Prenatal opioid exposure is not associated with the risk of neuropsychiatric disorders in children

Prenatal opioid exposure is not associated with the risk of neuropsychiatric disorders in children

Opioid use during pregnancy is not associated with a significant increase in the risk of neuropsychiatric disorders such as ADHD in children, says a large study from South Korea published byThe BMJToday.

A slight increased risk of neuropsychiatric disorders was found, but researchers say this should not be considered clinically significant because it was limited to mothers exposed to more than one opioid prescription, high doses and for prolonged periods during pregnancy.

According to 2019 data from the Centers for Disease Control and Prevention, about 7% of women in the United States were prescribed opioids during pregnancy.

Previous studies have shown mixed results on the association between opioid use in pregnancy and various health outcomes in offspring due to small sample sizes and short follow-up periods.

To address this knowledge gap, an international team of researchers set out to investigate the possible link between opioid exposure during pregnancy and the risk of neuropsychiatric disorders in offspring.

Their results are based on data from South Korea's National Health Insurance Service (NHIS) for 3,128,571 infants and 2,299,664 mothers born between 2010 and 2017 (mean age 32 years).

Mothers were divided into groups based on the dose, duration, and frequency of opioid prescriptions during pregnancy, and infants were followed for an average of six years.

Factors taken into account included the mother's age at delivery, household income and pre-existing health conditions, as well as the infant's gender, birth weight and breastfeeding history. Additionally, a sibling comparison analysis was performed to account for genetics, lifestyle, and environmental influences.

A total of 216,012 (7%) of the 3,128,571 infants were exposed to opioids during pregnancy (prenatal exposure).

A small increased risk of neuropsychiatric disorders was found in children exposed to prescription opioids during pregnancy compared to children who were not exposed, but researchers interpret this as clinically insignificant.

And no significant association was found in the sibling comparison group.

However, exposure to prescription opioids during the first trimester of pregnancy, at higher doses, and for 60 days or longer was associated with a slightly increased risk of mood disorders, ADHD, and intellectual disability.

Because this is an observational study, no firm conclusions can be drawn about cause and effect. Although the researchers considered a number of factors, they cannot rule out the possibility that others may have influenced their results or that misclassification of opioid use may have occurred.

Nevertheless, this was a large study based on high quality data and several statistical analyzes were carried out to test the strength of the results and thus provide greater confidence in the conclusions.

Therefore, they conclude: “These results support cautious prescribing of opioids for pain relief during pregnancy and highlight the importance of further research for more definitive guidelines.”

In a linked editorial, researchers agree that while short-term use of prescription opioids at lower doses after the first trimester appears relatively safe, caution should be exercised when prescribing opioids for longer periods of time or at higher doses.

This study "provides additional evidence for clinical decision-making in women requiring pain management during pregnancy," they write.

“Given the unique clinical value of opioids for the treatment of severe pain, additional research is needed to fully characterize the degree of risk and thoroughly disentangle the association between pain, pain treatment, and various pregnancy outcomes,” they conclude.

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