Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry

Abstract

Objective: To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk. Methods: Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non–methadone-exposed children were studied from birth (2003–2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score. Results: Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0–5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01–1.11]), higher social risk (RR = 1.35 [1.20–1.53]), male sex (RR = 1.69 [1.27–2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94–0.99]). Conclusion: Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower‐quality caregiving environments.

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

“…Multivariable linear regression was used to determine which antenatal exposures were independently associated with neurodevelopmental outcomes, after accounting for patient characteristics and treatment modality. Covariates were chosen based on variables that infer impact on neonatal and later outcomes in this and other patient populations (23)(24)(25)(26). All models include race, sex, maternal age, private vs. public insurance, antenatal treatments, and prenatal exposures; all variables were retained in the model on clinical and theoretical grounds, regardless of statistical significance.…”

“…Most importantly, we lacked socioeconomic data, information about maternal intelligence or education level, and environmental variables such as maternal nutrition and food insecurity, maternal mental health, consistency of prenatal care, trauma history, adverse childhood experiences, medical complications, and quality and stability of the child-rearing environment which all have a critical role in mediating long-term neurodevelopmental outcomes (9,11,17). Cognitive and language development are strongly influenced by early experiences, developmental stimulation, and stability of the social environment; the possibility remains that social environment may be more predictive of cognitive and language delays than prenatal exposures or neonatal NOWS treatment (9,17,26,(55)(56)(57)(58). However, it is most likely that a complex web of interconnected factors all influence development in this vulnerable population (9, 17, 57) Information about maternal intelligence, home environment, and postnatal caregiver was unavailable in our cohort; collecting this key information in future studies is essential.…”

Brain‐derived neurotrophic factor and nerve growth factor concentrations in maternal and umbilical cord blood of opium‐addicted mothers

“…Lee, Woodward, and Henderson (2019) and Lee, Pritchard, Austin, Henderson, and Woodward (2020) observed that children born from opioid‐dependent women were at a high risk of educational delay/impairment. They suggested that this defect may be due to a fault in the neurodevelopment of children born from opioid‐dependent women.…”

Maternal Substance Use: Consequences, Identification and Interventions

“…Advantages include more stable maternal drug levels, reduced withdrawal and drugseeking behavior, and improved self-care, which should lead to a better pregnancy outcome because of reduced risk for fetal distress, miscarriage, growth restriction, and preterm birth. 32 Compared to data on buprenorphine-maintained pregnancies, more longitudinal data on methadoneexposed pregnancies are available. In a prospective longitudinal study, 68 methadone-exposed children and 88 nonmethadone-exposed children were evaluated at 2.0 and 4.5 years for executive functioning and later emotional behavioral and emotional adjustment.…”