and nonopioid-exposed comparison children, reporting outcomes data on standardized assessments. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers independently extracted data. Pooled standardized mean differences (SMDs) were analyzed using random effects models. Risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale. RESULTS Across 16 studies, individual domain outcomes data were examined for between 93 to 430 opioid-exposed and 75 to 505 nonopioid-exposed infants/children. Opioid-exposed infants and children performed more poorly than their nonopioid-exposed peers across all outcomes examined, demonstrated by lower infant cognitive (SMD = 0.77) and psychomotor scores (SMD = 0.52), lower general cognition/IQ (SMD = 0.76) and language scores (SMD = 0.65-0.74), and higher parent-rated internalizing (SMD = 0.42), externalizing (SMD = 0.66), and attention problems (SMD = 0.72). LIMITATIONS Most studies examined early neurodevelopment; only 3 reported school-age outcomes thereby limiting the ability to assess longer-term impacts of prenatal opioid exposures. CONCLUSIONS AND IMPLICATIONS OF FINDINGS Children born to opioid-dependent mothers are at modest- to high-risk of adverse neurodevelopment at least to middle childhood. Future studies should identify specific clinical and social factors underlying these challenges to improve outcomes.
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Affiliation(s)
- Samantha J Lee
- School of Psychology, Speech and Hearing, University of Canterbury (SJ Lee, A Westerman, and JMT Henderson), Christchurch 8140, New Zealand
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland (S Bora), South Brisbane, Queensland 4101, Australia
| | - Nicola C Austin
- Department of Paediatrics, University of Otago (NC Austin), Christchurch, New Zealand
| | - Anneliese Westerman
- School of Psychology, Speech and Hearing, University of Canterbury (SJ Lee, A Westerman, and JMT Henderson), Christchurch 8140, New Zealand
| | - Jacqueline M T Henderson
- School of Psychology, Speech and Hearing, University of Canterbury (SJ Lee, A Westerman, and JMT Henderson), Christchurch 8140, New Zealand.
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35
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MacMillan KDL. Neonatal Abstinence Syndrome: Review of Epidemiology, Care Models, and Current Understanding of Outcomes. Clin Perinatol 2019; 46:817-832. [PMID: 31653310 DOI: 10.1016/j.clp.2019.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence of neonatal abstinence syndrome owing to prenatal opioid exposure has grown rapidly in recent decades and it disproportionately affects rural, non-white, and public insurance-dependent populations. Treatment consists of pharmacologic and nonpharmacologic interventions with wide variability in approaches across the United States. Standardizing clinical assessment, minimizing unnecessary interruptions, and prioritizing nonpharmacologic and family-centered care seems to improve hospital outcomes. Neonatal abstinence syndrome may have long-term developmental and biological effects, but understanding is limited owing in part confounding biosocial factors. Early intervention and longitudinal support of the infant and family promote better outcomes.
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Affiliation(s)
- Kathryn Dee Lizcano MacMillan
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital for Children, Good Samaritan Medical Center, 55 Fruit Street, Founders 5-530, Boston, MA 02114, USA; Division of Pediatric Hospital Medicine, Massachusetts General Hospital for Children, Good Samaritan Medical Center, 55 Fruit Street, Founders 5-530, Boston, MA 02114, USA.
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Meulewaeter F, De Pauw SSW, Vanderplasschen W. Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective. Front Psychiatry 2019; 10:728. [PMID: 31681040 PMCID: PMC6813727 DOI: 10.3389/fpsyt.2019.00728] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/11/2019] [Indexed: 01/23/2023] Open
Abstract
Background: A growing body of research underlines that interpersonal trauma in childhood leads to heightened susceptibility for substance use disorders (SUDs) in later life. Little research has been conducted on parenting experiences of mothers in recovery from substance use, taking into account their own upbringing as a child and the potential aftermath of interpersonal childhood trauma. Methods: Through in-depth qualitative interviews, 23 mothers with SUDs reflected on parenting experiences and parent-child bonding, related to both their children and parents. Interviews were transcribed verbatim and data were analyzed adopting thematic analysis. Results: Throughout the narratives, consequences of trauma on mothers' sense of self and its subsequent impact on parenting arose as salient themes. Five latent mechanisms of intergenerational trauma transmission were identified: 1) early interpersonal childhood trauma experiences in mothers; 2) trauma as a precursor of substance use; 3) substance use as a (self-fooling) enabler of parental functioning; 4) continued substance use impacting parental functioning; and 5) dysfunctional parental functioning and its relational impact upon offspring. Discussion: Findings suggest disruptive attachment can increase the vulnerability for SUDs on the one hand, but can be an expression of underlying trauma on the other, hence serving as a covert mechanism by which trauma can be transmitted across generations. Results indicate the need for preventive, attachment-based and trauma-sensitive interventions targeted at disruptive intergenerational patterns.
