Outcomes of Children Prenatally Exposed to Opioids Around the World: A Systematic Review

Saturday, 27 July 2019: 8:45 AM

Sara J. Arter, PhD, RN
College of Nursing, University of Cincinnati, Cincinnati, OH, USA
Brian Tyler, PhD
Department of Anthropology, Miami University, Oxford, OH, USA
Cameron M. Hay, PhD
Department of Anthropology, Miami University, Oxford, Ohio, OH, USA
Jennifer McAllister, MD
Neonatal Abstinence Syndrome Follow-Up Clinic, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Elizabeth Kiel, PhD
Department of Psychology, Miami University, Oxford, OH, USA

Purpose: Opioid addiction is a growing global public health concern. While the United States still consumes a majority of the global opioid supply, consumption in other countries is on the rise (International Narcotics Control Board, 2018). Opioid use and abuse has had far-reaching and sometimes unexpected consequences, such as increasing incidence of infectious disease, escalating violence in Mexico, and lower participation in labor markets amongst men (Hoban, 2017). Children especially have been the silent victims of the opioid epidemic. In the United States, roughly 75% of states have seen unprecedented numbers of children entering the foster care system with parental substance abuse cited as the primary reason (United States Department of Health and Human Services, 2017). In Ohio alone, there has been a 712% increase in the numbers of infants prenatally exposed to opioids and other substances between 2006 and 2015 (Ohio Department of Health, 2015). Currently, it is unclear how prenatal opioid exposure effects development throughout childhood. This is important to determine given the sheer number of children who have been exposed, primarily in North America and increasingly in Europe. By identifying areas of development most effected by exposure, interventions can be developed to improve those specific areas. The purpose of this systematic review was to synthesize studies of the long-term developmental outcomes for children prenatally exposed to opioids compared with children who were not exposed.

Methods: This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (Moher, Liberati, Tetzlaff, Altman, The PRISMA Group, 2009). PubMed, EBSCO HOST/Medline, Web of Science, and reference lists were used to identify studies. Included studies were original research published in English that addressed outcomes of children, aged 2 years and older, who were prenatally exposed to opioids. Four independent reviewers extracted data and assessed study quality using NIH Quality Assessment Tools. The synthesis of data was only qualitative. A meta-analysis was not performed because the primary purpose of this review was to identify a wide range of developmental outcomes secondary to prenatal opioid exposure, which is not conducive to quantitative analysis.

Results: Fifty-nine studies (5 randomized trials, 49 observational studies, and 5 retrospective cohort studies) examining 11 categories of outcomes were found. Study quality was good for 5 studies, fair for 40 studies, and poor for 14 studies. Many studies reported differences in outcomes between exposed and non-exposed children, however outcomes varied widely, and some exposed children’s outcomes were no longer significant after controlling for other variables (such as perinatal outcomes, maternal education, or socioeconomic status). Most frequent differences between groups were found in outcomes of academic success, attention/ADHD measures, behavior, vision, and hospital admissions/morbidity. In all outcome categories with significant differences between groups, children prenatally exposed to opioids had worse outcomes than non-exposed children. When outcomes were categorized by age, an interesting pattern emerged. More significant differences were seen between groups as participants aged; so by adolescence, there were significant differences between groups on most outcomes. When outcomes were assessed by country of study origin, there were no differences found.

Conclusion: Results from this systematic review suggest there are differences in multiple developmental outcomes between children prenatally exposed to opioids and non-exposed children. However, there remain questions about how much of the outcome can be attributed to environment or to prenatal opioid exposure. Some of the limitations of this study were the heterogeneous nature of the outcome measures and the quality of included studies. Going forward, future research should focus on development and implementation of interventions and policies that facilitate improved outcomes, especially in areas of most need. This research also has implications for nursing practice. As nurses, we have a responsibility to health promotion and disease prevention. Developmental problems arising from adversity during the prenatal period and early childhood increase the likelihood of difficulty with mental and physical health across the lifespan (National Scientific Council on the Developing Child, 2014). It is important to be aware of children who have been prenatally exposed to opioids and the potential developmental effects so that nurses can intervene as early in the developmental trajectory as possible. While developmental effects may not be readily apparent during early childhood, it will be important to assess for developmental issues as the children grow.

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