Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

Abstract

BackgroundIt is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use.MethodsQuantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012.ResultsThere were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p < 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria.ConclusionsChronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes.

An examination of sex differences in the effects of early-life opiate and alcohol exposure

“…In addition, a small study found that methadone-exposed children had trending lower IQ scores and greater reports of anxiety, aggression and rejection compared with control children [47]. There have been other studies, however, that show little to no significant cognitive differences between babies exposed to opiates and control subjects later in life [48,49], which suggests that other factors (not controlled for in these studies) likely influence the risk of behavioural or cognitive deficits associated with prenatal opiate exposure. Interestingly, children exposed to heroin prenatally that were then adopted into a controlled household at a young age experienced behavioural deficits associated with ADHD at much lower rates [46].…”

Cognitive Functioning in Formerly Opioid-Dependent Adults after At Least 1 Year of Abstinence: A Naturalistic Study

“…Kurita et al [24] established that one-third of opioid-treated patients with cancer had possible or definite cognitive dysfunction. In contrast, Baldacchino et al [25] found that children with Schmidt chronic intrauterine exposure to opioids experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers. These findings indicate that chronic opioid exposure is not automatically associated with impairments in neurobehavioral outcomes.…”

Cerebral Magnetic Resonance Imaging in Children With Prenatal Drug Exposure

“…70 A recent systematic review and meta-analysis on neurobehavioral consequences of in utero opioid exposure in infants and preschool children showed no significant impairments for behavioral, psychomotor or cognitive outcomes in exposed children compared to non-exposed controls. 71 However, an error in data entry was uncovered after publication, and in the repeated, corrected analyses significant impairments with small effect sizes were found in opioid-exposed children for all the included neurobehavioral outcomes. 72 A national, population-based cohort of 38 children born to mothers included in OMT and 36 comparison children from a low-risk population have been followed from birth in a Norwegian, longitudinal study.…”