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Conradt E, Flannery T, Aschner JL, Annett RD, Croen LA, Duarte CS, Friedman AM, Guille C, Hedderson MM, Hofheimer JA, Jones MR, Ladd-Acosta C, McGrath M, Moreland A, Neiderhiser JM, Nguyen RH, Posner J, Ross JL, Savitz DA, Ondersma SJ, Lester BM. Prenatal Opioid Exposure: Neurodevelopmental Consequences and Future Research Priorities. Pediatrics 2019; 144:peds.2019-0128. [PMID: 31462446 PMCID: PMC6759228 DOI: 10.1542/peds.2019-0128] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 01/14/2023] Open
Abstract
Neonatal opioid withdrawal syndrome (NOWS) has risen in prevalence from 1.2 per 1000 births in 2000 to 5.8 per 1000 births in 2012. Symptoms in neonates may include high-pitched cry, tremors, feeding difficulty, hypertonia, watery stools, and breathing problems. However, little is known about the neurodevelopmental consequences of prenatal opioid exposure in infancy, early childhood, and middle childhood. Even less is known about the cognitive, behavioral, and academic outcomes of children who develop NOWS. We review the state of the literature on the neurodevelopmental consequences of prenatal opioid exposure with a particular focus on studies in which NOWS outcomes were examined. Aiming to reduce the incidence of prenatal opioid exposure in the near future, we highlight the need for large studies with prospectively recruited participants and longitudinal designs, taking into account confounding factors such as socioeconomic status, institutional variations in care, and maternal use of other substances, to independently assess the full impact of NOWS. As a more immediate solution, we provide an agenda for future research that leverages the National Institutes of Health Environmental Influences on Child Health Outcomes program to address many of the serious methodologic gaps in the literature, and we answer key questions regarding the short- and long-term neurodevelopmental health of children with prenatal opioid exposure.
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Affiliation(s)
- Elisabeth Conradt
- Departments of Psychology, Pediatrics, and Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah;
| | | | - Judy L. Aschner
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York;,Department of Pediatrics, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, New Jersey
| | - Robert D. Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente, Oakland, California
| | - Cristiane S. Duarte
- New York State Psychiatric Institute,,Department of Psychiatry, Columbia University, New York, New York
| | - Alexander M. Friedman
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | | | | | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Christine Ladd-Acosta
- Department of Epidemiology and,Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Angela Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Columbia, South Carolina
| | - Jenae M. Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
| | - Ruby H.N. Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan Posner
- Department of Psychiatry, Columbia University, New York, New York
| | - Judith L. Ross
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
| | | | - Steven J. Ondersma
- Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk and Departments of Psychiatry and Human Behavior and Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island;,Women and Infants Hospital in Rhode Island, Providence, Rhode Island
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Skurtveit S, Nechanská B, Handal M, Mahic M, Mravčík V, Gabrhelík R. Hospitalization of children after prenatal exposure to opioid maintenance therapy during pregnancy: a national registry study from the Czech Republic. Addiction 2019; 114:1225-1235. [PMID: 30725515 PMCID: PMC6899595 DOI: 10.1111/add.14576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/17/2018] [Accepted: 01/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Our understanding of the long-term safety of prenatal exposure to opioid maintenance treatment (OMT) is insufficient. We compared childhood morbidity (0-3 years) between OMT-exposed and relevant comparison groups. DESIGN Nation-wide, registry-based cohort study. Registries on reproductive health, addiction treatment, hospitalization and death were linked using identification numbers. SETTING The Czech Republic (2000-14). PARTICIPANTS Children with different prenatal exposure: (i) mother in OMT during pregnancy (OMT; n = 218), (ii) mother discontinued OMT before pregnancy (OMT-D; n = 55), (iii) mother with opioid use disorder, but not in OMT during pregnancy (OUD; n = 85) and (iv) mother in the general population (GP) (n = 1 238 452) MEASUREMENTS: Episodes of hospitalization were observed as outcomes. Information on in-patient contacts, length of stay and diagnoses (International Classification of Diseases version 10) were assessed. Binary logistic regressions were conducted to estimate the associations between OMT exposure and the outcomes, crude and adjusted for the socio-economic status and smoking. FINDINGS No significant differences were found in the overall proportion of hospitalization among OMT-exposed children, children of OMT-D and children of women with OUD [54.1%, 95% confidence interval (CI) = 47.3-60.1%; 47.3%, 95% CI = 33.9-61.1%; 51.8%, 95% CI = 40.7%-62.6%], while the proportion was significantly lower (35.8%, 95% CI = 35.7-35.8%) in the GP. There were no significant differences in risk of specific diagnoses between OMT-exposed children, children of OMT-D and children of women with OUD. In the adjusted analyses, differences between OMT-exposed and children in the GP were still present for infections and parasitic diseases (OR = 2.0, 95% CI = 1.4-2.7), diseases of the digestive system (OR = 1.7, 95% CI = 1.2-2.6) and diseases of the skin and subcutaneous tissue (OR = 1.9, 95% CI = 1.2-3.2). CONCLUSION This study did not find clear evidence for an increase in risk of morbidity during the first 3 years of life in children with prenatal opioid maintenance treatment exposure compared with children of women who discontinued such treatment before pregnancy or suffered from opioid use disorder without this treatment. Compared the general population, there appears to be an increased risk of hospitalizations for infectious, gastrointestinal and skin diseases.
