Behavioural outcomes of four-year-old children prenatally exposed to methadone or buprenorphine: a test of three risk models

Konijnenberg, Carolien; Lund, Ingunn Olea; Melinder, Annika

doi:10.1080/03004430.2015.1016506

Cited by 19 publications

(16 citation statements)

References 65 publications

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“…The Reynell Developmental Language Scales were used in two studies (93 methadone‐exposed vs 76 unexposed children) at 3 years and at 4 years; both reported reduced performance in expressive and comprehensive language. Of the seven studies assessing behaviour, six reported more behavioural problems in methadone‐exposed children than in unexposed children . Details of all studies reporting childhood neurodevelopmental outcome after prenatal methadone exposure are summarized in Table SII (online supporting information).…”

Section: Resultsmentioning

confidence: 99%

Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta‐analysis

Monnelly

Hamilton

Chappell

et al. 2018

Develop Med Child Neuro

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Aim To systematically review and meta‐analyse studies of neurodevelopmental outcome of children born to mothers prescribed methadone in pregnancy. Method MEDLINE, Embase, and PsycINFO were searched for studies published from 1975 to 2017 reporting neurodevelopmental outcomes in children with prenatal methadone exposure. Results Forty‐one studies were identified (2283 participants). Eight studies were amenable to meta‐analysis: at 2 years the Mental Development Index weighted mean difference of children with prenatal methadone exposure compared with unexposed infants was −4.3 (95% confidence interval [CI] −7.24 to −1.63), and the Psychomotor Development Index weighted mean difference was −5.42 (95% CI −10.55 to −0.28). Seven studies reported behavioural scores and six found scores to be lower among methadone‐exposed children. Twelve studies reported visual outcomes: nystagmus and strabismus were common; five studies reported visual evoked potentials of which four described abnormalities. Factors that limited the quality of some studies, and introduced risk of bias, included absence of blinding, small sample size, high attrition, uncertainty about polydrug exposure, and lack of comparison group validity. Interpretation Children born to mothers prescribed methadone in pregnancy are at risk of neurodevelopmental problems but risk of bias limits inference about harm. Research into management of opioid use disorder in pregnancy should include evaluation of childhood neurodevelopmental outcome. What this paper adds Children born to opioid‐dependent mothers prescribed methadone are at risk of neurodevelopmental impairment. Exposed infants have lower Mental Development Index and Psychomotor Development Index scores than unexposed children. Atypical visual evoked potentials, strabismus, and nystagmus have increased prevalence. Estimates of impairment may be biased by intermediate to poor quality evidence.

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Section: Resultsmentioning

confidence: 99%

Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta‐analysis

Monnelly

Hamilton

Chappell

et al. 2018

Develop Med Child Neuro

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“…Results supported both the maternal risk and combined models, with the combined model being most predictive of a child's developing internalizing and externalizing behavior problems. 80 Many more factors beyond the scope of this review (such as maternal emotion regulation, attachment behaviors, parenting stress, and maternal and parental parenting behavior) may also play a role in childhood developmental outcomes and are difficult to detangle from risk of drug use. Studies suggest an interaction between stress and substance use.…”

Section: Environment and Nas Outcomesmentioning

confidence: 99%

Cognitive and Behavioral Impact on Children Exposed to Opioids During Pregnancy

et al. 2019

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The developmental impact of opioid use during pregnancy is a subject of ongoing debate. Short-term neonatal outcomes, such as lower birth weight and neonatal abstinence syndrome, are the most well-recognized outcomes. However, knowledge gaps exist regarding longer-term neurocognitive and mental health outcomes. In this article, we summarize an expert panel discussion that was held in April 2018 by the Substance Abuse and Mental Health Services Administration and attended by national experts in the field of perinatal opioid exposure and its impact on child development. Despite the challenges with research in this area, there is emerging literature revealing an association between neonates exposed to opioids in utero and longer-term adverse neurocognitive, behavioral, and developmental outcomes. Although adverse sequalae may not be apparent in the neonatal period, they may become more salient as children develop and reach preschool and school age. Multiple variables (genetic, environmental, and biological) result in a highly complex picture. The next steps and strategies to support families impacted by opioid use disorder are explored. Model programs are also considered, including integrated care for the child and mother, parenting supports, and augmentations to home visiting.

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“…They also underline the differences between the mothers of the two groups concerning education and employment rates and other possible factors (such as maternal use of tobacco, other legal and illegal drugs in pregnancy, family situation) which could have influenced the results. Konijnenberg test out three risk models in her latest publication and the findings suggest that behaviour problems of children of women in OMT may not be a direct exposure effect [135]. She writes that this underscores the importance of taking multiple factors into consideration when studying the effects of prenatal OMT exposure on child behaviour.…”

Section: Omt In Pregnancy -Possible Long-term Effects For the Childmentioning

confidence: 99%

Neonatal outcomes following in utero exposure to methadone or buprenorphine: A National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009

Welle-Strand¹,

Skurtveit²,

Jones³

et al. 2013

Drug and Alcohol Dependence

102

123

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The clinical relevance of these findings is that both methadone and buprenorphine are acceptable medications for the use in pregnancy, in line with previous studies. If starting OMT in pregnancy, buprenorphine should be considered as the drug of choice, due to more favorable neonatal growth parameters. Early confirmation of the pregnancy and systematic follow-up throughout the pregnancy are of importance to encourage the women in OMT to abstain from the use of tobacco, alcohol, illegal drugs or misuse of prescribed drugs.

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Behavioural outcomes of four-year-old children prenatally exposed to methadone or buprenorphine: a test of three risk models

Cited by 19 publications

References 65 publications

Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta‐analysis

Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta‐analysis

Cognitive and Behavioral Impact on Children Exposed to Opioids During Pregnancy

Neonatal outcomes following in utero exposure to methadone or buprenorphine: A National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009

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