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Affiliation(s)
- Svetlana Skurtveit
- Norwegian institute of Public HealthOsloNorway,Norwegian Centre for Addiction Research at the University of OsloNorway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of MedicineCharles UniversityCzech Republic,Institute of Health Information and Statistics of theCzech Republic
| | | | | | - Viktor Mravčík
- Department of Addictology, First Faculty of MedicineCharles UniversityCzech Republic,National Monitoring Centre for Drugs and AddictionPragueCzech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of MedicineCharles UniversityCzech Republic
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Azuine RE, Ji Y, Chang HY, Kim Y, Ji H, DiBari J, Hong X, Wang G, Singh GK, Pearson C, Zuckerman B, Surkan PJ, Wang X. Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated With Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population. JAMA Netw Open 2019; 2:e196405. [PMID: 31251378 PMCID: PMC6604084 DOI: 10.1001/jamanetworkopen.2019.6405] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE The opioid epidemic increasingly affects pregnant women and developing fetuses, resulting in high rates of neonatal abstinence syndrome. However, longitudinal studies that prospectively observe newborns with neonatal abstinence syndrome or with maternal opioid use and examine their long-term physical and neurodevelopmental outcomes are lacking. OBJECTIVE To examine prenatal risk factors associated with maternal opioid use during pregnancy and the short-term and long-term health consequences on their children. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the Boston Birth Cohort, an urban, low-income, multiethnic cohort that enrolled mother-newborn pairs at birth at Boston Medical Center (Boston, Massachusetts) starting in 1998, and a subset of children were prospectively observed at Boston Medical Center pediatric primary care and subspecialty clinics from birth to age 21 years. Data analysis began in June 2018 and was completed in May 2019. EXPOSURES In utero opioid exposure was defined as maternal self-reported opioid use and/or clinical diagnosis of neonatal abstinence syndrome. MAIN OUTCOMES AND MEASURES Pregnancy outcomes, postnatal child physical health, and major neurodevelopmental disabilities, documented in maternal and child medical records. RESULTS This study included 8509 Boston Birth Cohort mother-newborn pairs for prenatal and perinatal analyses. Of those, 3153 children continued to receive pediatric care at Boston Medical Center and were included in assessing postnatal outcomes. Overall, 454 of the 8509 children (5.3%) in the Boston Birth Cohort had in utero opioid exposure. At birth, opioid exposure was associated with higher risks of fetal growth restriction (odds ratio [OR], 1.87; 95% CI, 1.41-2.47) and preterm birth (OR, 1.49; 95% CI, 1.19-1.86). Opioid exposure was associated with increased risks of lack of expected physiological development (OR, 1.80; 95% CI, 1.17-2.79) and conduct disorder/emotional disturbance (OR, 2.13; 95% CI, 1.20-3.77) among preschool-aged children. In school-aged children, opioid exposure was associated with a higher risk of attention-deficit/hyperactivity disorder (OR, 2.55; 95% CI, 1.42-4.57). CONCLUSIONS AND RELEVANCE In this sample of urban, high-risk, low-income mother-child pairs, in utero opioid exposure was significantly associated with adverse short-term and long-term outcomes across developmental stages, including higher rates of physical and neurodevelopmental disorders in affected children. Efforts to prevent the opioid epidemic and mitigate its health consequences would benefit from more intergenerational research.
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Affiliation(s)
- Romuladus E. Azuine
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Yuelong Ji
- Center on Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Hsing-Yuan Chang
- Center on Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yoona Kim
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica DiBari
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Xiumei Hong
- Center on Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Guoying Wang
- Center on Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Gopal K. Singh
- Office of Health Equity, Health Resources and Services Administration, US Department of Health and Human Services , Rockville, Maryland
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiaobin Wang
- Center on Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Harder HJ, Murphy AZ. Early life opioid exposure and potential long-term effects. Neurobiol Stress 2019; 10:100156. [PMID: 31338390 PMCID: PMC6629922 DOI: 10.1016/j.ynstr.2019.100156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/13/2019] [Accepted: 03/08/2019] [Indexed: 11/09/2022] Open
Abstract
The long-term consequences of perinatal opioid exposure and subsequent development of neonatal opioid withdrawal syndrome is largely unknown and likely dependent on a multitude of factors, including co-morbid drug use, pre- and post-natal care, and individual factors including the maternal-infant relationship and home environment. This review summarizes the current literature from clinical and preclinical studies on perinatal opioid exposure, focusing on the consequences in the offspring. Although a large number of preclinical studies have been conducted examining the impact of prenatal opioid exposure, the models employed are not necessarily representative of clinical use patterns, making it challenging to translate these results to the impacted population. Use of more clinically-relevant models of perinatal opioid exposure are requisite for the development of improved pharmacological and behavioral treatment strategies to improve quality of life for this vulnerable population.
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Affiliation(s)
| | - Anne Z. Murphy
- Neuroscience Institute, Georgia State University, Atlanta, GA, 30308, USA
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Association between prenatal opioid exposure, neonatal opioid withdrawal syndrome, and neurodevelopmental and behavioral outcomes at 5-8 months of age. Early Hum Dev 2019; 128:69-76. [PMID: 30554024 PMCID: PMC6348117 DOI: 10.1016/j.earlhumdev.2018.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND While use of prescription opioids and medication assisted therapy (MAT) for opioid use disorder in pregnancy, as well as the incidence of neonatal opioid withdrawal syndrome (NOWS) continue to rise, little is known about outcomes for children with NOWS beyond the newborn period. METHODS We examined 1) prenatal MAT exposure vs. unexposed healthy controls [HC]; and 2) treatment for NOWS and NOWS severity on infant neurodevelopmental and behavioral outcomes at 5-8 months of age in 78 maternal-infant pairs from the ENRICH prospective cohort study. Data were obtained from 3 study visits: prenatal, delivery, and neurodevelopmental evaluation at 5-8 months of age. Neurodevelopmental outcomes included the Bayley Scales of Infant Development [BSID-III], caregiver questionnaires (Parenting Stress Index [PSI-SF], Infant Behavior Questionnaire [IBQ-R], Sensory Profile), and the experimental Still-Face Paradigm (SFP). RESULTS No differences in the BSID-III, PSI-SF, or IBQ-R scores were observed between MAT and HC groups; however, MAT-exposed and HC infants differed with respect to SFP self-regulation (β = -18.9; p = 0.01) and Sensory Profile sensation seeking (OR = 4.87; 95% CI: 1.55; 15.30) after adjusting for covariates. No significant differences between Treated-for-NOWS vs. not-Treated-for-NOWS were observed. Shorter timing to NOWS treatment initiation was associated with higher Total Stress (β = -9.08; p = 0.035), while longer hospitalization was associated with higher Parent-child dysfunctional interaction (p = 0.018) on PSI-SF. CONCLUSIONS Our results provide additional evidence of little-to-no effect of MAT and pharmacological treatment of NOWS on infant neurodevelopmental and behavioral outcomes at 5-8 months of age. However, prolonged hospitalization might increase family psychosocial stress and requires further examination.
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Byrnes EM, Vassoler FM. Modeling prenatal opioid exposure in animals: Current findings and future directions. Front Neuroendocrinol 2018; 51:1-13. [PMID: 28965857 PMCID: PMC5649358 DOI: 10.1016/j.yfrne.2017.09.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 01/03/2023]
Abstract
The past decade has seen a drastic rise in the number of infants exposed to opioids in utero. It is unclear what lasting effect this exposure may have on these children. Animal models of prenatal opioid exposure may provide insight into potential areas of vulnerability. The present review summarizes the findings across animal models of prenatal opioid exposure, including exposure to morphine, methadone, buprenorphine, and oxycodone. Details regarding the drug, doses, and duration of treatment, as well as key findings, are summarized in tables with associated references. Finally, significant gaps in the current preclinical literature and future directions are discussed.
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Affiliation(s)
- Elizabeth M Byrnes
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, United States.
| | - Fair M Vassoler
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, United States
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Gilardi F, Augsburger M, Thomas A. Will Widespread Synthetic Opioid Consumption Induce Epigenetic Consequences in Future Generations? Front Pharmacol 2018; 9:702. [PMID: 30018553 PMCID: PMC6037745 DOI: 10.3389/fphar.2018.00702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/11/2018] [Indexed: 11/13/2022] Open
Abstract
A growing number of evidence demonstrates that ancestral exposure to xenobiotics (pollutants, drugs of abuse, etc.) can perturb the physiology and behavior of descendants. Both maternal and paternal transmission of phenotype across generations has been proved, demonstrating that parental drug history may have significant implications for subsequent generations. In the last years, the burden of novel synthetic opioid (NSO) consumption, due to increased medical prescription of pain medications and to easier accessibility of these substances on illegal market, is raising new questions first in term of public health, but also about the consequences of the parental use of these drugs on future generations. Besides being associated to the neonatal abstinence syndrome, in utero exposure to opioids has an impact on neuronal development with long-term repercussions that are potentially transmitted to subsequent generations. In addition, recent reports suggest that opioid use even before conception influences the reactivity to opioids of the progeny and the following generations, likely through epigenetic mechanisms. This review describes the current knowledge about the transgenerational effects of opioid consumption. We summarize the preclinical and clinical findings showing the implications for the subsequent generations of parental exposure to opioids earlier in life. Limitations of the existing data on NSOs and new perspectives of the research are also discussed, as well as clinical and forensic consequences.
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Affiliation(s)
- Federica Gilardi
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, Lausanne University Hospital - Geneva University Hospitals, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Augsburger
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, Lausanne University Hospital - Geneva University Hospitals, Geneva, Switzerland
| | - Aurelien Thomas
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, Lausanne University Hospital - Geneva University Hospitals, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Levine TA, Woodward LJ. Early inhibitory control and working memory abilities of children prenatally exposed to methadone. Early Hum Dev 2018; 116:68-75. [PMID: 29195088 DOI: 10.1016/j.earlhumdev.2017.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Methadone maintenance is the most common method of treating opioid-dependent pregnant women. However, little is known about the impact of prenatal methadone exposure on child neurocognitive development. AIMS To examine the early executive functioning of children born to methadone-maintained mothers, and to assess relations between executive functioning and later emotional and behavioral adjustment. STUDY DESIGN Prospective longitudinal study. PARTICIPANTS The sample consisted of 68 methadone-exposed children and 88 non-methadone-exposed children. OUTCOME MEASURES At age 2years, children's inhibitory control and working memory were assessed using the Snack Delay and Three Boxes tasks. At 2 and 4.5years, their emotional and behavioral adjustment was assessed using the caregiver-completed Strengths and Difficulties Questionnaire. RESULTS Methadone-exposed children had poorer inhibitory control than non-exposed children (p<0.0001). These differences were explained by maternal education and prenatal benzodiazepine use. With respect to working memory, although both groups performed similarly on the first trial set, non-exposed children significantly improved their performance on the second trial set (p=0.002), while methadone-exposed children did not (p=0.92). Inhibitory control at age 2years was predictive of higher conduct (p=0.001), hyperactivity (p=0.0001), peer relationship (p=0.02), and total (p<0.0001) problems at 4.5years even after adjustment for behavioral problems at 2years. CONCLUSIONS Methadone-exposed children demonstrate difficulties with inhibitory control and possibly sustained attention/learning. These difficulties were explained by factors correlated with maternal prenatal methadone use. Longer-term follow-up of these children is needed to understand the effects of prenatal methadone exposure and related maternal factors on executive functioning and behavioral adjustment.
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Affiliation(s)
- Terri A Levine
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Lianne J Woodward
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Psychology, University of Canterbury, Christchurch, New Zealand.
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Hadera MG, Andersen JM, Paulsen RE. Effects of methadone in the developing chicken embryo as a model of neurodevelopmental toxicity. Reprod Toxicol 2017. [DOI: 10.1016/j.reprotox.2017.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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